Health Promotion for Municipal Employees – Leveraging Resources in

Tough Economic Times

HP Career Net WebinarDecember 13, 2012

Today’s Learning Objectives

Participants will be able to:

1.Learn how the Monterey County Health Department leverages resources, operating on a foundation of simplicity…and provides wellness resources and programming to meet the interests and needs of its employees.

1.Recall 3-5 ways in which Monterey County Health Department’s employee health initiative partners/builds relationships with the County, its employees and the community.

2.Identify ways in which Monterey County Health Department communicates its programming components, goals, and outcomes to its stakeholders.

County of Monterey

• Founded 1850—one of the original counties in California• Industry: Local Government• 4300 employees• Over 80 work locations scattered

throughout 3,771 square miles of agricultural, military, recreational/wilderness/parks, and urban land

A Long Time Commitment to Employee Wellness• Created in 1985 by the County

Board of Supervisors as a partnershipbetween Management, Labor, & Employees

• To address employee health and safety,health insurance costs and Workers Compensation claims

• All (4300) regular full/part time (benefited) employees eligible to participate, select programs open to family

• Program available in 100% of work locations

Program Model

Quality of Work Life Traditional or Conventional Health & ProductivityManagement

Health focusSome risk reductionWeak personalizationModest incentivesWeak evaluation

Sample Activities Health risk assessments Health screenings Web based health information Wellness newsletter Incentive campaigns

•Add productivity focus•Strong risk reduction•Strong cost management focus•Some required activity•Personalized•Strong evaluation•Site and virtual based

•Sample Activities Health Coaching (telephone/live) Benefit linked incentives Achievement incentives Integrated programming Resiliency initiative for productivity

•Fun activity focus•No risk reduction•Site based•Minimal incentives•No evaluation•No personalization

•Sample Activities Health Fair Workshops/Classes Brochures Wellness Library

Chapman: 2006: Absolute Advantage Planning Wellness—Getting off to a Good Start Vol. 5:4. pp.17-58

MC Program Today

MC Program 1980’s

Our Mission

•Increase employees' knowledge about health & prevention

•Encourage employees' involvement in their own health decisions

•Encourage employees' adoption of healthy habits, and

•Facilitate recommendations for organizational change that promote a safe and healthy work environment

Program Goals

•Improve employee morale

•Increase presenteeism

•Improve productivity

•Help contain Workers Compensation claims and costs

•Reduce absenteeism

The Health Promotion Partnership works to create a healthyworkforce and a healthy workplace for all Monterey County

employees

Provides Programs in 7 Areas

1. Eating & Weight Management

2. Physical Activity

3. Smoking Cessation

4. Stress /Resiliency

5. Healthy Pregnancy &Parenting

6. Managing Work and Life

7. Managing My Health

Delivery Approach #1: Basic Wellness

• Website/health portal• Workshops • Wellness Library• Employee Wellness Newsletter• Monday Health Tips• Onsite Weight Management, Smoking

Cessation, and Physical Activity programs

• Gym Discounts

• Resiliency Training• Policy Support &Technical Assistance• Health/Wellness Fairs• “Take the Stairs” signage and tool kits• Department specific trainings/workshops

for employees & managers/supervisors

Awareness and Education: workshops, campaigns, and interventionsconstantly evolving to meet the changing needs of employees.

Delivery Approach #2: “Just for You” Wellness

• Voluntary health risk assessment s provide customized health report & specific strategies to improve current health behaviors.

• For those with chronic health issues, confidential, specific support is provided to help each employee better manage their condition.

– Health Risk Assessments & Screenings

– Individual health advisement/consultations and referral

– Online health improvement and chronic conditionmanagement classes/self directed programs

– Educational self study Tool Kits on multiple health topics–– Nutritional Consultation from Registered Dietician

Objective #1

• Learn how the Monterey County Health Department leverages resources, operating on a foundation of simplicity…and provides wellness resources and programming to meet the interests and needs of its employees.

The Foundation: Strategic Planning

If You Don’t Know Where You’re Going, You’ll Waste a Lot of Money Getting Anywhere

Step 1: Assessment

• Best practices in wellness industry• Best practices in public sector wellness• Monterey County employee health risk data• Monterey County organizational data• Management/HR interviews• Employee surveys• Employee Wellness Council

Step 2: Gap Analysis1. Health risks increase risk of chronic disease.a

• MC levels are above national/regional standards.

2. Management support/buy-in critical for success.b• Managers do not always have program/outcomes information.

3. Participation drives outcomes.c• Current levels make outcomes difficult to achieve.

4. Work environment/culture critical(2.5x more health risk reduction).d• Opportunities exist to make workplace more supportive of

health

a, http://www.healthypeople.govb. Partnership for Prevention, 2007/ www.prevent.orgc. Edington & Shultz, 2008. The Total Value of health: A Review of the Literature. International Journal of Workplace

Health Management 1:1(8-19)

d. Terry et al. 2008. Association Between 9 Quality Components & Superior Worksite Health Management Program Results. JOEM 50: 633-641

Step 2: Gap Analysis5. Marketing is crucial to participation.e

• Need for improved branding, communication

6. Employee/Department needs exceed existing staffing resources.• Operational efficiency & scalability needs to be improved

7. Fiscal resources threaten ability to provide best in class wellness to employees/Department.

• Address/improve fiscal sustainability

8. Evaluation key to maintaining wellness programming.f• Some data not current, has not been recently analyzed,

Management not aware of HPP outcome metrics.

e. Wong et al 2000. The Influence of Job Stress and Supervisor Support on Negative Affects and Job Satisfaction…Journal of Social Behavior and Personality. 15:85-98.

f. Chapman, 2005. Meta-Evaluation of Worksite Health Promotion Economic Return Studies. The Art of Health Promotion 2005 Update.

Step 3: PrioritiesIf You Don’t Have a Lot, Spend the Money Where It Counts

1. Health Risk Reduction/Condition Management2. Management Support and Buy-in3. Participation4. Supportive Environment5. Communication, Marketing, & Promotion6. Operational Efficiency & Scalability7. Fiscal Sustainability8. Evaluation

Step 4: PLAN & Approach:Leading in Business by Leading

in Health

Plan the Work….and Work the Plan

Business AlignmentA Critical Step to Getting & Keeping Financial Support

Monterey County Business Priorities: Wellness Alignment:• Service provision Supports all departments/wide menu of services • Cost reduction Fiscal Sustainability Initiative

Health Dept. Strategic Plan: Wellness Strategic Plan Initiatives:“Improve health through programs and policy”

• Emphasize prevention Population Health/Risk Management• Health in all policies Supportive Environment• Integrated approach Wellness “Connect” Referral Model• Realign/improve efficiency of programs/services Efficiency Initiative• Evaluate systems/changes Evaluation Initiative

Health Risk Prevalence Headcount # of EEs Affected (BxC)

Excess Cost per Condition per ee/yr**

Excess Annual Cost(D x E)

Readiness to Change

Opportunity Index (Cost Savings)(F x G)

High Blood Pressure

26% 4543 1181 $1020 $1,204,620 20% $240,924

High Cholesterol

25% 4543 1136 $712 $808,832 10% $80,883

High Blood Sugar

12% 4543 545 $2271 $1,237,695 18% $222,785

Overweight/Obese

74% 4543 3362 $1872 $6,293,664 20% $1,258,732

Sedentary 53% 4543 2408 $1110 $2,672,880 35% $935,508

Tobacco 9% 4543 409 $1117 $456,853 39% $178,172

Stress 45% 4543 2044 $1774 $3,626,056 30% $1,087,817

Depression 26 % 4543 1181 $1579 $1,864,799 27% $503,496

*Adjusted for 40% carve out of health costs (Goetzel et al. 1998. Health Costs Worksite Health Promotion Participants/Non-participants. 40(4): 341-346) **Whitmar, Goetzel, & Anderson. 1999. The HERO Study on Risks & Costs: Research FindingsSource for County Data: 2009-10 Health Media Health Risk Assessment Executive Report

Monterey County Opportunity Index

What Can YOU Expect?DepartmentInvestment

What if ONE of your employees….

Avoided cost/savings/yr.*

Savings minus investment

ROI for your Department

$78/ee./yr. + Stops smoking $1117 $454.12 $1 : 1.69

12 hrs. x $48.74= Achieves normal weight?

$1872 $1209.12 $1 : 2.82

$662.88Becomes active? $1110 $447.12 $1: 1.68

*Does not include direct health costs

Department of Social & Employment Services“The Monterey County Wellness Program is a wonderful resource for

the employees of Monterey County.

The upfront cost per employee is a worthwhile investment in the productivity, health, well-being and morale of our employees.”

…..Elliott Robinson, Director

Social and Employment Services

Lead by example:Participate in exercise challenges Attend wellness workshops with their staff,Schedule quarterly specific trainings for their department Champion staff participation in wellness eventsSchedule time for wellness activities into trainings, staff recognition days, all department meetings

Provide recognition to employees for participating in wellness programs:Host healthy lunches Certificates/department provided incentives

Integrate wellness in their work environment:12 hours Wellness work release time annually Support healthy policies in the workplace

CAO Engagement:Wellness included in Labor Negotiations County PPPR Manual wellness content

Board of Supervisors Alignment:Established program/release time HHS Committee includes wellness reports BOS champions wellness initiatives

Leveraging Senior Leadership

• WC and injury/disability reviews and remedial wellness programming

• Tailored programming and activities for divisional events, employee recognition days, training/development days

• Recognition for supporting health initiatives such as Exercise Challenge, Fitness Team events and competitions, and daily exercise for their employees

Featured in “What’s New” and “Success Stories” on Wellness WebsiteProfiled in Wellness NewsletterTrophies and certificates of recognition

• Education about association between employee health and productivity and relation to their business:“So You Want to Be a Supervisor”“Manager Academy”

“He pointed out that he (Probation Services Manager, Joe Whiteford) knows he will get twice the productivity if we stay active and keep in shape.”

……Probation Department Employee

Leveraging Middle-Management

2010 2011

Yes 39.9% 58%No 60.1% 42%

Participation is Growing…

“I appreciate all you do, we really don't know how lucky we are to have a county that actually cares about it's employee's health. Thank you.”

….2011 Wellness Survey

“I have been given tools to handle stress at work and home better. I have also been given tools to be a better parent. Most of all I have been given a different outlook on life.”

….2011 Wellness Survey

2010 2011

Yes 35.2% 49.1%No 34.6% 24.4%Don’t 30.2% 26.5%Know

Managers/Supervisors are Making Wellness a Priority for Their Employees!

“As a supervisor, I encourage my staff to take advantageof any (Wellness) programs available to them.”

….2011 Wellness Survey

“He resends the classes that he feels would be good for our department staff andhighly encourages getting out of the office for exercise.”

….2011 Wellness Survey

• Smoke/Tobacco Free

• Lactation Accommodation

• Seat Belt/No Cell/Texting (CA law)

• Drug/Alcohol Use and Screenings

• Physical Activity in Meetings, Breaks, and During the Workday

• Healthy Food at Meetings (selection and compensation for purchase)

• 12 Hours Work Release Time for Wellness Activities

• Healthy Vending

• Workplace Violence

• HIV/AIDS

Leveraging POLICY as a ResourceMaking it “easy” to be healthy at work

Objective #2

• Recall 3-5 ways in which Monterey County Health Department’s employee health initiative partners/builds relationships with the County, its employees and the community.

County Wellness Referral ModelWellness Role Referral Partners (Internal)

1. Provide health information, programs & resources Natividad Medical Center• Wellness Workshops -Wt. loss/obesity• Department specific trainings -Preventive physical exams/screenings• Newsletter, Website, Library, Resource Directory -Dieticians/Cafeteria

-Physician experts, lactation support/education2. Manage risk reduction campaigns for health/lifestyle change• Health risk assessment/screenings Benefits/Health Plans• Coaching/Personal Health Improvement Plans -HRAs• Topical health information campaigns -24/7 Nurse Lines• Motivate/support healthy behavior change -Disease Management

– Stress management/Resiliency -Speakers, e-health tools, behavior change prog.– Nutrition/Weight control – Smoking cessation EAP– Physical Activity -Counseling/system of care

• Refer to MD/disease & condition management - Alcohol/drug• Connect to internal/community resources - Stress/crisis resources

3. Support healthy work environments for employees Ergonomics • Physical Environment - Ergonomics training/workstation assessments

– Bike to Work - RMI prevention– Healthy Back Care -Remedial/preventive equipment– Mother’s Rooms– Health Work Stations Safety– Healthy meetings - Injury prevention– Physical Activity guidelines at work - Online training/courses

• Organizational Environment– Manager & Supervisor/new employee training Human Resources

and New Hire Orientation - Wellness Release Time– Work stress - Alternative/Flex Work Schedules– Employee development - Policy (lactation, smoking, vending etc) – Healthy foods -Training/Development/Manager Training– Lactation accommodation

• Benefits provides, Wellness promotes avoiding impact on the Wellness budget, and still providing quality services to employees.

• HR Link presentations each quarter

• One on one meetings with Department HR/Director

• HR Specific Needs and Interest Survey

• Department Specific Wellness Programming• Cross Promotion

– Benefits links on Wellness Website– Periodic Health Benefit Communications – Cross functional task forces

• Wellness messaging in open enrollment packets

• Partner with “Grow Your Own” training site

Building a Bridge with HR/Benefits

Safety Partnerships

• Departmental managers include Wellness education in Safety Meetings

BackWorking in Hot Environments/HydrationSleep HabitsWork Stress

• Wellness promotes annual workstation ergonomics trainings

• Wellness refers employees to annual back safety/back health trainings

• Self-ergonomics assessments, staffed ergonomics evaluations

:

Facilities & Physical Environment

Thinking Outside the Box

Digi-Walk: “The Stroll”, “The Hike”, “The Journey”

Building Relationships w/Employees

• Health/Wellness Fairs• Leveraging existing events• Responding to needs/interests• Wellness Council• Surveys• Table tops/topic related • Recognition • Success stories• Customer Service

Community Partners

Objective #3• Identify ways in which Monterey County Health Department

communicates its programming components, goals, and outcomes to its stakeholders.

Communications MatrixAudience Vehicle Sender Communication

ObjectiveKey Message/ Description

Timing Status

All Employees Home Mailing Booklet Wellness Team Increase Awareness and Utilization

“Do you know” Yearly

Managers Supervisors

Managers Tool Kit Department Head Management awareness/education

“Management Skills and Resources”

Quarterly

UnionBargaining Units

PresentationsOne-on-one meetings Branch Chief

CAO

Awareness, education and buy-in

“Do you know”Benefits for their employee units

Annual update

Departments Presentations at department meetings

Wellness Team Increase Awareness and Utilization

“Do you know” Ad-Hoc

ExecutivesBoard of Supervisors

One-on-one meetings HPCHD Director

Gain buy in and support, be role models

Benefits to the county. Value-add/ROI

Prior to launch and ad hoc

All Employees segmented by areas of interest

Electronic Newsletter Wellness TeamVendors

Targeted Awareness and Promotion of programs and services.

“What’s in it for me”“Be a part of this”

Monthly

All Employees General Delivery email Wellness 411Vendors

Awareness/Promotion “What’s in it for me” As required

All Employees Wellness Web Site Wellness TeamHPC

Awareness/PromotionAdd names to email lists for e-newsletter

“what’s in it for me” Daily

Human Resources

One-on-one meetings HPC Awareness/promotion/support/buy-in

“Do you know”Integration/support of health benefits packages

Prior to launch, open enrollment and quarterly

Employee Communications• All employee emails 1-2/week announcing events

• Monday Health Tips

• Wellness Council and Wellness Champions

• Bulletin boards and themed posters in departments

• Unique brand and identity (logo and tag line) on all communications

• Alignment with health and business goals included in Wellness Strategy Plan asseparate section “Marketing”

• Customized for multiple target audiences: age, gender, ethnicity, education, language, work situation and location

• Website

Employee Website: http://www.mtyhd.org/wellness/

Employee Communications

• Aligned with preferred learning styles andcommunication preferences of audience based onAnnual Wellness Survey responses

• Program and product specific surveys

• Blog: WellnessWorks4You

• Health information and resources accessible through plan provider health portals

• Newsletter produced internally, tailored to needs from survey/input every other month

• Cross-promote using County wide publications e.g. CAO Weekly Report, Health dispatch, NMC Newsletter and Bulletin Boards, New Hire Orientation, Timecard messaging, HR Link

Customize by Delivery Preference

Customize by Learning Style

“Why Wellness?”

We asked Monterey County employees, “Why Wellness…. How has it helped you?”

Here are some of their answers……..

I’ve lost 25 pounds….and dropped my A1C from between 6.2 and 6.8 down to 5.7….Also dropped my blood pressure from 135/80 or higher to 112/60. Simply by beginning to exercise. …….Rich

I have dropped my body fat percentage, my blood

pressure is normal again…..

…..Anonymous Employee

“I will to be able to keep up with my kids as they grow up.”

…..John

I am continuing to walk, and now have a stationary bike that I am NOT using as a clothes hanger, but actually using it as I should, worked my way up to 20 minutes and counting!

……Arlene

……Arlene

What can Wellness do for you?

get started today……..

Management Communications

• Annual one-on-one meeting with Department Heads• Annual Operating Plan/Report • Spring Department Head/Management Council overview• Annual Board of Supervisors update• Manager Tip Sheets monthly, staff meeting presentations• “Wellness as a Business Strategy” in Leadership and Supervisor

Academies• Annual Manager Satisfaction Survey• Technical Assistance on issues important to Departments• Next Steps: Advisory/IHPM Council

Child Support Services

“I believe strongly that participation of staff in the….Wellness Program….helps the workforce be as productive as it can be. I have been impressed with the quality of the workshops I have attended and the flexibility of even providing workshops on site, which has helped…..in attitude and overall health of our employees….

The amount of money that is being charged…is very reasonable and the direct and indirect savings…can actually save positions if worker compensation costs go down and absenteeism is minimized.”

….Stephen H. Kennedy, DirectorChild Support Services

Treasurer-Tax CollectorResiliency Post Training Evaluation

• Reported occurrence stress symptoms: average reduction of 25%

• 10% increase in productivity indicators

• 16% increase in ability to finish difficult tasks

• 5% increase in employees who thought their workload was manageable/not excessive

• Average 6.3% improvement in job satisfaction indicators

• 6.2% increase in morale at work “We want to continue to utilize these services because we have had nothing but success…our department is very excited to continue this type of training”

….Mary Zeeb, Treasurer-Tax Collector

Next Steps: ActionIncentivize and recognize

participation

• Proposed Action: Healthy Lifestyle Rewards Program

– Annual wellness activity and incentive tracker.

– Activities organized by categories such as nutrition, exercise, screenings and checkups, etc.

– Each activity has a point value.– Employees record points once a month.– Employees work towards reward levels- Gold,

Silver, and Bronze. – Incentives vary for each level.

• Status: Proposal development

Comprehensive data collection, tracking, reporting, and financial analyses to helpDepartments understand Wellness Program benefit/ ROI.

• Proposed Action: “Working Well” Initiative

– HRAs (Health Risk Assessments)– Onsite Health Screenings– Workforce Health Profile– Risk Based Predictive Modeling Identifies

Savings Opportunities – Quarterly Management Reports– Department Scorecards

• Status: In progress

Questions & Thank You!

Judy Webster Health Promotion Partnership

831-755-4574or

websterja@co.monterey.ca.us