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Travis County Commissioners Court Voting Session Agenda Request

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Meeting Date: March 31, 2015 Agenda Language:

Consider and take appropriate action on a request to approve the rebranding of the Travis County wellness program.

Prepared By/Phone Number: John Rabb, 512-854-2742

Elected/Appointed Official or Department Head: Leroy Nellis, Interim County

Executive

Commissioners Court Sponsor(s): Commissioner Margaret Gomez Background/Summary of Request and Attachments:

See attached.

Staff Recommendations:

The Wellness Committee recommends approval of the Travis County CARE Program and the wellness program initiatives to include the program name and logo.

Issues and Opportunities:

See attached.

Fiscal Impact and Source of Funding:

This item requires no additional funding. The staff resources are already included in the current budget and additional financial resources are available through the wellness allowance provided by UnitedHealthcare.

Required Authorizations:

Josie Pena, Health and Wellness Program Administrator John Rabb, Benefits Manager

Debbie Maynor, HRMD Director Leroy Nellis, County Executive

Travis County Commissioners Court

Voting Session Agenda Request

Item 15

FILED FOR RECORD

3/31/2015 9:00 AM

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HRMD

Human Resources Management

Department

700 Lavaca Street, Suite 420

P.O. Box 1748

Austin, Texas 78767

(512) 854-9165 / FAX(512) 854-6677

Backup Memorandum

DATE: March 31, 2015

TO: Members of the Commissioners Court

VIA: Leroy Nellis, County Executive, Planning and Budget Office Debbie L. Maynor, Director of Human Resource Management

FROM: Josie Pena, Health and Wellness Program Administrator John Rabb, Benefits Manager

SUBJECT: Travis County Health and Wellness Program

Proposed Motion

Consider and take appropriate action to approve the implementation of an updated Travis County health and wellness program.

Background

In 2004, in recognizing it was good business to provide a supportive environment to help employees make healthier lifestyle choices; Commissioners Court approved a wellness program. The program focused its efforts on wellness promotion communicated through employee presentations, education, and various activities, such as classes and competitions. Unfortunately, the program had minimal participation and was not linked to any means to measure potential improvements in employee health. In 2013, the Wellness Committee took the initiative to reevaluate the wellness program; the goal of the committee was to re-introduce a wellness program which would result in an increase in participation levels, and to design a program that could show a correlation or relationship between participation and improved health and overall health plan costs.

Approval of the proposed Travis County CARE program allows the opportunity for refocused marketing and employee outreach. This new Travis County wellness initiative includes a

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3 mission statement, program goals, and performance measures. The proposed program is a comprehensive program with a multiyear phased implementation plan.

The committee identified a need to reevaluate and identify the purpose of the program; this included a need to revisit the mission and identifying the overall goals for the program.

The first step the committee took was to obtain information from employees to assess the organizational culture on wellness, and to ascertain the needs and interest of employees regarding wellness programming. In April 2014, the Wellness committee created and initiated the distribution of an employee “Needs and Interests Survey”. The survey was sent by email to all active employees. Total survey respondents were 659 or 14% of the active employee population.

The following questions were asked about the employee’s perception of Travis County’s culture towards employee health.

Question % Agree or Strongly Agree

I believe that the County cares about my health status 74.70 %

Being healthy is important to me 97.50 %

I am encouraged to lead a healthier lifestyle 77.90 %

These responses reflected a positive employee perception of leadership support of worksite wellness, which is the first step for wellness programming. Additional questions asked of employees related to a wide variety of educational, fitness, nutritional and screening questions. (The top responses by category are found in Attachment 2 - Needs and Interest Survey Top Responses by Category) These responses were utilized in developing the proposed comprehensive wellness initiative.

Travis County CARE Program Summary

The committee then worked together to identify the mission, vision and objectives of the revised wellness initiative based on their discussions and the feedback from the employee surveys.

Mission

The mission of the CARE program is to inspire, create and maintain a workplace environment that supports healthy lifestyle choices.

Vision

Develop and implement initiatives that encourage employees to make healthy choices. Objectives

 Educate employees on available resources and tools to maintain or improve health, or to reduce the risk of disease

 Provide employees with opportunities and support for successful behavior change

 Actively engage employees in lifestyle and disease management programs

 Create a work environment that promotes healthy lifestyles with both individual and organizational programs and interventions

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Performance Measures

Measurement of the overall success of the program will be based on participation and engagement in a multitude of program activities and services. The result of increased participation and engagement in lifestyle and disease management programs have shown to result in the improvement of employee health, a more productive workforce and a reduction in health care claim costs. The program measurement categories are:

1. Health and Wellbeing Program Participation 2. Case and Disease Management Education 3. On-site Health Coach Encounters

4. Health and Wellness Workplace Environment 5. Health Plan Costs and Trends

The specific measurements for each category are detailed in Attachment 1 - CARE Program Performance Measurements.

Branding

The next step in the assessment of the wellness initiative was to identify a means to brand the program in a manner that would uniquely identify the program, and to reflect the purpose and goals of the program. The branding helps to establish a significant and differentiated recognition of the program as an initiative focused on positive employee lifestyles. The Committee worked together to come up with a name and a logo that would be easily recognizable by employees, retirees and their dependents. The result of this is the proposed CARE program.

CARE Program

CARE is an acronym for Checkups, A Healthy Outlook, Regular Exercise and Eating Right. The name not only incorporated the focus on health and wellness but also captures the feeling Travis County has towards its employees, retirees and their dependents. Each key focus area addresses prevention and management of current disease states.

Checkups

Checkups or regular health exams and tests can help identify problems early, when the opportunity for treatment and cure are better. By getting the right health services, screenings, and treatments, you are taking steps that can improve your chances for living a longer, healthier life.

A

Healthy Outlook

A healthy outlook means that you are choosing to balance the needs of your mind, body and spirit. Regular exercise, eating right, resting or meditation and seeking support can lead to emotional and physical well-being.

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Regular Exercise

Regular exercise or physical activity can help the body’s systems to function better, and can keep a host of diseases, such as diabetes and heart disease, at bay.

E

ating Right

Eating right means making informed choices about our intake; choosing the right food can give you more energy and may improve your health. Good eating habits can help reduce your risk of disease.

CARE Program Logo

Branding the wellness initiative included creating a unique image for the program and for employees to recognize.

The logo was selected among a number of samples created and provided to the Wellness Committee by the ITS-Web team. The circular logo was selected because of the symbolism of unity among people in a continuum of care and represented the four foci of the program. The logo will identify the program along with the consistent CARE message.

Multi Year Program Plan

Phase I

In the first phase, collecting data, providing education, tracking participation and identifying resources will be essential for program development and implementation. Involving everyone develops strong collective support and creates a culture of cooperation between employer and employee. The objectives for Phase I are as follows:

1. Communicate the CARE program to Commissioners Court, and receive approval for implementation.

2. Communicate the program mission, vision and goals to Executive Managers, managers and supervisors.

3. Introduce the CARE program to employees with a proposed start date of April 1, 2015. The program will be communicated to employees and retirees upon approval by Commissioners Court via email, a posting on Travis Central, and in person presentations at various department and staff meetings. The initial communication will provide an introduction of the program name, the mission, introduction of program staff, a summary of program goals and a list of available resources. To aid in the introduction and to provide additional information for the program, the following items will also be delivered;

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 Completion and implementation of a CARE program website to provide access resources such as (need some examples)

 A unique County CARE program email address for employees to receive communications from and to assist participants with program questions.

 Develop and deliver program initiatives via presentations and/or webinars

4. Develop and implement an onsite Health Coaching session model. The Health Coach is able to assist with making improvements to the members overall health and wellness, and provide resources and recommendations based on the member’s needs. The Health Coach can also work with members on setting and achieving nutritional, health, and fitness goals. In certain cases the coach may refer members to a primary care doctor, employee assistance program, registered dietician or onsite nurse.

5. Work with third party administrator to review health plan cost drivers and identify and develop specific programs and activities that will be of interest to employees and will provide a means to reduce or eliminate cost drivers.

6. Inventory existing County facilities, food venues, and existing health and wellness programs.

7. Identify external and internal resources to partner with for program related activities. 8. Develop and present a Mother Friendly Policy to Commissioners Court. Both federal

and state law mandates provide support in the workplace for mothers who choose to breast-feed their babies. The administrative policy is pursuant to Texas Health and Safety Code, Section 165.003 (Business Designation as “Mother-Friendly”) Patient Protection and Affordable Care Act, Section 4207 (Reasonable Break Time for Nursing Mothers); Texas Constitution, Article V, Section 18 (powers and jurisdiction over all county business); Texas Health and Safety Code, Section 121.003 (authority to provide for general health); and other applicable statutes, laws and ordinances.

9. Monitor and refine program based on participation, feedback, and effectiveness.

10. Conduct a Needs and Interest survey annually to keep employees engaged in the wellness programming.

Initial programming will be identified by three categories:

 Lifestyle Management - Health and Wellbeing education-via presentations, web site, email and/or webinars. Increasing health literacy through education. Working with departments to develop specific fitness, health education, nutrition and other health related programs customized for their workforce.

 Case and Disease Management Services – The CARE program will work to increase engagement and participation in the services provided by UnitedHealthcare. Using evidence-based medical guidelines, the case management nurses help participants make informed decisions about their health, whether they are living with a chronic condition or in need of long-term support. Nurses educate and empower members to minimize disease progression and decrease health care costs. Disease management services identify at-risk individuals and assess each individual's health care needs. The

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7 nurses work to resolve health care gaps by providing the right resources and support at the right time to engaged members. Member engagement in these programs help lower costs and make the most of our health care investment.

 Supportive Environment – encouraging healthy lifestyles via leadership engagement and support, healthy food options, physical environment that allow for fitness activities, and employee involvement. Moving participants through the stages of change for improved health. Increase knowledge regarding cost of health care.

Phase II

1. By year 3, initial results of health and wellness programming’s effect on health claims should be evident in the claims costs. This will be assessed through a review of the following program measurements as noted below and in Attachment 1.

 Health Plan Costs and Trends. In Phase II, the wellness initiatives and programs should start to show improvements in overall plan costs and trending and also result in an increase in preventive services and screenings.

 Health & Wellbeing Program Participation. Increased participation in CARE program activities, educational events and increased utilization in Case and Disease Management services. By this phase, program offerings may be adjusted and modified based on participation levels and outcomes from the prior years.

 Employee satisfaction surveys. Will be measured annually and staff will be monitoring for improvements in the employee’s perception of the County’s culture towards health and wellbeing.

2. Report to Benefits Committee and Commissioners Court on program results.

3. Review and propose recommended changes to nutritional contracts, such as vending machines and on-site food vendors to enhance available nutritional choices.

Program evaluation is continuous throughout this phase. Phase III

1. Review current evidence based wellness practices. 2. Re-evaluate program opportunities.

3. Apply for award recognition in wellness programming

a. Texas Association of Counties – Healthy County program b. Wellness Councils of America

4. Evaluate outcome measures to determine how well program is performing. 5. Continue annual employee satisfaction surveys.

Program evaluation is continuous.

Staffing and Resources

Available to the wellness programming today, which was not in the past, is the addition of an On-site Health Coach from the health plan’s third party administrator, UnitedHealthcare, and a new County position, the Health and Wellness Program Administrator. With these new resources, the County now has the staff and resources available to begin the implementation

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8 of a more comprehensive wellness program for development, implementation and monitoring to ensure the program is successful.

Also, as part of the competitive bid process completed in 2014, UnitedHealthcare has provided an allowance for health and wellness activities, services and programs beginning with Fiscal Year 2015. The Wellness Committee and HRMD benefit staff will work with UnitedHealthcare to make recommendations to Court on the most appropriate and effective uses of the allowance.

Staff Recommendation:

The Wellness Committee recommends approval of the Travis County CARE Program and the wellness program initiatives to include the program name and logo.

Issues and Opportunities:

Nationally, organizations are seeing the cost of employee health care rise. Many organizations have shifted the cost to employee with employees paying increased premiums or by requiring employee participation in a wellness intervention, such as completing smoking cessation programs, completing a health risk assessment, or having an annual physical. Even though the County has seen an increase in health care costs over the last eight years, the recommendation here is not to shift costs to employees, but to support employees in being successful in improving and managing their health and wellness.

Budgetary and Fiscal Impact

This item requires no additional funding. The staff resources are already included in the current budget and additional financial resources are available through the wellness allowance provided by UnitedHealthcare.

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Attachment 1 – CARE Program Performance Measurements 1. Health and Wellbeing Program Participation

Number of on-site program presentations conducted

Number of participants in presentations regarding health, wellness and/or fitness. Number of participants completing a biometric screening

Number of participants completing a health survey (health risk assessment) Number of CARE program newsletters distributed

Number of participants attending County health fairs Number of Employee Assistance Program (EAP) cases Number of EAP work-life cases

2. Case and Disease Management Engagement

Number of members touched by case and disease management nurses Number of members enrolled in a case or disease management program

Number of members actively engaged in a case or disease management program Number of nurse line contacts by unique participants

Number of services provided by nurseline service

3. On-site Health Coach Encounters

Number of participant contacts by health coach

Number of unique participants who had health coaching session(s). Number of health coaching individual sessions completed

Number of health coaching group sessions completed Number of referrals made during coaching session Total number of outreach to high risk individuals Satisfaction survey score

4. Health and Wellness Workplace Environment

Number of annual health and wellness employee surveys completed

Percentage of employee’s who agree and strongly agree with the perception of the County’s culture towards employee health

Number of worksites with healthy vending machines and/or food options Number of on-site fitness activies/sessions coordinated and scheduled

5. Health Plan Costs and Trends

Medical net paid PMPM for the fiscal year Pharmacy net paid PMPM for the fiscal year Emergency room visits per 1,000

Number of high cost claimants in the fiscal year High cost claimants net paid PMPM

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Attachment 2 – 2014 Needs and Interest Survey Top Responses by Category

Education Programs % Likely or Extremely Likely to Participate

Heart Disease Prevention 50.76%

Cancer Prevention 46.32%

Cholesterol Reduction 46.25%

Stroke Prevention Programs 44.46%

Assistance Programs % Likely or Extremely Likely to Participate

Financial Management 47.70%

Job Stress Management 46.04%

Managing Chronic Pain (neck & shoulder

injuries, back injuries, ...) 37.12%

Accepting Change 33.64%

Fitness Programs % Likely or Extremely Likely to Participate

On-Site, Low-impact Exercise Equipment 70.66%

Personalized Exercise Programs 67.28%

Fitness Membership Discounted Rates 65.14%

Stretching Programs 62.84%

Immunization Programs % Likely or Extremely Likely to Participate

Flu Shots 69.71%

Tetanus Shots 59.51%

Hepatitis 'B' Vaccine 51.45%

Nutritional Education Programs % Likely or Extremely Likely to Participate

Onsite Vending Machines with Healthy Choices 69.62%

Healthy Cooking (meals/snacks) 58.81%

Healthy Eating (do's & don'ts) 56.62%

Weight Management Programs (diet &

exercise) 55.80%

Screening Programs % Likely or Extremely Likely to Participate

Vision Screenings 68.62%

Cholesterol Levels 68.35%

Blood Pressure Checks 67.02%

Blood Screenings 66.36%

Cardiovascular (EKG's) 64.35%

Other Programs % Likely or Extremely Likely to Participate

On-site Healthcare Nurse 59.48%

Stress Reduction Programs 38.25%

Time Management Programs 32.41%

Program Participation Times % Likely or Extremely Likely to Participate

Mid-Day (11am - 1pm) 55.52%

Evenings (after 4pm) 41.13%

References

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