Travis County Commssioners Court
December 2, 2003
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Item 4
Now we do have our [inaudible] committee members here. This is a good time to call up number 4, consider and take appropriate action on the following: proposed Travis County wellness program; and letter to county employees from the Commissioners court on wellness program.
>> good afternoon. Last week we came before this court with several options for a wellness program, one of which was to send a letter from the Commissioners court to all employees to tell them about the affordability or the lack thereof of affordability of health care and a wellness program that the court asked be created and appointed a committee. Before you we have handed out a draft of a letter that will be sent to employees. The latest one was one that you see some changes in blue. Those were some of the changes from the one that we sent to you yesterday. They are minor changes, but we also then included a signature box for each of the court. It was our recollection that you wanted that there. We did try to make the letter fit on one page, as we were directed, and to express what the goals of the program are and what the immediate actions of the wellness program include, which include the survey, a quarterly wellness newsletter, classes and training in nutrition, health care management and other such topics related to a healthier lifestyle. And then health screenings at job sites were some of the things that we discussed last week. There are more activities, more programs that we would also like to discuss with you today that we didn't have a chance to finish off the memorandum that you got last week, but this is the letter before you. We are open to discuss that and take any edits or suggestions you may have to change the letter. We had recommended it go out on the 15th with the paycheck, and one of the reasons for doing that is that by that we are assured that everyone opens and sees the letter. It's just a real kind of tried and true method to get information out to employees as opposed to just using the personnel [indiscernible] for each of the departments and it's also more efficient because they go out with each and every check.
>> is it possible this can also go out as e-mail? Many of us are on direct deposit and we don't even open the envelopes because we know what's in there and we get around to picking them up when we get around to picking them up. It seems like an e-mail would be a good thing.
>> we can do that.
>> we could also load it on the internet site to have it available there.
>> I would have some recommendations, therefore I ask we have this back on next week. That will give us a chance to make changes that are appropriate and also get them to the rest of the court. And if we're thinking about distributing this with the 12-15 state check, plus putting it on e-mail about that time, we have one more week to work with it.
>> okay.
>> unless there are objections?
>> no. [papers rattling].
>> okay?
>> uh-huh.
>> on a., The long-term recommendations we did not get to discuss last week.
>> yes, sir. We'll move forward with long-term recommendations and these are recommendations that are still under consideration by the wellness committee. They also would require some cost estimates and I think some more research on behalf of the committee to bring forward to the court before we asked you to finally deliberate and take action on these, but the establishment of an on-site county employee health clinic was discussed, and this would be either hiring a doctor or physician assistant that would have an office, either a mobile office or an office at -- I say mobile in terms of each of the large buildings maybe that we would have that would have an office there. Dedicated to them. They would be able to fill out prescriptions, they would be able to see employees for minor health issues, for preventive efforts. For example, if we brought in a -- some medical staff to test for blood pressure or diabetes or any of those issues that if -- also the flu shots, that that p.a. Or doctor, and that's physician assistant, would be there coordinating that particular program. Cindy, do you want to elaborate on that?
>> we did some research. This is not an original idea with Travis County. We have talked with jefferson county. The -- I guess city of garland are both doing this right now. Jefferson county has been doing it for about four years. And we happened to be on some committees with the lady up there and called and talked to her indepth. This is something they feel like they are saving between $36,000 and $40,000 a month on their health plan. It's kind of a difficult thing to measure the savings because you wouldn't have a one for one ratio, you know, if you see one employee here, that means that same visit wouldn't hit the health plan. That's kind of the idea, but you have to do some manipulation of that too because what they found is a lot of employees will go to the health clinic when they wouldn't go ahead and go off to the doctor and take time off and go, try to make an appointment and sit in the doctor's office if they could just run downstairs and say I know I'm getting a sign news infection, get a prescription, they will do that and they are back at the job. What they are finding is less lost time from work. A lot of the minor things are being taken care of right then without having to -- the costs having to hit their health plan. They feel that's the value of the health clinic, they can also manage their wellness efforts through the health clinic, have a health professional in there to manage the whole wellness effort they are doing. But they started out with the intent to see what they could do to curb the rising cost of their health plan, which is what we're all interested in because the costs are just spiralling. And they really feel like -- of course, they haven't reduced the cost of their health plan significantly, but they have leveled it o they haven't seen the rise they think they would have otherwise seen.
>> by setting it up -- how many employees does jefferson county?
>> not as many as Travis County, but I think it's about 1200, 1400, something like that. Now, that's off the top of my head. And the feeling I got from speaking with shannon morgan there was that it was paying for itself in reduction of costs to the health plan.
>> it pays for itself, but also reduced the --
>> well, it paid for itself in charges that did not hit the plan, in claims cost they felt like having the health plans available to employees to get seen at no charge to employees really took away that amount from their health plan costs, which in effect makes it pay for itself. City of garland is doing something similar. They started out with their health clinics just for work comp issues and it's phofrbed into being a health clinic and they are doing very much the same thing. City of odessa is just in the formative stages of doing the same thing. They've been to look at jefferson county and city of garland's. They've offered to come down here and talk to us or us go up there and scope out their operation, whatever seems to make the most sense, if we want to learn from what they've done in their areas. But it sound like a pretty viable idea.
>> cindy, what is -- what is the difference, if you know this, on what we are charged with patient visits via physicians versus what our premiums are as a result of medication? Isn't medication, by far, the greatest part of what has happened to our and everybody's --
>> right now medication is about 22% of our health care plan costs, I believe. This -- this effort probably would not reduce the cost of medications because the p.a. Can write prescriptions. Shannon mentioned at jefferson county they did see a bit of decrease on medications because they were eligible for all the samples the pharmacy companies hand out. So they did have some samples that they could distribute. Again, it depends what your setup is and what your whole -- how you want it to be set up. A p.a. Can write prescriptions. If you had just a nurse in there, then you wouldn't have the prescription thing going on. She did say they had noticed the impact of having samples available where people weren't running out and getting that particular prescription because they got a sample from the health clinic.
>> the practical side of -- because I read this article and it was interesting to me. You know, the smaller communities can do them, number one, I mean you are a lot more centralized where your employees are. The biggest problem we have, like, for example, with our flu shots, is that, you know, it was in this building. Even though you say we can go to maybe the airport now since we're going to have a large group of people over there, unless doctors or medical people, whether they are p.a.s or nurses or whatever, are going to be able to easily access that person, you know, we probably in a larger community would find, my gosh, I mean with 4,000 employees, 3500 employees, you know, somebody may find, well, yeah, I can see you in July. Then what's going to happen is people at first are going to utilize it, but after a while they are just going to go back. I mean, now the cost of settle that up, I mean, is a physician or p.a. With -- you know, they have to have some sort of a setup for them. You can't just have it out in the hall way like we did the shots. You know, so there are a lot more costs. When I started thinking that thing through, even mow immediately it was like boy, we ought to try something like this.
>> in their main courthouse building, they've gone ahead and used one office suite space and she says it looks like a real doctor's office. You go in, they have the glass partition, the clerk there, and you go in and you see the p.a. Our thoughts, since we are more spread out, since we're such a large county, is to establish a site like that and then have some alternate locations that maybe the p.a.s are there on Tuesday or Thursday, maybe del valle or something that makes it the -- the whole idea accessible to more of our employees. It may be that we could use the public health clinics, and we don't want to really put that out there at this point until we check out the whole situation with the public health khreupbgsz and find out how the pwhroeu ease would feel about that. Kind of determine what our hoe setup would be. But it is something we would like to investigate.
>> on the second item that was suggested by the committee is the utilization of the county public health clinics as locations for remote sites for the county physicians or assistants to work in. That's tied to number one. If you didn't have a physical location at a court facility or at various court facilities, perhaps the public health clinics could be used. There was someone that said they were underutilized at this time. Again, there was no -- we have not talked to h.h.s. About that to try and work through the toeurb see if that's a viable idea. But I did want to share that with you. Another item that we discussed is building an exercise room. Right now there is space in the u.s.b. In the basement. Talked about getting maybe equipment there and having one of our employees that's already a trainer perhaps hold classes before work, at noon and then after work. That also has a cost and -- for the equipment and for some of the buildout, but that would be really very minor. We discussed that and it would not be a whole lot of cost to do that. That area that we had discussed already has two showers. There was some discussion about, well, that won't be enough if you have, you know, 15 people attend each of the classes, and there is one for women and one for men, only one shower, so, again, this might be something we do as a pilot program as opposed to a full-scale component of the wellness program.
>> I think somebody brought this up last time. It may have been you, Commissioner Daugherty, I don't remember. But the possibility of partnering with a spa or health facility that already exists.
>> that is number 4, Commissioner.
>> okay. Go ahead, I'm kind ahead of you then.
>> that's number 4, contract with area fitness centers and medical providers not only for the training and the exercise but also for providing classes. As we shared with the court, seton has an extensive curriculum and offering of different classes. But we also talked about using the fitness centers that are already in existence and in the area, and, frankly, in every area of Austin. And perhaps contracting with them or providing a discount as incentive for employees to participate. And so that -- we are looking into that. Or the ymca. I think the last time we worked with the ymca the discount was minimal so we really didn't have a whole lot of employees take us up on that offer.
>> are there other governmental entities that are doing that now, that could also be a part of that -- I mean if we pooled the government employees together and said, hey, look, we would like to maybe join forces with you and further reduce costs with you if they've already got it existing.
>> we haven't polled the local entities about this but I do remember seeing ads that local gyms or fitness centers do offer a discount for some of the larger governmental entities in the area, but we would probably have to do a poll of what's going on right now.
>> okay. Thanks.
>> we also talked about number 5, walking groups, weight watchers, budget and stress counseling, those sorts of things we discussed, that sometimes people under a lot of stress because of financial issues will seek medical care, that perhaps being proactive on those issues may be of assistance to our employees. And then number 6 is we talked about initiating a series of pilot programs. We will send out a survey to employees. Once we get that back, I think we'll have a better idea of what the employees -- what sort of programs they are interested in, what motivates them and what they would like to see as perhaps incentive to participate in a wellness program. But we may have to start with pilot programs to see how much participation we get and what works and what doesn't work. Other discussion that we that, there was much discussion about a wellness program and whether a wellness program becomes mandatory or voluntary program. I think the county attorney has some advice for the court on the issue of mandatory, but there was much discussion among the committee. Everything from having it be mandatory and requiring people to attend classes all the way to just providing county time for them as an encouragement. -- and encouraging them to attend classes and training and wellness. -z dine employee programs that encourage measures and employees' progress and participation. We wanted to make sure that there were performance measures that any of the programs that wetake on we are able to provide measures. Either on participation, you know, with weight, we think that's relatively easy to do. Doctor's visits, perhaps. Preventive medicine. So -- and I think that goes back to number 6 in terms of the pilot programs. When you do small programs of this type that sometimes the results may not be as tangible as you would like. When you do smaller programs, you are able to, I think, design measures that do give you a better idea of the performance of the program. On a smaller scale and then you can expand it. But at least you have some data on which to expand a particular program. Incentives, there was discussion and debate about incentives. Whether you should offer incentives. Is money an incentive, is time an incentive, is recognition, converting sick time to vacation, leave, what sort of incentives would the court consider. There was some discussion of -- as I mentioned to the court before, well, what do we pay people to stop smoking. Someone else said pay me for not smoking. I mean you get those sort of debates especially in a public entity in terms of is it not incentive enough to be healthy. And, you know, look good or accomplish your own goals or is it that sometimes you do offer some Mondayer to incentives. -- monetary incentives. And we've seen that in other entities. In fact, this morning I heard of a program where attendance was rewarded with additional -- I think it was st. Edwards, that a -- it was from you, barbara.
>> st. Edwards sick leave policy has an attendance bonus. And if you are -- have no -- not used sick leave or had any absences related to I will innocence or a continuous period of six months you earn an extra eight hours of annual leave.
>> incentive.
>> and if you are a part-time employee, you get that on a prorated basis. What I didn't get to tell alicia is there was another thing that we came across when we were looking for the legal answers on the questions you all had asked last week that gave some other rather interesting incentives. Like one place for six months of performance they give a $100 bonus. If you had a year's perfect attendance, you were put in a lottery for $3,000. So one employee could get $3,000 for perfect attendance. With a little creativity you can come up with ideas.
>> if people are really sick and they need to go home and not infect the rest of us -- [laughter]
>> and the last thing on this, being too tough could prompt employees who are too sick to come in endangering co-workers.
>> $2,000.
>> so you can see, some of these there was much discussion, we wanted to bring those to you and get any feedback from you in terms of those that you would like us to pursue and those that you are saying, no way, don't even go down that road. I think that the series of pilot programs will also -- along with the survey will provide us a a lot of information in terms of what employees are willing to do and what they will do to assist in this effort.
>> I know that the budget gurus from around the state are doing their fly-in. Is that this Friday, leroy? Thursday and Friday. That was one of the topics that was on that list of all the budget people that are flying in, and that is wellness programs, does anyone have anything that's working. And so I would really like to know what our counterparts in some of these other large counties, if anybody does have any brilliant ideas that can be shared, that's essential going to be a very easy -- certainly going to be an easy opportunity to pick up ideas from our other counterparts. Certainly they've got to be dealing with the same kind of issues that we are. See what they are doing.
>> good point.
>> the one thing that I would be personally very much against is turning any part of the building into a workout facility. I mean if you know any of the numbers in the health club business, retention, I mean, is the thing -- that is a dead-end road. All you are going to do -- you may think that you can, you know, facilitize that very easily, that stuff is expensive stuff. Some sort of encouragement with working out something with some of the facilities that I know a number of people do belong to would be the way to look at that. You find yourself probably witnessing that people would probably come to you and say, you know what, I don't use it anymore so I'm not going to get the benefit. But that's -- you know, we're really talking about personal things here. What does it take to motivate someone to lose weight, to stop smoking, to -- you know, the things that we know that are absolutely bad for your health. I think, you know, all the encouragement we can give people is one thing, but getting them there is the trick. And it will be interesting to see if there is anything that somebody says, hey, this has worked. Unfortunately the only way you really get things to work for people is to take something away from them. You know, taking something away from the employees may be that you don't get raises. You know, that's -- and if that's not the incentive, you know, to do it, because that really is the carrot that everybody wants. I mean, give me the opportunity to be paid for it. Well, -- because I fear that health insurance will continue to go up because it rafp et cetera up -- ratchets up every year the expense. It's not an industry finding ways to cut its costs. I mean, plus, we are promoting every day to go out if you have a hang nail go and buy this bottle of pills that costs, you know, 50 bucks and miraculously, you know, you will hear that problem.
>> and to assume I think a wellness program is going to cut your health care -- is going to cut your health care costs from everything that I have read and studied and researched is not a fact. There are other things I think we can look at. For example, getting a better deal for our prescription drugs. I think that that will be fruitful. We need to address the policies in terms of our retirees. That is something in a we absolutely need to do. This is a component of I think a broader program. I do not anticipate we will see the same increases that we saw this year, and I think that all of us that have studied the financial aspects of our program will tell you that, that this year we will in 70 5rbgs I guess -- in '05, we have built a reserve that will help us so you don't see 40%. That was out of the ordinary. What we're looking at now on a nationwide basis is leveling off of health care costs, but a continued increase of about 18% to 19% in pharmaceuticals. And a continued increase also in hospital care.
>> the reserve, alicia, is not spending less money.
>> that's correct.
>> all you are doing is preparing for it.
>> not having to contribute as much money because you didn't have a reserve.
>> sometimes the word is not so much incentive, it's disincentive. I would be the last person to tell somebody you must quit smoking. If somebody wants to smoke, smoke away, but my health insurance rate ought not be based on somebody else's choice to smoke. And so it's really -- it's like go right ahead, but there is going to be a rate, I hope, that can be based on somebody making the choice to do that. And to keep all of the rest of us who are non-smokers out of it. It's just --
>> that's number 4, and if you want us to do more research -- I mean if smoking is an issue --
>> to me you've got to start with something, and to me smoking is such a discretionary act. Yes, it is an addiction, but it starts with a discretionary act. I would be the last person to say you have to lose weight because that is something that there's so many medical reasons and just change of life reasons that get tied into that, that is so complicated that it's not just about you choose to go put something in your mouth. That's the easy way to look at it, but it's not, it's too complicated. There's a lot of medical things associated with that. But smoking is totally a discretionary act that is not tied into somebody wanting to do anything other than take up a discretionary act.
>> smoking the first day or smoking 10 years later?
>> well, it starts with the first day, judge, you know. And like I said, I would never say you must quit smoking, but I would like to be able to say there's a smoking rate and there's a non-smoking rate. Your choice, folks. Your choice.
>> when do we plan to get the survey to the employees?
>> it's ready to go. All we're waiting is for the court to authorize. I'm working with i.t.s. This afternoon. Lit be ready to go out.
>> it's comfort in the letter, right?
>> yes.
>> why don't we try to approve the letter on Tuesday and go ahead and get the letter out by e-mail.
>> okay.
>> and contact the person who are coordinators next Wednesday morning and have the payroll distribution also December 15th.
>> that will work.
>> several shots at it.
>> sure.
>> the survey information is important, I take it.
>> yes, sir. That will give you a good idea of what employees are looking for.
>> judge, due mean to hold on the survey until next week or go ahead and get the survey out?
>> we mention the survey in the letter. If you think it's okay to go ahead and get it out by e-mail, do it.
>> we intend to do get it out and leave it out until about the 12th where we could come back to you the Tuesday following the 12th and give you the results of the survey. Now, we can leave it out whatever period of time you want us to leave it out, but that's just what we were thinking up front.
>> we mention the survey in the letter. The last would be the 15th, so they ought to have it by the 16 16th or 17th unless that falls on a weekend. I'm thinking the letter would be a reminder the survey is already ourbgts please complete it and send it back. I don't see any reason holding off on getting this out it's ready.
>> so in the long-term recommendations, seems to me we ought to pick two or three to get additional information on. On the fitness approach, if we think that the best approach is really to try to being contact a couple of the local fitness centers and see what kind of deal we can get, why don't we contact them and see if we can get one. Would it make sense to contact maybe one of the human resources offices or some of the major work places and see if they have some kind of deal?
>> sure.
>> rather than calling and asking can you make us -- we can ask can you give us the same deal --
>> [inaudible] mccormick, I know he's working on that.
>> on the p.a. Or the nurse in a county clinic, may as well see if that will work for us. At some point we have to ask ourselves what will that investment cost, right?
>> yes, sir.
>> and what do we think the benefits will be. Costing it out, it seems to me, would be an important first step. And I would think that on the survey information should indicate a lot about that. Now, we talk all the time about this rate reduction and having some level of competition. Can we ask the committee what is being tried and what's working on that? I would like nothing better than to lose 10 pounds more than my colleagues on the court here. Although I'm sort of down to muscle now and no fat. [laughter] 10 more pounds, I will try to squeeze it out if necessary. In the name of competition. [laughter]
>> have a little contest.
>> everybody has to start -- [multiple voices] standing right out there so everybody can see what their starting weight is. That's when you are going to have people [indiscernible] [laughter]
>> let's give that some thought so we can come back.
>> sure.
>> is that enough to think about between now and next Tuesday?
>> yes, sir.
>> any tobgsz any of those directions? I agree we sort of pull from the long-term stuff what I think is workable, what we ought to do follow-up work on and maybe report back next week. And in our letter we can encourage employees to please answer the survey and get it back, the information is valuable. And we have that somewhere on the survey anyway, right?
>> yes, sir. We talk about the survey.
>> do we think -- do we use our personnel liaisons to the extent that we can? I think if we activate them we may have little tentacles in parts of the county workforce maybe a little better than trying to use e-mail taken web.
>> we had planned to do e-mail, web, send it out to the h.r. Liaisons and have them posted and distributed if next. Especially for like t.n.r. Or the sheriff's department where people aren't sitting behind desks and don't have it in front of them. That way if they want to fill it out hard copy and return to it me, i'll go ahead and enter their responses so we can still do our electronic talk hraeugsz. So however anyone wants to complete the survey, we'll take it.
>> anything further today?
>> no, I don't think so.
>> let's keep moving in the right decks. -- direction.
>> thank you all. You've done a great job.
Last Modified: Tuesday, December 3, 2003 6:52 AM