Travis County Commissioners Court
February 28, 2006
Item 13
C13 is to discuss and take appropriate action regarding the first annual performance report on the Travis County employee wellness and health clinic. Good afternoon.
>> afternoon, judge, Commissioners. We're pleased to be here in front of the court to present the first year annual performance report for the employees wellness and health clinics. You recall the court approved a clinic back in early fiscal year of '05. The clinic opened on February -- actually, February the 9th. The grand opening was February the 14th. So we just completed our first year of operation and want to present to the court some of the successes that we have had. The clinic purr sues three avenues of service, wellness education, disease management and acute care. And they work together to control or help manage the health care costs. The purpose of the clinic is to address the rising costs of health care, and I think that you'll see that it is done in its first year of operation something that has helped control and identify out we can better manage our health care dollars. The disease management through screening program, physical exams and wellness education are beginning to pay dividends by improved life-style. I think we've had a number of employees who have complimented the work that these folks do in the clinic with helping them get back on track with managing their life-style for improvements and weight loss, exercise and general health care. When we talk about the efforts of the clinic on managing cost drivers, if you'll turn to exhibit 1, which is the average bmi by diagnosis, that's an example of some of the measurements and some of the work being done to manage these types of diseases. I値l ask dr. Turner to talk more about the bmi and diagnosis relationship.
>> and what does bmi stand for?
>> body mass index.
>> okay. I know about bmw [ laughter ]
>> it's a measurement of computation that kind of gives you an idea if you're a little bit -- got some weight that you might need to lose. And in some of these we -- it's well-known that the higher your bmi, the higher your chance of having high cholesterol, diabetes, stroke, high blood pressure. It's one of the things --
>> we're getting some static, aren't we?
>> there we go.
>> it's one of the things that we measure and our of our parameters that we're trying to keep track of on folks and get some improvement. What I壇 like to say, though, is that this is our yearly -- first yearly report, and a lot of these parameters that we're tracking, such as your cholesterol, diabetes, blood sugar levels and your bmi, your blood pressure, these things, we haven't really gotten far enough into this to be able to yet have a sufficient amount of data to really hand you and say well, it's improved this much. And that's because for most of the patients that come in, we've started them with very conservative measures of treatment at first, trying to control sometimes very difficult problems such as high cholesterol or high bmi, with the greatest efforts we can to get them life-style changes with diet and exercise. Sometimes that works and sometimes it doesn't, but the key is going to be to follow up on these patients over time. If these parameters don't improve with the conservative measures, then we then go into possible medication to help blood pressure, to help cholesterol or to help elevated blood sugar like diabetes. And so it's almost like we need to see the patients quite a few times before we really can tell you, you know, this patient -- we're now expecting great improvement right now at this point. You know what I知 saying? We start off kind of conservatively and then with -- with each patient and get more aggressive with the treatment as needed. So at this point at a year, it's difficult to say -- come back with a bunch of -- with the same amount of data that I hope we'll have in two or three years to present to you that says the county cholesterol average has come down by x amount, a substantial amount. Or the bmi has come down.
>> let me ask you this before you continue. I just want to throw that way -- throw this out. The type of report that you're putting before us today, is there any intervention, future intervention that this will end up going through the actuary, send to Travis County employees with the we willness program, this is where we are in one year's time, but the projection according to where we're going, we should be here at a later date and we'll see our health plan, our health care network, do they examine this for what we present to them or how does that work? And I知 really -- I知 trying to get --
>> you mean a predictive model?
>> a model of where we are, but also a model of where we're trying to get, especially if it intertwienz with what the actuary will have to say about what we're doing as far as looking at the success of the wellness program. Tying it into the actuary --
>> our report utilizes the claim history, the claim data. So as the impact on that occurs through the clinic or other wellness programs, it will show up in lower claim dolores, and that's what the actuary will actually use as experience related data to project a trend or to project what future costs would be. So it's the end results that will show up in the claim history that would be used by the actuary.
>> and in the tracking mechanism, what he's presenting today and the other things that are being presented, my question is when would there be a point of what the actuary will actually see? What will that be presented to him or how will l. It be presented to them? I guess the when is more --
>> well, it's a factor in what happens on claim costs and the work through wellness program, work through the clinic, the wise consumer education, all those will work as tools to manage health care costs and bring those costs down or keep them from rising as fast as they have been. And those savings materialize and show up in the claim cost, the actuary will use that data to make projections for future cost and health care programs.
>> the actuary is not interested in this. They're interested in the results.
>> the outcome, that's exactly right. Now, they are interested in this because they've been very involved, but not from the point of view of conducting the actuarial study, you're absolutely right, they're interested in the end result.
>> what I also want to say is with these parameters of health that we try to improve, one of the things that we face is there's a whole bunch of workers for the county on the health plan. And even just seeing them all for the first time is something we're still trying to accomplish because there's so many of them. And some of them we are far down that road. A small percentage we've seen three or four times already and seen the lab values. Most of them we still need to see just because of sheer numbers. It's still early to be able to have what we'll have in like two or three years.
>> going along the line with what dr. Turner just said, you're going to see in a moment some hard direct savings and some soft savings of what dr. Turner is telling you with the future data that comes up from the efforts of seeing and treating and disease management of other employees. So there's hard and soft dollar savings here and we're going to try and demonstrate those to to you. It is an example of another range of data that we're tracking in the clinic.
>> attachment two here shows some of the parameters that we track. These are our average lab results we've been seeing in 2005. And you can see in general we've had improvement from first quarter to fourth quarter in just about every category, notably in the glucose levels, in the total cholesterol levels. But like I say again, this is early still, you know? Some of these people that have labs coming in in the fourth quarter are first time visitors to the clinic. So we're still a ways away from being able to say what we hope ton able to say in two or three years, which is the patients in Travis County on average went from a starting average value of blank total cholesterol and then improved on value of -- started at x and improved to y. And that's eventually what we hope to be able to make a presentation about.
>> dr. Turner, what is the response from y'all, the ldl. It's showing that it's the only thing that has short of gone in reverse.
>> it went back in reverse in the fourth quarter. It was improving in the first, second and third. Could be the holiday season. That's one thing. But also the thing is -- the holiday season probably is a good reason for that. But also the thing is, you know, the clinic sees more and more people every quarter. So just there's more people coming in the fourth quarter and the first quarter and more of those people that are coming in the fourth quarter are first time visitors. So a lot of the fourth quarter stuff is first time labs, which are going to be the worst for any individual hopefully. Hopefully we improve after the first time. But I think maybe we'll look into a holiday season.
>> also we really haven't done much in the way -- we're very conservative in what we do to treat cholesterol and the best things -- the big hammers of ldl are the medicines out there like lip tore and we really try try to stay away from those if we can and try to change the lifestyles. So ldl -- the holiday season will probably affect that one more.
>> going to attachment 3, the legal size spreadsheet, this is something that he tracks on a daily basis and the red sheet has been reduced to a monthly reports. It tracks the office business and it's broken down by plan. So those that are in the epo have a 15-dollar co-pay as opposed to the other two plans, that's why you see office visits broken down that way so we can track by plan. The total office visits for patients for the first year of the operation was 3314 office visits. I think that represented almost 1200 employees. And the employees saved a total of $49,035 in co-pays. Now, the thing we did not track is deductibles because most of the time they do not apply to office visits. So there may be some deductible cost savings that are in there as well, but the office co-pay savings for employees was $49,035. The overall savings for the health plan was $379,216. And those are what we would consider hard dollar savings. As patients come into the clinic, I値l let you explain how you track whether or not they would be going to their doctor if the clinic wasn't there.
>> we have a sign-in sheet that we have. I would say 90% said yes, they would come to the clinic or they would go to the doctor for the particular visits. That's mainly what we do with the sign-in sheet and then it depends on the deductible, if they pay $20 or 15 according to the insurance. The insurance plan.
>> to give you an idea, in 2004 the het plan for primary care office visits had 324 office visits in the fiscal year 2005, which we're looking at now. It had 2325 fewer visits, about a 10% reduction. I wouldn't want to say that every one of those reductions is due to the clinic, but I think a substantial number of those fewer office visits were because of the clinic. I think there's a direct relationship there that off said those costs.
>> and we also added more employees between 2004 and 2005. So really that 10 percent is really based on just the gross number of visits. It's not based on the number of lives that we are insuring.
>> that's very true. That's true. Those are some of the hard facts that we can bring before you. Now, the figure of the patients do not attend those that attended wellness classes. And if those classes were held at a clinic, such as arc or family practice clinic, they would be paying about a 40-dollar fee to attend these classes. So that's an additional savings of $29,176. The soft savings, and this is something that I was visiting with our county auditor yesterday and she mentioned and gave me a copy of the report they just conducted. And during the same period we were talking about the office visits, the accrued sick leave time increased by 27,289 hours, meaning that that's the number of sick hours that hadn't been used last year compared to the previous year. Again, I wouldn't sit here and say the clinic is responsible for that, but probably a good portion of it. So there's hard cost savings, there's soft cost savings and I think that we're beginning to see some results. As dr. Turner pointed out, it's going to take some time for the data to come in to really be analyzed to show that the cost drivers are being managed and they are being reduced in the way of cost and trending the increases there. There's one other item under the wellness program. In September we opened a smaller clinic out in del valle, and the airport clinic did not get open this year, but we are included in the plans for phase 2 out at the airport, which should be a January 2007 opening, and that's going to be a clinic similar to the one in the campus area. And eventually there will be two main clinics and we'll be able to circulate to the outer offices that the county has so we can provide clinic services. We'll be looking at that more closely and hopefully coming back during the budget process with some information.
>> is that with the proposed airport and the site in del valle and then the one here we have downtown as far as the clinic is concerned, is that going to require additional staffing or will it be staggered hours as far as service is concerned? How will you -- how have you proposing to accommodate the staffing requirements to ensure that they get the kind of service -- the employees get the kind of service that they need?
>> we're probably looking at coming back to ask the court for additional staffing. One of the problems we're running into is a staffing issue and being able to see the number of patients that we'd like to be able to see, so our budget requests will include some new f.t.e.'s and hopefully we'll be able to support the request with some backup information that shows the number of visits that we're looking at increasing, being able to increase the number of visits that we have.
>> thank you.
>> one of the areas that has worked very well is the combination of clinic service and the wellness programs. And one area that we started working on with weight loss in two part series. One was the lecture series and the second part was exercise. And dr. Turner wants to speak a little bit more about the exercise aspect of that ma'am.
>> we've given many different classes on weight loss and exercise, and at some point it becomes important to offer I think the people who come to these things, some sort of resource, especially in the summertime. We all notice that one of the big hur dills to getting into any established exercise routine is time, when you will fit it in your schedule. For a lot of people I think lunch is a time that they -- that would be pretty convenient for them. , but what they lack here, especially in the summertime they pa find it difficult because it's so hot they don't have anywhere to shower and they don't have have anywhere to exercise unless they're walking in the hot sun. One of the things we thought of doing is turning the classroom into a room we can teach people and educate people about exercise and also provide a little bit of equipment and some circuits there, they can go through some exercise stations. I brought some equipment I have from home up there and we've got it. It's very rudimentary, but you don't need a lot to exercise. And one thing we were thinking about doing is giving them some sort of very rudimentary, maybe a stationary bike or two for them to get some arobic exercise in in the roam that we've made. So dan has looked up some -- a couple of bikes here.
>> I want to point out that lee mccormick in our office, one of our risk and safety specialists, is doing some of the training. As a matter of fact, Tuesdays he does the training. He's a certified trainer. So we've had people coming into the exercise room. One of the things we would like to add are a couple of stationary bicycles. And attachment five is a printout of the cost of those bicycles. They're $300 each. We'd like approval to use some of the wellness budget to purchase two of the stationary bicycles that would be in that room. The idea is that those would be used to train and help people understand how to increase their heart rate or some of the exercise training that's being done.
>> if our goal was to select the two best pieces of exercise equipment to improve cardio vascular, would these are the two bikes that they would get?
>> I think so.
>> I think that a lot of people have asked are we going to have treadmills in that room at some point, but really a lot of people don't have very good knees for high impact type of work such as running, even walking is hard on some people. But bicycling is pretty low impact. And it's also comparative to walking. It burns about twice as many calories per time spent. It's more efficient, I guess you would have to say, with low impact.
>> why wouldn't you get one of each then?
>> we probably could.
>> my guess is that it kind of turns on what employees will use. And I guess my first thought was rather subjective. I haven't been on a stationary bike in a long, long time, but I was on a treadmill last night. Last night, exercising. [ laughter ] my recommendation would be to try to ascertain what employees will use. And after that it seems to me that an investment in two or three or four pieces of equipment would make sense if employees will use them.
>> I知 all for four. [ laughter ]
>> but it kind of turns on whether -- it's kind of like my equipment at home. It's real valuable if I use it. A stationary bike is in the garage with stuff stacked on it.
>> to tell you the truth, when we started this room, we had a bunch of people come up very interested. We actually offered a class that they had to go through that was a two-part class before they were allowed to use the room on a regular basis. And I think we were having, I don't know, quite a few people showing up each week for these classes, like up upwards of 50.
>> some people came in on their own.
>> and I値l say this, they got there with high hopes, they saw that the room was really well intended, but the majority of it was dr. Turner bringing hays weights from home. And I think they thought, well, you know, this might not be all I thought it was. But if we had just a few pieces of equipment, I think we would have a lot of interest in there. Like a couple of bikes maybe, a treadmill, whatnot.
>> I壇 survey the employees and see. If you're walking around downtown in the warm weather months, I think chances are that you'd use indoor exercise equipment like this a whole lot more.
>> definitely.
>> and as far as this room goes, we've thought that we want to keep it valuable for people to use, not just during the lunch hour, but if they have some other time in the day they're free to come use it, from 10 to 3:00 right now. Probably going to expand that later. So if that's -- my whole goal is to get people to exercise as much as they can. So making it as much opportunity for them as we can.
>> dan was kind enough to give us a preview so when judge Biscoe and I went to dallas last week for a meeting, this was one of the management highlights that we talked about. And susan had gotten us those absence data as well. So this was one of the things we bragged upon to send over to poor's and moody's last Tuesday.
>> anything from a nurse's perspective that we need to hear?
>> no. We do want to tell you that we are work wg Austin parks to provide free screening to 48 participants. Now, they do have to meet a special criteria. They do have to be -- I知 sorry. It's a peripheral vascular screening. And there is certain criteria that they have to meet. They do have to attend a class, be at least 55 years of age and meet four of four criteria. That means high cholesterol, diabetes, high blood pressure, if they have a history of smoking, those types of things. So screenings will be held every Wednesday, but it's only once a month. It's March 29th, April 26th and may 24th. So that's going to be announced via clinic administrator. So be one of the first.
>> this is a program that is actually being paid for by pfizer. And they're going to -- this will be a year-long study and it's very interesting. The cost of those tests, because I just had one, is $99. So the study that they want to conduct with Austin heart hospital is the provider, is having interesting and I think that if people are interested, they should come to the class and learn more about the program. And if they meet the criteria, sign up.
>> is there any -- according to our current health plan, is there any type of discount or deductible. How could our health plan address that cost that you said dan costs $99. Will insurance pay any of that?
>> if it's medically necessary and ordered by a physician, then it would be covered by the health plan. And depending on what plan you're enrolled in, it would either be paid at the 100% of the epo or be subject to a deductible unless that was already met and then the employee would pay 10%, the plan would pay 90%.
>> and it's per screen. So if theter had ordered -- this will include three different screenings. There's three screenings. If they were to do it on their own on their own physician, they would probably have to pay what dan's talking about times three for each screening. Where they're getting all three of them.
>> is it one day?
>> it's about a 20 minute session.
>> it doesn't take long at all and it's not invasive. It's very --
>> blood work?
>> no blood work. It's all ultrasound.
>> so even screamish people like the -- scweemish people like the court members should be able to go through.
>> we happen to be 55.
>> I値l be there to hold your hand. [ laughter ]
>> thanks.
>> that completes our presentation. If there are any questions, we'd be glad to answer them.
>> dan, if anybody that looks into this taped session teend they need to get more information, especially on the screening stuff, is there any number they can call, any employees out there that can get firsthand information on what we're discussing here today?
>> it's the 854-5509, the number for the clinic.
>> 854-5509.
>> and it's open from kw-7 8:30to 5:00. Except Thursday we go to -- except Tuesday we go to del valle.
>> that's very good information.
>> thank you very much.
>> we'll check as the judge suggested with employees and determine what kind of equipment we should be buying and come back.
>> okay.
>> thanks.
>> thank you very much.
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.
Last Modified:
Wednesday, March 1, 2006 7:37 AM