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The Vermont Department of Health

Commissioner Harry Chen, MD

November 1, 2012

The Business Case for a

Healthy Workplace


Vermont has a Big Problem

60% of adult Vermonters are above a healthy weight.

Vermont spends an estimated $291 million every year on medical costs related to obesity.

The obese workforce costs Vermont $895 million every year.


Vermont Health Care Expenditures Set to Double This

Decade


How much does excess weight cost?

In a company of 50 employees

37 will be above a healthy

weight and

Will COST the employer

$35,175 per year

Each obese employee costs an average of

$1478 more per year

A Partnership of the Healthy Business Group, National Business Group on Health, and University

of Michigan Health Management Research Center - 2012


Weight Watchers reports that an obese employee:

How much does excess weight cost?

http://www.weightwatchers.com/templates/marketing/marketing_utool_1col.aspx?pageid=1317711


Wellness Saves $$$

Corporate wellness magazine, 7/12


Wellness takes a thoughtful

comprehensive approach:

a. Make a Plan

b. Create a “Culture” of Wellness

c. Offer Wellness “Programs”

d. Engage all employees

e. Measure/Monitor Your Success

The VDH FREE Worksite Wellness

Resource Guide will show you how.

http://healthvermont.gov/family/fit/documents/WorksiteWellness_Resource.pdf



Just telling people

how to be healthy

doesn’t work, we

need to change

the environment


BAD POPCORN IN BIG BUCKETS:

PORTION SIZE CAN INFLUENCE

INTAKE AS MUCH AS TASTE

Moviegoers in Philadelphia

Popcorn in medium and large buckets

Fresh and 14 day old popcorn

Large buckets + fresh popcorn- +45%

Large buckets + stale popcorn- +34%

Wansink and Kim, 2005

Determinants of Health Factors influencing Health Status

Improvements in Longevity 100 years of Progress


34%

40%38%

22%

18% 18% 18%

13%

24%

33%

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Youth prevalence

1991: Prohibit sales <18 yrs

1995: VKAT begins

1997: Prohibit vending machines; possession illegal

2002: Tax to $1.19

2006: Tax to $1.99

2010: Tax to $2.62

2009: Tax to $2.24

2001: OVX begins

1995: Smokefree schools

2000-2001: TCP started with MSA

2001: Quit Line begins

2007: Youth access Quit Line

What we know from Tobacco…


…Obesity is going in the wrong direction


You can be part of the solution

Changing lifestyle

behaviors is hard without

social and physical

environments that support

a healthy lifestyle.

Change the environment.

Make ‘the healthy choice the easy

choice’


What Can You Do?

1. Implement healthy food purchasing and/or healthy vending machine policies.

(VDH can help)


What Can You Do?

2. Create a healthy

foods/beverages “at meetings”

policy. (VDH has samples)


3. Go tobacco-free.

(VDH has Free Counseling/NRT Services)

1-800-QUIT-NOW

What Can You Do?


What Can You Do?

4. Provide refrigerators,

microwaves, and break areas

making it easier for employees

to make the healthy choice.


5. Help employees to get 30 minutes of physical activity per day:

Provide:

bike racks, fitness space, showers, locker rooms, inviting stairwells, walking paths, etc.

What Can You Do?


• Incentivize your employees to take part of preventive health

care screenings/exams:

• Complete an annual exam

• Know your numbers (BMI, cholesterol, blood sugar, blood

pressure)

• Refer tobacco users to the Vermont Quitline

• Encourage 30 minutes of daily physical activity

Health Benefit Considerations


We Can Help with FREE Effective Resources

The Vermont Worksite Wellness Resource Guide:

A new updated version will

be available Spring 2013!

• Walks you through the steps of

setting up an employee wellness

program

• Includes assessment and prioritizing

tools

• Includes sample policies and links to

resources



Additional FREE resources:


http://healthvermont.gov/prevent/tobacco/documents/QUITatWORKVQNJuly09.pdf

http://www.womenshealth.gov/breastfeeding/government-in-action/business-case-for-

breastfeeding/easy-steps-to-supporting-breastfeeding-employees.pdf

http://healthvermont.gov/prevent/tobacco/documents/QUITatWORKVQNJuly09.pdf

http://www.womenshealth.gov/breastfeeding/government-in-action/business-case-for-breastfeeding/easy-steps-to-supporting-breastfeeding-employees.pdf



Show Off Your Program!

Apply for a Vermont Governor’s Council on Physical Fitness and Sports Worksite Wellness Award!

2012 Award Applications are open until November 17th, 2012

Review past winner’s programs and apply at http://vermontfitness.org/

http://vermontfitness.org/


Our health care system is broken

It’s too costly and contains no mechanism for

cost control.

It is funded in a manner which is unfair,

inefficient and inequitable.

Too many people are uncovered (47,000) and

underinsured (160,000)

And it doesn’t provide Vermonters with the

best value for the health care dollars we

spend.


The Opportunity of Health Care Reform

Cover all Vermonters regardless of age income, or employment status

Preserve quality and patient choice

Separate health care from employment

Lower health care spending

Improve health

Create jobs and economic opportunities


Health Reform Goals

29

Assure that all Vermonters have access

to and coverage for high quality

care

Improve the health of

Vermont’s population

Assure greater

fairness and equity in how

we pay for health care

Reduce health care costs and

cost growth


Health Care Reform Timeline

Green Mountain Care Programs

Private Health Insurance

Employer Self Insured Plans

Today

Vermont Health Benefit Exchange

2014

Green Mountain Care – unified system

After ACA waiver is available

30


The Logic of Health Reform:

Expanded Insurance Coverage

• Medicaid & CHIP

• Exchanges

Expanded Access to Care

• Emphasis on primary care and prevention

• Seeks to increase supply to meet demand

High Value Care

• High Quality

• Delivered Efficiently

Effective Care

• In and out of clinical environment

• Patient self-efficacy, health literacy, adherence

Improved

Health Outcomes • Conditions

are amenable to care

• Social determinants of health addressed

Reduced Health

Spending

• Population health and spending are the sum of individual health and spending


11/2/2012 32

Unified Health Care

Budget

Health insurer rates

Payment reform pilots

Hospital budgets

All-payer provider

rates

Certificates of need

Data analysis

Benefits standards

Green Mountain Care Board

Can planning, policy and regulation be coherent and coordinated?


Why do we need an Exchange ?

Individual tax credits are available only through

the Exchange

Funds to design and build the Exchange and

revamp our eligibility, enrollment and claims

processing for Medicaid to serve a larger

population

Reduced complexity of insurance purchasing

Federal limitations on waiver

Potential for single claims processing

mechanism 33


New: Proposed Visual Identity

Vermont Health Benefit Exchange

The visual identity of the Exchange will be a public face of health reform in

Vermont. A range of possible names, taglines, logos, color schemes and

images were developed. Then, focus groups of Vermonters – including

both individuals and small business owners – were asked to give

feedback and discuss their reactions. This is the result.

The Vermont Blueprint for Health

Central to Payment and Delivery System Reform

Bundled payment (example: hip replacement)

Physician/hospital global budgets

Blueprint/specialist model for targeted conditions (example:

oncology project)

Population-based payments

Success of all depends on primary care

capacity, quality and coordination

BLUEPRINT FOR HEALTH

Payment reform goals

Move away from fee-for-

service

Build on the Blueprint

Include all payers

Incorporate performance measurement for cost and

quality

Practices and Populations with

Access to Team-Based Services

Thru June 2012

* Based on 2010 Vermont Population, U.S. Census Bureau

Approximate % of Total HSA Population in Practices with Access to Team-Based Services*

21% - 26%

26.1% - 66%

66.1% - 96%

Newport6 Practices

18,612 Patients66% Total Pop.

Rutland6 Practices


Burlington20 Practices


Barre9 Practices


Randolph5 Practices


St. Johnsbury6 Practices


Bennington8 Practices


St. Albans11 Practices


Middlebury7 Practices


Brattleboro2 Practices


Morrisville4 Practices


Upper Valley2 Practices


Springfield7 Practices


Windsor2 Practices


0

5 7 7 12 12

19 25

30 38

44

55 59

70 80

86

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Patient Centered Medical Homes # NCQA Recognized Practices in Vermont


The finish line

Health care is a right – all Vermonters are

covered

Health care costs are sustainable – closer to

our rate of economic growth

Providers are paid fairly

Everybody pays their fair share

Vermont is the best place to do business

Vermont is the best place to practice

medicine

Vermont is the healthiest place to live


We Can Win!

Obesity is a preventable cause of death.

With adequate funding, we have a winnable battle.

Vermont spends ~$300 million per year on obesity related medical costs.

State funding for obesity prevention is only $355 thousand dollars.

“The weight of the nation is not healthy. And to get it healthy, we are all

going to have to do our part.”

Dr. Thomas R. Frieden, Director, Centers for Disease Control and Prevention

Eat Well • Move More • Work Better • Live Longer

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