Travis County Commssioners Court
October 28, 2003
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Item 45
45 is to consider and take appropriate action on Travis County strategy to promote holistic health pract Travis County employees, including the following: a. Committee membership; b. Best practices by other major public and private employers; c. Earliest possible adoption and implementation schedule; d. Work plan; e. Appropriate marketing strategy; and. F. Other appropriate steps.
>> move approval.
>> I don't have any backup.
>> all of those provided by the county judge who did not provide backup. This was my response to opinings throughout the other members of the court throughout the last year as news of the budget impact of employee health insurance for '04.
>> yeah.
>> emerged, and in terms of committing membership, we already have an employee health committee, who is on that committee? There's alicia, she is a member of that committee, right?
>> yes, sir.
>> who are your colleagues on the committee?
>> well, we have several of them, howard hair ron, [indiscernible], t.n.r., The auditor, leroy nellis out of p.b.o., We have joe gieselman, some of his staff, also, attend the meetings, we really need to formalize, though, the process and go ahead and reappoint the committee. We've had some complaints about not having maybe enough rank and file members. We did have a -- a supervisor in the custodian division, reggie, but reggie left, he retired. We really, I think, probably need to just bring to the court a break out of the type of folks to go on the committee so that you have a representation of all sectors.
>> who is the Travis County health guru or do we have one?
>> well, we have got several of them. [laughter] and dan --
>> not self proclaimed, I mean --
>> dan man sewer is probably the person -- man sour.
>> absolutely.
>> and cindy. Yeah.
>> I think it's a good idea, judge, to do this? Are these things like taking the soft drink machines out of the building and --
>> I don't know that we would focus on those things right away. I had talked to the judge earlier this week as I have spoken to some of -- some of you. In terms of we are very supportive of the wellness program, I think there's some things and action that's we can take right away. We are looking at space at the usb as a possibility for -- for exercise area with -- with donated equipment and we have some staff on board. But we are looking more at things like that.ñi areas where we know that you can have a quick bang for your buck, control of diabetes, obesity, osteoporosis, heart disease, those sorts of things. Along with this you really need to have an analysis of what the cost drivers are, what the highest percentage of type of medication that employees are taking, what they are getting treated for more. We have that information. But more than just wellness, I wanted the -- the committee or the health care program really to have a work plan that was more holistic. In terms of we absolutely need to focus on the Travis County policy for retiree health care. That will be a very significant cost driver in the future as you have more and more people retire. We don't have policies that stipulate or that provide the standards for an individual that works here either 8 years or 28 years and what health care they are expected to receive. I think that was an edid it of the court last year, o that we would like to complete. The wellness program would be, of course, part of what the committee would like that. The quarterly reports on expenditures and trends, we need to develop an r.f.s. For actuarial services, the analysis of cost drivers --
>> what I have in mind is something that we can get a report back on in two to four weeks for this first part. There are other issues I think we need to work on throughout the year. But if we are to have impact on next year's employee health insurance cost, it seems to me that we need to implement something, I would say within 30 days.
>> if we can come back next week and just bring you the committee, kind of the areas of the -- of the committee so that youñr do have good representation.
>> well, I was about to move that we appoint the following people -- perez, perry, nellis,spiaaror, gieselman, add mansour, [indiscernible]
>> wheels?
>> [inaudible - no mic]
>> barbara.
>> [indiscernible] [laughter]
>> barbara wilson, that's different.
>> sils wilson, maybe someone from the sheriff's department. We will get a name. Purchasing.
>> all of these folks will be interested in working this --
>> I believe that they will be. I had a really active committee. Well, I don't know the committee may have been active, but I don't know if we have done a real good job of getting that word to the county workforce about what's available. Somewhere in this -- we need to get out -- unless we really work to keep the cost of employee health insurance down, we will not have money for pay increases. If you take another 8 million dollar hit, I don't know how in the world we can get on top of that, it's just that simple. The other thing is that unless we move in this direction seriously it seems to me that it's expected that the cost will keep increasing.
>> yeah.
>> now, I don't know how we -- the law prohibits us from -- from pulling medical fouls and fining die bet ticks like -- diabetics like myself, but we can say that we will have a diabetes expert on the Travis County premise miss at a certain time and place and all diabetics are invited to go down and participate and the county judge will be number one. What I'm thinking is that I know generally what to do, but there's got to be more specific information, if you tell me I can go and get there somewhere, a two, three, four, 500 pager, we are a lot more inclined to show up. I think that we are at the point where we ought to do that and facilitate implementation of specific programs. And on top of this, we need to get supervisors and managers on board to help employees appreciate that in the end, the employee health insurance costs has a direct bearing on funds available for pay increases in '05. And I don't think I'm exaggerating. I think we all have pretty much been saying this.
>> we can pull out all of the coke machines and candy machines over at city hall. You can go get them but you have to walk three blocks and walk back.
>> the good news is that other major employers, both public and private, in Texas and other states, have been implementing programs over the last months.
>> yes.
>> or they have been reported in various materials. So maybe part of our strategy ought to be to pull the best practices from those materials and see what we can bring here. In addition to ideas that we originate ourselves. So I'm hoping that this community can kind of brainstorm over the next two or three weeks, then come back to the court. We adopt something and help get out the word basically to go ahead and do that.
>> right.
>> now, I think that the cost of employee health insurance is so great that we ought to be willing to spend a little money if we think that the logical result will be keeping that cost down.
>> uh-huh.
>> and when I say little that's in all caps. I don't know -- [indiscernible] -- on some of this it may be that we have to spend a little money, but I would think that we can get the experts from st. David's, seton, other medical facilities around here to come for an hour and a half or two hours for a little bit of nothing. The other thing is that I have noticed we expect the employees to use these lunch hours. Maybe if in the long run we save money to let you use some of your county time to attend these sessions. So start at 9:00 to 10:30 instead of 12 to 1:00. Maybe that don't help -- I just think we ought to be willing to basically hear recommendations that will help in this area.
>> uh-huh.
>> so --
>> it may actually do some something things that are already happening at the governmental level to be expanded upon. If you go over to the new emergency operations center, there is a workout area because those are folks that are stuck there for large periods of time, they need to, you know, get active because they sit all the time. If you go over to tcso, they do have a work training workout training area. And certainly at any of the city fire stations, it is a mandated piece of -- of -- of their day because of the equipment to make sure that they are getting the proper exercise and I don't know, all that stuff. So there may be good ideas that are already out there that we have not thought about the rank and file, it's been been very job specific.
>> > wouldn't the natural place to go here to find out definitively is to have our health care provider come in and give us examples? I mean, say, you know, here is -- here are the reasons why why you have, why you have seen the increases because of this, this, this and this. You don't have to identify the people that are having those issues, but then that's when you really say here are the things that we do need to -- then we put out some sort of a memo saying, you know, these are drivers of -- of what is the problem with our -- with our insurance. I would think.
>> and that's part -- partly what you were saying is part of the reason that it would be prudent. We can focus on wellness, but that is just one component. The research that we have for Travis County employees showed that issues such as carcinoma, the outpatient surgeries that are preventive surgeries because the -- because the detection of tumors or cancer is so much better now that you may still see those sorts of increases, so you want to be able to not only to focus on wellness, which I think can help, but also on -- on policies, on buying a strategy -- on buying strategies with other governmental agencies. We have had wellness programs in the past. I think not as extensive as -- as what the court would like to -- to see. And we can again work on that. But understand that that is one component of the whole health care issue.
>> right.
>> [multiple voices]
>> what you are saying, I did -- these are some great recommendations, but I'm kind of looking at also we are not only talking about Travis County employees, but the extension of the employees which leads [indiscernible] my whole point is, let's face it, the premiums are trif convenient by the family setting -- are driven by the family settings, how many persons are in the family, stuff like that. My whole point is how could this same information be -- be filtered into the family that also uses the Travis County's health benefits program. So -- so this is something that I don't know how they can be translated, you have an employee that comes in and hears everything, how is that translated to the other family members that may have some wellness issues as far as that's concerned.
>> I think we can work on that, too, on messages to the family because understand a lot of the costs that you incur in terms of your health care is a subsidy of family.
>> exactly.
>> premiums. 65 and 70% of all of the insurance that is provided to families of Travis County employees is paid for by the county. So, yes, sir, I think that we can do that.
>> how much of this can you get back to us in two to three weeks?
>> let me go ahead and meet with the committee. I think that we can get something back within three weeks for sure.
>> move that we appoint perez, perry, nellis, spitaro, gieselman, mansour, [indiscernible], wilson, a sheriff's representative and lottie jones to the employee health/wellness committee.
>> I don't know that mr. Nell is will be here so someone from p.b.o.
>> okay.
>> will that be about the 20, somewhere there --
>> nellis or smith, how's that? Any discussion of that motion? All in favor? That passes by unanimous vote. Three weeks?
>> yes, sir.
>> that would be the 18th. As they report back and that is c, the other thing would be that we check the best practices of others, which is b. And formulate some sort of work plan. It's kind of two-phase work plan, isn't it? One for immediate action, the other a bit more long term.
>> yes. That would include then the retiree health care and those sorts of issues.
>> do we need to give some thought to a marketing strategy between now and November 11th by that I mean how do we get word out to employees of availability and different programs and how do we encourage them to take advantage of these programs. It seems to me that getting out word that performance pay next year depends on us keeping the -- any employee health insurance increase under control.çó I would think that this -- last year was out of control, I would think.
>> uh-huh.
>> although we control it as much as we can.
>> right, right.
>> uh-huh.
>> yeah, I wouldn't use the words out of control. I would say that people are fortunately or unfortunately taking advantage of the health insurance benefits and you have to wonder, and I don't know what the answer is, of whether there was some adverse selection happening or people coming back to Travis County to access our insurance because of what was happening at the spouse or partners workplace. There was some substantial changes in benefits within this community, it used to be that -- that state did certain things, they made changes in their benefits policy mid year. So there may be some folks that -- that are kicking things over more to the county side, so -- [multiple voices]
>> this is to the doctor and medication -- visits to the doctor and medication irrelevant to our lives we would be so healthy.
>> uh-huh.
>> not out of your control, but let's manage our lives in such a way that we don't need a doctor.
>> yeah.
>> if you look at health care nationally, I think that you probably hear the same.
>> oh, yeah.
>> same thing.
>> it's getting bad all over, yeah.
>> I move all of that.
>> amen.
>> second.
>> b, c, d, e and f. And on 11 we'll have a deliverable from the committee. By the way, if the committee recognizes a Travis County expert that ought to be on this committee between now and then, bring that person with you on the 18th we'll put them on the committee, how's that.
>> it works.
>> was that motion seconded.
>> I seconded it.
>> all in favor? That passes by unanimous vote. Thank you all very much for volunteering.
>>
>> I move that we bring back up for additional consideration item no. 45.
>> second.
>> all in favor? That passes by unanimous vote.
>> judge, I would ask that I am able to [indiscernible] from my office on the holistic health committee.
>> second that motion.
>> any more discussion of it? All in favor? That passes by unanimous vote.
Last Modified: Wednesday, October 28, 2003 7:52 AM