Travis County Commssioners Court
November 25, 2003
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Item 7
Number 7 is to consider and take appropriate action on the following: Travis County wellness program and b, the addition of two wellness committee members, lee mccormick, safety specialist, risk management, management,hrmd, and crystal wiltz, ph.d., Extension agent, Travis County extension department. Move approval of 7-b any more discussion? That passes by unanimous vote. We've got three members on the committee. Now let's discuss item a.
>> the court approved formation of a Travis County employee wellness committee about three weeks ago. And they wanted us to look at developing a program that promoted healthier lifestyles and habits for Travis County employees. We have the initiative included to provide education and training, to promote healthy life-style choices for Travis County employees, and by doing so use that as a means of controlling the annual increases in costs for health care benefits. The committee has been meeting. We have a variety of wellness ideas and suggestions. And we're trying to determine what is in the best interest of employees and the county. And a couple of ways that we'd like to move forward is included in the memorandum that you have. We have short-term action items, and then long-term options under consideration. We'd like to discuss with the court those. And then there were other items that were issues of much civil debate that we would also like to discuss with the court and kind of get your ideas of where we would go with that. So I will refer you to page 2 of your backup memorandum, goal for the short-term action. The recommendations from the committee was to send out a letter to county employees, probably with a December the 15th paycheck, from the court that lets them know that Travis County is embarking on this -- on a wellness initiative, the importance of healthy lifestyles and making healthy choices. The letter would discuss the importance of the wellness program in keeping health care costs affordable and how important that is in order to be able to afford any perhaps pay increases or being able to avoid any more cuts in programs by being able to maintain our health care cost increases. So we'd like to propose a letter from the court to each employee. We also proposed an employee wellness survey. And the survey is attached to your memorandum. This would allow Travis County employees to provide their input as to what they thought the most important components of the wellness programs, what their greatest participation would be in which of the programs, and also get any -- gather any of their recommendations or ideas for the promotion of a healthier workforce. That's recommendation number 2. We would recommend a wellness newsletter. We would be working with health and human services on the development of a newsletter that would be bimonthly or quarterly newsletter. And they're already, I think, putting one together, so we would work with them. Again, no additional resources, but using the existing resources to put together a wellness newsletter. We would provide employees with an education and a curriculum format in some of the following areas. We have asked crystal to pass out some books from seton. That will give you an idea of some of the classes that are offered in our community already. We want to partner with such efforts so that we don't have to reinvent the wheel, and we would also have more cost effective means of providing education and training, both to our employees and to families and to our retirees. So that would be a good idea of the classes offered, and we would also provide them in Travis County. And we should be able to get -- when we get the information back from the employees, we should be able to put together a good curriculum. Our fifth recommendation is one that was in response to a lot of the committee members seeing people coming to work sick. So the recommendation is during the season of the flu, which is about from now until about February or early March, the wellness committee encourages managers to send home employees who display symptoms of the flu. A lot of employees come to work sick. And we want to avoid the spread of illness throughout the departments, especially during the flu season. We know that that's a very contagious virus. But those conclude our short-term actions. We have long-term actions or options under consideration. Ben, do you want to go through those?
>> the long-term options include as a first option, establishing an on-site county employee health clinic. This would be to provide three essential parts of our program. One is treatment of minor or acute conditions that would be staffed by a physician's assistant and medical clerk. The other is to provide preventive care such as the flu shots, the screenings that we generally contract with someone to come out and do. We would be able to do this on an ongoing basis. And finally, to manage or monitor the wellness program. It would essentially become the nuk clee us of the wellness program. We would focus on using both internal resources such as nancy was saying with the newsletter, and crystal, who is the wellness coordinator with the extension service. And we would use outside resources such as what crystal passed out from seton hospital with their nutrition and wellness program. So it would be an integrative program that would be managed through the health clinic. The second item is utilizing the county public health clinics as locations for -- or off-sites for the wellness clinic or health clinic I should say to provide services to our employees. So while we would have a facility that would be in a central location, using public health clinics that we have throughout the county would enable our pa or nurse practitioner to go out into the field and be able to be in outreach to our employees that work in the outer areas. The third item is an exercise room. Previously the space was used by the sheriff's department as a weight and training room. We're looking to establish an exercise room at that location. It does have dressing rooms, including showers. So it would be a good area to establish that. We're also considering contracting with area fitness centers for discounts on employees. If some of our employees were interested in joining the gym or the fiptness center, that we might be able to do that on a basis as one of the pilot projects that was mentioned. The other is -- the other long-term is to develop support groups as part of the education curriculum such as walking groups or dietary practices through weight watches or atkins or one of these support groups that other organizations provide. And the pilot programs would depend on what response we get back from employees on the survey as to what we would like to try first. It would be two or three-month programs to see how successful they are, how much participation we have in those. And those are the longer term programs, but I think the most important one in the long-term is the employee health clinic.
>> and what about support for employees who are already in a fitness program, maybe doing exercising and dieting? I think that could be supported as well. And I kind of wonder if we could know what the savings would be if employees joined a wellness program. And instead of spending the money on a doctor, we spend it on, you know, contracting with a fitness program, and maybe the money could instead be invested that way. Because we also want to support businesses in this community who are in that business. And there are some who want to work with women because of the health issues that are involved for women of all ages. And instead of asking them to decrease their revenue, maybe we can help supplement with like a co-pay. We'll get the benefit, they'll get the benefit. And the employees will certainly get the benefit. But I think it's extremely important, especially from a women's point of view, to do exercise, to improve the bone mass, which is extremely important to women as we age. And then, of course, the diet has to go with the exercise to get the full fit of the program. So we want to be healthy older women and not have the falls where you break hips and knees and joints that can limit our movement, which is not a good thing. And especially since the medicare program may not be there for us in the future. I think this is a tremendous investment to take right now. And, of course, we're concerned about the men, the male employees, but -- [ laughter ] but I really want to emphasize that the exercise and the diet is extremely important for our future if we're going to be healthy elder citizens participating actively in this community or with our families or wherever.
>> we do plan to be an equal opportunity wellness program for everyone. [ laughter ] number 6, which is the pilot program, we put that in here as a means of why we should develop good measures, where we have programs maybe that are quarterly. And several programs. And by doing that we develop measures and then we're able to improve on those so that we can really get down to what does it cost and what can we say. And I think you can -- you can do that with a small pilot.
>> sure. And I think what would really be useful and a great investment of our money, if someone can find a club, a fitness club already and let's say that they charge $40 a session or whatever. We would supplement it with $20. And as a co-pay for our employees. And I really would like to see that work.
>> it depend on how many employees are interested in doing something like that. What's the purpose of this?
>> the purpose of this is to show how we would partner with other agencies that are already -- that already have wellness programs and already are offering classes so that we don't reinvent the wheel. Some of the resources are already there.
>> move approval of the suggestion that we have a letter from the commission ers court and we have the draft letter on the agenda for the court next Tuesday. That in that letter we indicate the importance of wellness to our employees and show a relationship between what we spend for employee health insurance and performance pay. I would make reference to the fact that this year the increase was $8 million. A similar increase next year would leave us unable to provide necessary performance pay in my view.
>> right.
>> otherwise I don't think this issue is urgent. It is personal in a way. It is not so personal, though, if it's connected to our ability to provide performance pay. I think that's how you drive home the point. And I think that's the truth. That was seconded by Commissioner Gomez. The thinking is that we have a draft letter to look at. If not by five tomorrow, then certainly 10:00 o'clock Monday morning.
>> sure.
>> and that it be on the court's agenda next Tuesday, that we hope to review that, approve it, have a place for the entire Commissioners court to sign so we can district it to -- district it to the employees the first part of next week. Any discussion of that motion?
>> judge, I would really love to get -- it's probably legal advice related to what other counties and cities can do, could do, should do, would do related to smoking. That's my rant. I've seen where some other cities, basically by January first, 2004, that say by this point forward, nobody will be hired who is a smoker. Because that's something that is a totally discretionary kind of activity. Is it addictive? Absolutely. But in terms of is somebody forced to smoke. No, they're not. And basically they're weaning themselves off of having any more shoal smokers and doing what they can to get folks who are smoking to get off or to pay higher health insurance premiums. And that's the part b, barbara, is there discretion related to higher premiums being charged folks who smoke versus not? That's the only area I want to get into related into can you differentiate on a premium because a lot of those things are things that really go into hippa, medical conditions, etcetera. But smoking is not. There's no medical republican to smoke. It is a totally discretionary activity. I'm just trying to get some sense of where we could get some more clout related to smoking of basically smoke all you want, but you're going to pay a price for it in terms of your insurance premium and your family insurance premium if there are others in your family who smoke, and I think next Friday, Thursday, Friday is when all the budget managers are flying in for the big fly-in. I know that this is -- this is their topic as well, are there wellness programs that work. I would really like that question asked in terms of what have people done that are created, related to smoking? That's just my issue.
>> the thing is we can address those addictions through the health wellness program. And overeating is an addiction as well. And so we need to really address addictions.
>> start with the easiest.
>> I know you have it on the table and we can discuss some of this --
>> discussion of that motion, which covers number one, that letter from the court?
>> I wanted to add something as far as this discovery. When we had the flu shot services offered here on the first floor here this building, what was the participation level of the employees that actually came in to get flu shots?
>> wasn't it 400 or something?
>> 450.
>> how many employees do we have in Travis County?
>> we have -- I think we have between 300 and 350, leroy says 450.
>> out of how many employees?
>> out of how many employees total do we have currently in Travis County?
>> currently we have 3500 employees.
>> if you want to really make it meaningful in terms of having the flu shots, you need to think about the campus, because a good number of those people are out at del valle and that kind of thing.
>> and I think that was brought up with the outreach, doing things out of the downtown central location and then going out into the areas that really just don't really get down here or have a relationship with us.
>> it's been a very successful program. We've received a lot of very positive feedback from employees. And, of course, it then becomes very, very affordable and convenient. But I do think you are correct in that we need to take that show on the road.
>> on the road, exactly. And I think that's part of the outreach. I think that anne did -- he did bring up in his portion of the presentation is bringing out to those portions that are actually not here in the downtown campus. So again, I applaud you for going the direction we're going. Thank you.
>> all in favor of the letter from the court on the agenda next week? That passes by unanimous vote. My second motion is to approve the wellness survey, have a deadline on December 20th. Is that enough time?
>> second.
>> should we do the 15th?
>> 20th is -- with the holiday coming up, 20th probably would be better.
>> December 20th is the deadline. Let's ask our personnel liaisons to encourage employees and their departments to complete the survey and the information will be used by the committee and the Commissioners court. Is there a second?
>> second.
>> any discussion? All in favor? That passes by unanimous vote. The wellness newsletter I guess all y'all want is directions to proceed?
>> yes.
>> that's the motion.
>> second.
>> any more discussion?
>> is that going to be on electronic version as opposed to we're going to create more paper?
>> no. No. Because of our crews that -- tnr and some -- [overlapping speakers].
>> it would be e-mail.
>> thank you.
>> for those who can access it electronically, we'll have it available. Those without that capability, we'll have hard copies available.
>> yes, sir.
>> okay. Did we vote on that?
>> no.
>> all in favor? That passes by unanimous vote. Help me understand 4, the action part of that is what?
>> just to get together and put together a curriculum once we get the information back on the survey and partner with some of the other community education centers to provide a curriculum for employees, send it out and see the participation that we would get for some of these classes.
>> the curriculum from your perspective?
>> the curriculum would be the title of the class and then information on what the goal, objective and the training material would be.
>> last time y'all indicated to us on what we were preparing for and there were some chronic diseases mentioned, one of which I'm the victim of, diabetes. Also you mentioned high blood pressure, cholesterol, cardio vascular, etcetera. I'm left with the impression that there's a whole lot of reading that the curriculum implies from that. I'm left with the impression that it would be a lot more productive for us to get an expert in the different areas -- in each area to come to Travis County to visit, that we give employees basically time off to come and hear that hour, hour and a half lecture, maybe even in this courtroom. There's all kind of information on diabetes, really too much to read. But my guess is there are enough diabetes experts in this community where we could get one down here for an hour and just encourage all interested in diabetes or who suffer from it to come here and ask questions.
>> and that was our intention. Our intention in terms of curriculum was to provide choices of -- in different areas that people may want to take training or educate themselves on.
>> I think what the committee's intention was to have an integrative program, if it's for diabetes, of diet, exercise and those aspects that make up a healthy life-style for someone who suffers from that condition. If it's cardio vascular diet, exercise and monitoring your blood pressure, things such as that. Crystal liwlz is -- wiltz is the wellness coordinator and as she has programs to offer, she might be able to offer something to this.
>> one of the programs that we worked with was project hope, and it was a hypertension outreach that dealt specifically with the incidents of high blood pressure. And again you go back to diet and exercise. And I think diet and exercise are going to be paramount in any chronic disease that you're looking at, whether it be cardio vascular disease, stroke, diabetes, high blood pressure, high cholesterol. And our focus primarily is on tie et and exercise. -- diet and exercise.
>> well, those are two words I'm familiar with, diet and exercise. But I'm thinking that there's a whole lot more specific information that different chronic illnesses will help with. Do you see what I'm saying?
>> yes.
>> I mean, I remember sort of chatting with other diabetics and you always start with that, but when you say diet, how do you simplify that and what foods should you really eat and what foods should you really try to stay away from do you see what I'm saying? And in terms of exercise, how do you make it easy? A lot of diabetics are not really overweight. Not all of us can participate in the five-mile run or the marathon, but there are other exercises that based on your fitness level, you really ought to be able to do. And our goal is to encourage each individual to start doing those right. And to start doing them now. So I guess I can understand exercise, diet. It's specific, but at the same time it's real general. And what I have in mind is if I have high blood pressure, then I would go to a meeting with the high blood pressure expert where I would have a chance to ask some questions and hopefully that person would sich la fi -- simple will simplify my problem. So on one hand it's informational, but on the other hand it's motivational. And my hope is that we can take it to the next level where we actually can provide the information, motivation, not necessarily a threat, but enough sort of coaxing to get county employees to start moving on some of this.
>> I think we're talking about the same thing, judge. I think that the word curriculum may have just thrown us off, but all that means is just a list of classes and education and information, some written material, but that written material would be provided by a teacher, a doctor, a trainer, a specialist in physical fitness and new triltion. So again, we would provide that and give people choices, but it's just like we do with training. Every year we provide a booklet and say these are the training sessions. This is what they're going to cover. Which would you like to attend?
>> okay. What's the perspective on number 4?
>> on number 4, again just to say move fard and do that and have perhaps by December a booklet out of choices of classes that people can attend.
>> where's the competition in this?
>> that would be with our pilot programs. That would be probably in number 6. And some discussion in terms of incentives further down, but we have talked -- there's been a lot of discussion about bringing the competitive edge into it, nothing suggested a couple of programs that she's managed where they've done -- do you want to talk about it?
>> one of the programs that we discussed was the pound off wisely, which was p.o.w. And it was a financial incentive for our unit to lose weight, become more aware of your life-style, to make some significant life-style changes and to really represent the life-style that you're trying to present to other people in order for them to have that element of motivation. So there was a financial incentive tied to that.
>> and wisely so that we don't damage our heart or our --
>> absolutely. But there are all kind of incentives. People are motivated by various things. I think once you become in tune to that individual and what it is that's going to motivate them, then I think that that is -- will aid in those things that we're looking at.
>> we talked also, another suggestion was made that we provide training and perhaps pay for the entrance to the capital 10k and get people to be motivated to train between now and that particular event. So there's been a lot of I think ideas that have come up. And those are the things that we're working through in bringing back to the court of pilots and maybe we bring back seven of them and you choose two or three of them.
>> what are the various things that our provider has identified that would be, if you did this, you most likely could see this? I mean, you have 3500 employees and you have a million pound if you weigh everybody. If next year you come in at 900,000 pounds, I mean, you get this kind of a discount. Can anybody quantitatively tell you what you would need to do in order -- I mean, this is great stuff because this is going to help someone, but your incentive ought to be your own health. I mean, if you can't get incentivized with being healthy in your life, you can be good at a lot of things in your life, but health is one that will get your attention. So can anybody quantitatively -- can a provider tell us do these things -- I would assure you that if you had a policy that you can't smoke or that you have got to stop smoking, i'll bet you that's one of those things where they go yeah, you'll see a drop in that.
>> insofar as incentives from our administrator, it's not something they present. What they do tell us is they see obesity or weight as initial high cost, high driver, cost driver, smoking, but generally there are other life-style problems that bring forth issues of chronic illness. So you can't just focus on those two. There are generally a number of different cost drivers or chronic illnesses. I think as the judge brought up earlier, we should focus on where we see our cost drivers. And right now overweight and smoking are definitely two areas that I think -- lack of exercise each for those who might not be overweight, if you don't exercise, you don't keep the heart rate up, you don't keep your heart muscle strong, that can be a chronic illness. We're seeing some of that as well.
>> bone loss.
>> that's right.
>> so on 4 we're asking -- you're asking us to authorize that we proceed and refine.
>> yes.
>> unless there are incentives -- (indiscernible).
>> I think that probably what Commissioner Daugherty talked about, there are incentives in terms of tangible, but there's also your health, your looks, your mobility. One of the questions on the survey that will be sent out to employees will be asked -- eng number 12, what motivates you to make healthier life-style decisions, choose your top three, feeling better, looking better, lower insurance costs, recognition, longer life, time off, money, other. It could be money, it could be any number of things. And I think that's where we get at least some feedback from employees in terms of what motivates them. So there was much debate on the issue of incentives. Someone said, well, why don't we pay people to stop smoking. And another person said why don't you pay me because I don't smoke. So it's that sort of a debate. We did talk about perhaps recognition. We talked about providing people a vision plan. We talked about providing him -- maybe converting sick time to vacation, monetary awards. And again, there was much debate. This is one of the issues we wanted to discuss with the court. And we put a question in the survey to ask -- to get from the employees what would motivate them, but you can go everywhere from money to time off. In terms of incentives.
>> what's working elsewhere? Do we know that?
>> well, the whoang, I think, array of -- the whole, I think, array of money, as you heard from ms. Wiltz, she got, I guess, $100 for losing 10 pounds. That worked for her. Some people here in the county have done it just so they look better and feel better. We have many cases of those and where they ended up having to pay for the weight loss. So I think that I have not read of any general accepted incentive that people have. I think that's very individualized. And that we can do some competition with incentives, but I don't know that anyone could tell you yeah, that works every time, all the time.
>> so here's what will work, two days a year, all of us have to come to work in a bathing suit. [ laughter ] that would get your attention. [overlapping speakers].
>> it's usually combined with a dunking booth.
>> any more discussion?
>> just one question.
>> can you possibly tell me where we will be as far as looking towards next year's budget if there are -- and this is tied into the wellness program -- if we are changing and going the other direction so our health care obligations to employees have actually turned in the direction where we reduce it instead of increase it? Where would that be, the first quarter, serc, third quarter, last quarter of the year, where we can really see a difference in what we're doing? -- a tracking mechanism whereby we can really see that. Where is that integrated into what we're really doing here?
>> if you're asking about just the wellness program. Ij that would be -- I think that would be very hard to pinpoint. If you're talking about where we are with our health care costs now, we will bring a report to you in December that will give you an overview of last year's health care costs. We did not spend as much money as the actuary predicted. I think we will be in much better shape going into next year because the court has built a reserve that you won't have to fund again. With fitness programs, it's really hard to measure in a macro per spikt active. That's why the pilots would give us I think a much better measurement and a microcosm of actions and results and what you can obtain from your efforts.
>> okay.
>> I guess even in this type of scenario, my concern is that we have a direct relationship with the wellness program if we're going to end up doing these things, and also how has it impacts the budget -- the reduction in the expenditures that we have to make as far as -- of course, that's the good side. But if they're going in the direction, that's a bad side. But I want to make sure that there's a relationship there.
>> there are two aspects to the cost. One is the trend or the inflationary cost of medical care, the other is the utilization. And where you're going to see the impact of the wellness program is the utilization side. We won't impact trend or inflation here in Travis County based on nationwide costs, but we will be able to affect the utilization aspect of any cost increase.
>> that there is --
>> that's really one of the quantifying measures that we'd look at.
>> okay. Thank you for those comments.
>> we need to bear in mind that some of the things that we are finding -- one of the reasons we have these astronomical rises in our premiums is because we are as a society much more aware of what you need to do. I mean, 25 years ago cholesterol -- you didn't each have people that could spell it. I mean, today you could go out and a lot of people, many people are on medication for it. It is knots inexpensive -- it is not inexpensive medication, but is it going to be beneficial to you down the road? Absolutely from stroke or heart attack. So -- and that is the reason why it's going to be really hard to quantify this, Commissioner Davis. This is not something that you're going to find out in seven months that we have -- unless you do some things like stop smoking and identify people that stop smoking. Weigh everyone and say, do you weigh less? You've got to have -- [ laughter ]
>> that was suggested.
>> and have people tell you the truth, because nobody is willing to step on the scales and have the guy say okay, next. That's not going to happen. That's a very personal thing. Just talk about weight in the office and you've got people wanting to run out of the building. So unless we're going to identify definitively some things that we are really going to monitor, it will be real hard to identify these things in six or eight months.
>> I was trying to put my head around -- even if it's utilization aspect of it, that's fine. At least it's a direction. Of course you mentioned inflationary stuff. That's sometimes out of control, but the utilization of service is something that we can maybe start looking at.
>> any more discussion of the motion to approve four under the current action. All in favor? That passes by unanimous vote. Move item number 5. Do you encourage the manager to encourage the employee to go?
>> that I think I would probably leave to the managers, okay? The thing that we've dmoan and seen is that -- known and seen is that you do seem to have one person on a particular if floor or in a particular area that comes to work that's sniffling and coughing and sneezing and before you know it you have three or four or five. And you can see it -- probably the best --
>> does the manager have the right to make an employee could home I guess is the question? We can save that to until another day and can you get a legal opinion before we do this. There are some communications for the manager to act on.
>> right.
>> let get legal advice on that before we do that. Favor fifer? That passes by unanimous vote. We'll have this item back on the agenda next week for the actions that we approved earlier and for discussion of the long-term recommendations and the others. Is that okay?
Last Modified: Tuesday, November 25, 2003 8:52 PM