Travis County Employee Wellness and Health Clinic Integrating

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Travis County Employee Wellness and Health Clinic Integrating Health Education Wellness Training in a

Travis County Employee Wellness and Health Clinic Integrating Health Education Wellness Training in a Clinic Setting To Impact Health Care Cost Drivers Dan Mansour, ARM-P, CGBA Risk and Benefits Manager Travis County 512 -854 -9499 Dr. Hari Dhir MD MPH MBA Clinic Medical Director Travis County 512 -854 -6838 dan. mansour@co. travis. tx. us Hari. Dhri@co. travis. tx. us 10/24/2020 1

OBJECTIVES • Developing Health and Wellness programs (such as Smoking Cessation, Weight loss, Behavioral

OBJECTIVES • Developing Health and Wellness programs (such as Smoking Cessation, Weight loss, Behavioral change, Disease Management) to address cost drivers. • Structuring Programs that are efficacious and specific to each department in the agency. Program delivery may need to be varied according to specific departmental needs. • Program Promotion through communication. • Clinic setting as the focal point and core of the wellness and health initiative managed by a dedicated medical staff. 10/24/2020 2

Definition of Wellness: “Wellness is a multidimensional state of being describing the existence of

Definition of Wellness: “Wellness is a multidimensional state of being describing the existence of positive health in an individual as exemplified by quality of life and a sense of well-being. ” Or (Credit Prof. Corbin ASU) 10/24/2020 3

Google Definition of Wellness is not just the absence of illness, but the active

Google Definition of Wellness is not just the absence of illness, but the active process of achieving an individual's full potential of physical, mental, and spiritual well being. This quality of life definition can be applied to ANYONE regardless of any physical or mental limitations. Using this definition, a paraplegic or diabetic or mentally challenged person (for example) can achieve the best possible level of wellness for someone in their situation through health-producing activities. 10/24/2020 4

Employee Wellness and Health Clinic(s) • Three Clinics: All clinic services are free including

Employee Wellness and Health Clinic(s) • Three Clinics: All clinic services are free including free lab-work, x-rays, screening colonoscopy , diabetic supplies and smoking cessation medication. • 3 Board Certified Family Practice Physicians. Medical Director additionally Board Certified in Preventive Medicine and Public Health. • Two Registered Nurses • One Licensed Vocational Nurse • Two Medical Assistants • One Administrative Assistant 10/24/2020 5

Business Plan Decisions Ø Ø Ø Ø Purpose of clinic ü 3 -5 year

Business Plan Decisions Ø Ø Ø Ø Purpose of clinic ü 3 -5 year plan ü Clinic management ü Clinic protocol ü Staffing/job descriptions ü PA, Nurse-Practioner ü Service to all employees ü Projected funding source and cost ü Start up FY 2009 Budget ü ü ü Health/wellness Programs Projection - unclear Contract or in-house Approved by Court Doctors (create confidence) Nursing and MA for flexibility Multiple clinic locations Health fund reserve $70, 000 Main $90, 000 Airport $369, 500 Del Valle $1, 360, 400 $990, 900 On going 10/24/2020 6

Employee Wellness and Health Clinic(s) • COST DRIVER: In 2009 visits to the Emergency

Employee Wellness and Health Clinic(s) • COST DRIVER: In 2009 visits to the Emergency Room were 25% more than the Norm with many conditions being treated in the ER that are likely not appropriate. (United Health Care Executive Summary 2009) • RESPONE: To reduce this cost driver clinic schedules were revised creating additional availability of appointments. • In March 2010, clinic schedules were revised creating – An increase of 80% in the number of available appointments from 280 to 504 per month – Providing same day or next day visits for acute care. – Acute care patients unable to be scheduled for an appointment reduced from 25% to 8. 5%. 10/24/2020 7

Travis County Wellness Programs • Health risk factors increase the probability of large claims

Travis County Wellness Programs • Health risk factors increase the probability of large claims • Many health risk factors are driven by unhealthy behavior choices. • Wellness and Health Programs have been developed to address unhealthy behaviors and reward healthy behaviors. • HRA : Employee participation in the Tier 1, 2 and 3 programs will be eligible for shared savings. 10/24/2020 8

Tier 1 -Wellness Education Classes • Definition: An interactive informational presentation, creating an informed

Tier 1 -Wellness Education Classes • Definition: An interactive informational presentation, creating an informed health care consumer who makes healthier choices. • Purpose: To increase knowledge, awareness and health literacy. 10/24/2020 9

Tier 1 -Wellness Education Classes • Jan- Dec 2009: Various Tier 1 classes held

Tier 1 -Wellness Education Classes • Jan- Dec 2009: Various Tier 1 classes held • Cholesterol, Diabetes, Healthy Lifestyle, Smoking Cessation, Stress, Blood Pressure, Sleeping Disorders, Lipid Management, Colon Cancer, Skin Cancer, Healthy Pregnancy, UV safety, Immunization. • In the 12 month period: 1929 employees attended these classes. 10/24/2020 10

Tier 2 - Wellness and Health Programs • Defined: Using knowledge, behavioral strategies and

Tier 2 - Wellness and Health Programs • Defined: Using knowledge, behavioral strategies and competition to foster permanent change for optimal health. • Purpose: To encourage long term engagement in healthy behaviors improving health outcomes. 10/24/2020 11

Tier 2 - Wellness and Health Programs • • • Smoking Cessation Series American

Tier 2 - Wellness and Health Programs • • • Smoking Cessation Series American Lung Association Smoking Cessation Class Healthy Lifestyle Series Strengthening Cardio Training (10 week series by Trainer) Weight Watchers Walk Across Texas Challenge American Heart Association Start! Walking Program Runtex Annual Travis County Walk/Run Yoga 24 hour Fitness Corporate membership 10/24/2020 12

Tier 2 - Wellness and Health Programs • Walk Across Texas (2010) : 30

Tier 2 - Wellness and Health Programs • Walk Across Texas (2010) : 30 teams, made up of on average 204 Travis County employees, participated in the Walk Across Texas! Challenge recording over 44, 060 miles. • The total potential economic impact is $1, 510, 847 in health care cost savings and wages lost savings. • Teams walked 54. 8 times across Texas • On average, 204 individuals walked 223 miles each • 24 individuals could prevent the onset of diabetes through increased physical activity. 10/24/2020 13

Tier 2 - Wellness and Health Programs • Smoking Cessation: 9 participants • Physical

Tier 2 - Wellness and Health Programs • Smoking Cessation: 9 participants • Physical Trainer Classes: 914 participants from January- August 2010. • 24 Hour Fitness Membership: 214 • Healthy Lifestyle: 72 participants • Weight Watchers: 82 members in last 3 years, total weight lost 2482 pounds from the start until now. 10/24/2020 14

Tier 3 - Wellness and Health Clinic • Defined: One to one consultations with

Tier 3 - Wellness and Health Clinic • Defined: One to one consultations with licensed providers (physicians and nurses) to identify and modify risk factors of chronic disease and manage established diseases effectively to prevent long term complications • Purpose: To improve health through education, prevention, medication and personal responsibility reducing the cost of chronic illness 10/24/2020 15

Tier 3 - Clinic Programs • 2009: 79 employees prescribed medication for smoking cessation.

Tier 3 - Clinic Programs • 2009: 79 employees prescribed medication for smoking cessation. Twenty six quit for more than 6 months • Currently the annual economic cost of smoking is approximately $5, 600 (Mercer Human Resource Consulting New York) • This gives a saving of $145, 600 per year if the individuals above remain quit 10/24/2020 16

Impact of Cost Drivers • 34% employees have chronic illnesses accounting for 53% of

Impact of Cost Drivers • 34% employees have chronic illnesses accounting for 53% of total medical spend. – Chronic illnesses continue to increase with significant variances to the Norm. • Jan-Dec 2009 : 89 pre-diabetics detected and 16 returned to non diabetic level with diet and exercise. • The Cato Research Institute : Estimates the cost of a diabetic without complications at $1, 600 a year. This can be substantially larger if complications occur. For example a month of dialysis can cost $18, 000. – CDC : Cost among people with diabetes 2. 3 times higher than those without diabetes • The diagnosis and treatment of the 16 pre diabetics saved Travis County $25, 600 per year. 10/24/2020 17

Cost Drivers and Programs that Address • Intervertebral disc disorders and chemotherapy (top 2

Cost Drivers and Programs that Address • Intervertebral disc disorders and chemotherapy (top 2 diagnostic categories) accounted for 8. 7% of total medical spend • To address Intervertebral disc disorders Fitness training , Smoking cessation, Eating healthy, Back School and Back care advice. • To address Cancers and Chemotherapy in the Clinic Setting: Pap smears, Mammograms, PSA, Physical examinations, Screening Colonoscopy 10/24/2020 18

Program Promotion through Communications. • Wellness and Health Clinic Website • Ask the doctor

Program Promotion through Communications. • Wellness and Health Clinic Website • Ask the doctor section. • Hours of operation of clinic, Healthy tips, Links to health information sites • Video’s on health tips shown on TCTV • Guest speaker presentations • Challenges: Walk Across Texas, Travis County 5 K Walk/Run , Runtex University Walking Program • In addition Health Fairs held annually at different locations to increase health awareness: approximately 40 vendors and 500 employees attended the last Health Fair. 10/24/2020 19

Wellness Website 10/24/2020 20

Wellness Website 10/24/2020 20

Health Fair 10/24/2020 21

Health Fair 10/24/2020 21

Other Health Initiatives • In the process of developing and implementing a tobacco free

Other Health Initiatives • In the process of developing and implementing a tobacco free workplace policy after approval by Commissioners’ Court. • American Heart Association Start! Walking Program • Runtex Annual Travis County Walk/Run • Yoga • Pilot study with Baylor University using Hypnosis for Smoking Cessation • Farm to Work providing fresh organic vegetables/fruit: Approximately 200 participants. 10/24/2020 22

A Final Word of Advice • • • 10/24/2020 Confidence Credibility Competence Comprehensive Compatible

A Final Word of Advice • • • 10/24/2020 Confidence Credibility Competence Comprehensive Compatible Consistent Confidential Conclusion and QUESTIONS 23