Travis County Commissioners Court
August 9, 2005
Item 20
20. Consider and take appropriate action on the following: a. First quarterly performance report for the Travis County employee wellness and health clinic; and b. Revised item: license agreement form for use of county space by private providers of wellness activities; and authorize risk and benefits manager to execute agreements.
>> good morning. Alicia perez, executive manager for administrative operations. And I値l have staff, other staff join me soon. But we are here to provide to you a first quarterly report on the wellness clinic. Back in February of this year, the -- the Commissioners court had -- well, really it was last year that you approved the budget to establish a wellness clinic. And we opened the doors on first 1st of this year. -- February 1st of this year. Very well received as you have heard from a lot of the employees. It is well used, also. It has become a very good center for pinpointing or early advisory of what could turn into serious illness. Detection of high cholesterol, detection of diabetes, detection of -- of abnormal blood results. And it has really been a very good place where employees have gone and just gone to go get physicals and then have detected high blood pressure is another one that we see a lot of and then -- for the first time, they have noticed that there is -- there is something wrong because a lot of people do not have regular physicals. It has been very convenient and used by employees quite a bit. Since the clinic opened in February 1st of this year, we've had a total of 1,165 office visits and this is employees, retirees and families of retirees. 348 are almost -- or almost 30% were high-cost related treatment. And that means that they were -- they were the detection or the treatment of the illnesses that I talked about, the high blood pressure, high cholesterol and diabetes. There were 103 physical exams and 75 health clinics. We have also continued our wellness classes and that means the -- everything from weight loss to money management. There has been a whole array of classes that are put on by the wellness clinic to address the issues of employees from like I said from stress all the way to -- to a diet and exercise and if you have diabetes, how to manage that. And those have been also very, very well attended. In our analysis, the employees, because there's no co-pay at the clinic, have saved almost $23,000 out of pocket. When an employee or retiree or a dependent goes to clinic, there is no co-pay, the service is absolutely free. That has been a motivator for a lot of employees. And we estimate, also, that the actual health plan has saved about $133,680. We -- when we first implemented the -- or when we brought the proposal to the court on implementing the clinic, we looked at the -- at a return on investment of $1.16. The first year really we've got 1.18 cents return on investment. There are -- the wellness clinic continues to promote exercise, not only by providing the classes but also by the doctor himself, right here with us, I think about 20 pounds lighter, has been leading an exercise group in the morning. We continue to have walking groups in the afternoons in the mornings and after work. And so that has been very good. We encourage different runs during the year. The Texas run, run for diabetes, the -- the run/walk for breast cancer are all runs that we are proposing within the county -- promoting within the county and have had good participation through those. If you look on your tab 1, what we have here is cost drivers per diagnosis. And if you want to look at that, kind of talk a little bit about some of the things that you are seeing and how sometimes it's -- it's for employees going for a checkup, say, and you discover that they either have diabetes or high blood pressure or cholesterol, it's the first time that they have really known about it. That way it's helped with a lot of preventive measures.
>> yeah. We -- we see a lot of -- one of the great things that the wellness clinic allows us to do is to not just see people only for the problem that they came in for, say somebody comes in a cold or a rash. But we also are able to screen them for problems that -- that, you know, more of a general physical on future dates. So I値l bring them back, we are finding quite a few people have conditions that they don't know they had. We need to treat. We are finding a lot of hyper cholesterolemia, elevated levels of cholesterol in the blood. Finding a good number of cases of diabetes, high blood pressure, hyper cholesterolenima, is the first thing, high blood pressure the second. This allows us to really get ahold of the main risk factors and cautions of major illnesses such as heart attacks, strokes, diabetic related illnesses such as diabetic failure or renal or kidney failure. We are real happy about that. We do that whether or not a patient comes in for a minor illness. Right them if we have them on the spot they can do blood work if they haven't been eating, also reschedule for a physical at a future time. Also we go off-site quite a few times to the t.n.r. Sites and other sites off-site that we do presentations on certain topics that we discuss, like maybe a diabetic presentation or how to keep your cholesterol under control presentation, when we are there, we usually try to screen people, draw blood at the site for folks who in all practical -- well, there's a low likelihood they are going to have time during their day to come to the clinic, so we try to go out to the places where people don't get much of a chance to come in from. Now --
>> [indiscernible]
>> I知 trent turner, the physician over here. I just knew that I was supposed to come over here because we saw it going on on the tv, ran over here real quick. Excuse me if I don't know exactly where you all were at the member [laughter]
>> the stethoscope was a give away.
>> I didn't know that I had it on there.
>> or we thought it was halloween. [laughter]
>> if you look on page 4, which is a -- the tab 1, you have the actual numbers on high cost drivers and the diagnosis. You also have the most common office diagnosis. And of course cholesterol is the highest on there. And then you have upper respiratory. We know that Austin is famous or infamous for allergies, so dr. Turner gets a lot of those sorts of patients there with those sorts of conditions. High blood pressure is also high and then you have your of course, you know, your allergies and your others, but we are monitoring all of this -- all of the information and keeping a data bank that shows us what sorts of conditions, we would be most likely to see. In terms of savings, if you turn it to page 5, there's a financial report and those are the total savings in terms of -- this is a comparison of what it would cost if indeed a -- an employee went to just their regular doctor or a specialist for some of these conditions. And like in February we saved $9,265 and in June it was 31,395. Of course we just opened in February. So I think the visits, the more familiar that employees get with the clinic, its location, we are also going out to other sites, we are preparing a medical office at airport boulevard, precinct 4, and one at del valle. Del valle, I think, will give us the correctional -- Travis County correctional center at del valle. That will I think probably give us the -- the best results. In terms of that early detection.
>> I知 not sure that I understand this part about the correctional complex now.
>> yes. An office. We are preparing a regular schedule for the doctor to go out to the Travis County correctional center at del valle.
>> Travis County jail?
>> yes.
>> for employees?
>> yes, for employees.
>> yes.
>> okay.
>> yes, for employees, yes.
>> also an airport boulevard location.
>> for employees. As I said that will give us our best results just because sometimes people are just so busy, just don't go to doctors. And with this, the doctor is going to them. Okay? General wellness refresh my memory, do you want to talk about this piece? That's on page 6?
>> so I mention the [indiscernible]
>> dan mansour has been working on trying to institute a bona fide wellness plan along with united health care. He knows a lot more about this than I do. If you have -- you all know dan, there he is right here. [laughter] what I was going to say -- dan, you might want to talk about this part right here.
>> good morning.
>> good morning, dan.
>> we have spoken to the court occasionally about the bona fide wellness plan. And health savings account. What we are working on is combining the two to bring before the court for a proposal to bring that forward, which will integrate some of the wellness clinic activity with this bona fide wellsness plan, which is a high deductible plan. We will be bringing that forward here in -- probably in the next couple of weeks. That is a health savings account which you are allowed to put away money, tax free. For -- for health care. The difference between the flexible spending account, you put it away, take it out, also tax frequent is that the program that we have now you use it or lose it on an annual basis. With the health spending account you are able to roll it over and then it becomes essentially the money of the employee. They can pull it out for whatever reasons we hope that they keep it for -- for health reasons, but they can pull it out as long as they pay taxes if they use it only for health reasons, then they won't have to pay taxes on it. So it's a good -- it's a good program.
>> it's a good program because it's a way of giving back something to employees who do practice their wellness and adhere certain requirements and standards that -- that would be set for them individually.
>> overall that concludes our report unless you have some -- some questions. The clinic has been very well received. We believe it has indeed be a life saver in many instances. That it is a motivator, for employees going and having their blood work and physicals, a lot of times that has detected conditions that the employees have no knowledge that they were -- that they were -- had high blood pressure or high cholesterol that could have led to more serious illnesses. So -- so it's been very well received. You have heard from employees, we hope to expand the program to other sites. -- having the doctor do visits, by doing this, we hope to also lower then the cost of our health care or at least diminish the -- the increases in it that you see here by year.
>> so is the funding for the wellness clique in the preliminary budget for '06?
>> yes.
>> from the health reserve?
>> yes, sir.
>> yes, it is.
>> okay.
>> dan, overall whrks we first looked at this wellness program, in its infancy stage, for -- considered it in -- of course the end result we -- we end up approving with the particular initiative, in your estimate, your best judgment, the money that we are expended getting this thing going, all of these kind of things, it really was comparing that with the benefits that we are receiving from the program at this point, where could you say that we are actually positioned if we were to look at it from scale from one to 10 or whatever on what we -- where we are now and where we would have been without this program? Is that a fair question to you, when we just talked to you over the phone about that.
>> well, we -- I think there are soft savings, hard savings. They discussed and presented to the Commissioners court this morning what the hard savings are so far. The soft savings come from what alicia was talking about with regard to early screening, early detection. We know of two instances where employees were -- were diagnosed with -- with conditions that were life threatening, that were diagnosed early enough that things could help and -- and -- restore them back to the good health. Those are the soft savings. We are a little bit too early into this to recognize what those are. On a scale of one to 10, I think there's no question that the clinic has been a 10. And I think that just comes from the employees and the response that we have gotten from employees.
>> is there any direct relationship with -- with actuary looks at our benefits, looks at our program as far as our health initiative when it comes to cost? As far as looking at premiums, things like that, as opposed to what we have to pay for the health compensation package. There is a direct relationship between what we are doing now as far as being proactive instead of reactive? In a lot of particular situations as far as the wellness program, is that considered?
>> I think what -- over a period of time, two or three years, we are going to see the actuary take this, take the clinic as a benefit just like you would the ppo or the co-insured epo, look at that as a benefit that employees are using and be able to judge what impact it has had on the overall cost of the health plan.
>> thank you.
>> thank you all.
>> anything else under a? And what's b about?
>> the wellness program frequently is asked to sponsor different events or different programs I should say such as weight watchers, yoga, tai chi, pilates, I知 not sure what that is, but it looks like fun to me, as well as physical therapy, massage therapy. We have been informed by the county attorney's office that it would not be legal for the county to allow providers who charge a fee to use county space in order to -- to have these programs. We feel these programs are beneficial and the county attorney's office drafted a license for using space, county space to have these programs. What b is to prove use of this license for -- for occasions when we would allow a provider to come on county property to do massage therapy or have the yoga classes, things like that.
>> what hours are people thinking? I can see it right now in terms of excuse me, I need to go leave and go take a class in the midst of what most people would consider to be their traditional work day?
>> most of the yoga classes are lunch time or evening. Most of the massage therapy would be done on a schedule where if a department allowed the therapist to come into their department, it would be done on a schedule for employees to -- to be able to have the -- have the massage, we are talking about chair massage. Usually takes 10 to 15 minutes.
>> how do we decide which activities to allow, which ones to reject?
>> it would be based on employee interest. If we get one employee interested in something, we probably wouldn't pursue that, but we've had numeralrous employees ask about weight watchers, for instance, yoga, massage therapy, we would pursue those types of activities.
>> we don't have any shower facilities, so it seems like we ought not to do things that -- that may be disruptive to the workforce after somebody leaves that particular class because we just don't have any facilities for something -- to get back -- in the work mode, people sweat, it isn't pleasant.
>> there -- in -- we're not sponsoring this on an active basis. Doctor turner has a -- there's a couple of fitness centers close by that do have facility, did you not put that into an e-mail.
>> yes, he did.
>> not really just us people coming on to our property. It's also about having relationships to go off-site.
>> exactly.
>> we will leave that to the mature judgment of our employees.
>> yes. Yes.
>> and the supervising department.
>> the department head would have to approve any of these activities before licenses.
>> if we approve this, can you report back to us in six months, let us know how it's going?
>> absolutely.
>> on that base, I move approval -- on that basis I move approval. Discussion? All in favor? That passes by unanimous vote.
>> thank you.
>> thank you.
>> you all are doing a good job.
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Last Modified:
Tuesday, August 9, 2005 8:51 PM