Title
2013 Adopted Budget Amendment 1C013: From the Employee Benefits Administrator, Department of Human Resources, on behalf of the Employee Benefits Work Group, an informational report regarding Wellness initiatives. (INFORMATIONAL ONLY UNLESS OTHERWISE DIRECTED BY THE COMMITTEE)
Body
Background
The 2013 adopted budget provided three directives regarding wellness:
· Broaden the definition of preventive services eligible for 100% coverage
· Develop an RFP and select a vendor for a comprehensive County wellness plan
· Develop a series of voluntary exercise classes available at County locations
Below is a summary of the progress toward these initiatives, and an update on other related activities.
Preventive Services:
Currently Milwaukee County's plan provides 100% coverage for preventive care services provided on an outpatient basis including:
· Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force
· Immunizations that have in effect a recommendation from the advisory committee on immunization practices of the centers for disease control and prevention
· With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; and with respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
Some common examples of services included under this definition are:
Exams:
· Routine annual physicals
· Routine OB-GYN
Routine screenings:
· Breast Cancer Gene
· Mammography
· Cervical Cancer
· Colorectal Cancer (Colonoscopies)
· Depression
· Diabetes
· High Blood Pressure
· Cholesterol & Lipid disorders
· Osteoporosis
Vaccines:
· Hepatitis A & B
· Diphtheria, Tetanus & Pertussis (including other combos)
· Meningitis
· Polio
· Measles, Mumps, & Rubella
· Chicken Pox
· Influenza
· Pneumonia
· Human Papilloma Virus
· Rotovirus
· Shingles
This definition is compliant with Health Care Reform, and is consistent with common practices in UnitedHealthCare's and Willis of Wisconsin's books of business. This is already a broad definition, and there are no glaring omissions. However, more aggressive wellness plans tend to include nutritional counseling services by a registered dietician. Given the current prevalence of diabetes and pre-diabetes in the covered population, it makes sense to add this coverage to the current program. Willis has indicated the cost of adding these services to the current definition would be negligible.
The Benefits Division recognizes that while the current definition is broad, most employees' perception of the preventive services coverage is more limited. To resolve this, the benefits division will develop a communication campaign to raise awareness and encourage use of the current covered preventive services.
Wellness Coordinator
The Employee Benefits Division initiated recruitment for a Wellness Coordinator (final position approval reported in the prior committee cycle). This employee is critical to the success of an ongoing wellness program at Milwaukee County as the Coordinator will be responsible for organizing wellness activities, tracking the plan performance, and executing the incentive program. This position adds the capacity to existing staff to be more proactive regarding ongoing communication and education of wellness topics and the health plan in general.
Exercise Classes
While performing due diligence regarding hosting exercise classes at various County facilities, a number of risk related issues are complicating this program. To mitigate potential financial risk, the Benefits Division would be responsible for credentialing any contracted instructors, and developing a first aid/emergency plan for each class site. In addition, to be able to contract with individual instructors, the County requires levels of liability insurance coverage (with Milwaukee County listed as also covered) which an independent instructor is highly unlikely to have. Similarly, the liability coverage for an instructor associated with a larger facility would not apply to classes performed at County facilities.
The Benefits Division is researching alternatives such as sponsoring classes at area fitness centers, or expanding on the fitness reimbursement program that currently exists under the medical plan. A recommendation will be presented in an upcoming Board cycle.
Plan Design / RFP Progress
The preliminary plan design places an emphasis on smoking cessation, cardiovascular health, obesity, diabetes prevention. There will be measurable goals for the population in general, but participation will be based on improving general health rather than attaining a specific threshold. It will include health coaching and onsite-site bio metric screenings, however, the frequency and format will be left sufficiently vague in the RFP to allow the County to have additional flexibility in pricing options and the ability to collaborate with the potential vendor.
A draft RFP is completed, and will be reviewed by the Benefits Division, and the Workgroup prior to release. The process will be facilitated by Willis, with the selection process completed by a panel consisting of two representatives from employee benefits, Nelson Soler from the Community Business Development Partners, and two additional members of the workgroup. The panel will evaluate options and make a final recommendation to the Board for approval.
We anticipate releasing the RFP at the end of March, with the recommendation of the panel following as soon as administratively feasible.
Incentive Structure / Non-Compliance Fees
The budget directive calls for raising $144,000 of revenue from non-compliance fees to help fund the overall cost of the program. In order to collaborate with the potential vendor, this element of the plan will be finalized after the conclusion of the RFP process, and brought back to the board for approval. This will help to ensure we are applying industry best practices, and that the incentive program can be administered by the vendor and County staff.
Wellness Discounts/Perks
Currently, the Metro Milwaukee YMCA offers a discount and waiver of registration fees for County Employees, however, this has not been promoted and awareness is somewhat low. The Benefits Division is working on identifying and securing additional discount programs for wellness related services, products, and activities. These will be complied and updated on an employee perks page on the benefits website, and communicated periodically as free way to augment the wellness program.
Diabetes Prevention
The Benefits Division has expanded on our successful partnership with UnitedHealthCare for the "Not Me" diabetes prevention campaign. This voluntary program identified people at risk for developing type-II diabetes through an onsite screening, and provided them with educational resources and exercise/nutritional classes at the YMCA.
The 2012 Courthouse event was the highest attended of any of UHC's Wisconsin clients, with nearly 200 people receiving an A1c test, and 80 being referred into the sponsored prevention program with the YMCA. We will continue with this program in 2013, hosting an event at the County Courthouse, and adding a second event near the BHD campus.
BHD Walking Challenge
While the Benefits Division has been working on a County-wide wellness program that meets the parameters set forth by the Board, it is important to note that employees have taken an interest promoting employee health at a department level.
The most successful example to date has been the walking challenge recently organized by Donna Jensen, an RN at the Behavioral Health Division. Donna organized 17 walking teams at BHD, with some teams as large as 30 people. The highest individual participant recorded approximately 15 miles in a single day. The Benefits Division supported this effort by securing a donation of 350 pedometers from UnitedHealthCare to be given to each participant. The event concluded in January with an awards ceremony for the top three teams.
Individual efforts like this show that there is an interest in wellness among employees - such efforts will only help to enhance the outcomes of the organization-wide focus on improving employee health.