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The Vermont Department of Health
Commissioner Harry Chen, MD
November 1, 2012
The Business Case for a
Healthy Workplace
The Vermont Department of Health
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.
The Vermont Department of Health
Vermont Health Care Expenditures Set to Double This
Decade
The Vermont Department of Health
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
The Vermont Department of Health
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
The Vermont Department of Health
Wellness Saves $$$
Corporate wellness magazine, 7/12
The Vermont Department of Health
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
The Vermont Department of Health
Just telling people
how to be healthy
doesn’t work, we
need to change
the environment
The Vermont Department of Health
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
The Vermont Department of Health
The Vermont Department of Health
The Vermont Department of Health
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…
The Vermont Department of Health
…Obesity is going in the wrong direction
The Vermont Department of Health
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’
The Vermont Department of Health
What Can You Do?
1. Implement healthy food purchasing and/or healthy vending machine policies.
(VDH can help)
The Vermont Department of Health
What Can You Do?
2. Create a healthy
foods/beverages “at meetings”
policy. (VDH has samples)
The Vermont Department of Health
The Vermont Department of Health
3. Go tobacco-free.
(VDH has Free Counseling/NRT Services)
1-800-QUIT-NOW
What Can You Do?
The Vermont Department of Health
What Can You Do?
4. Provide refrigerators,
microwaves, and break areas
making it easier for employees
to make the healthy choice.
The Vermont Department of Health
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?
The Vermont Department of Health
• 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
The Vermont Department of Health
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
The Vermont Department of Health
Additional FREE resources:
http://healthvermont.gov/family/fit/documents/WorksiteWellness_Resource.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
The Vermont Department of Health
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/
The Vermont Department of Health
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 Vermont Department of Health
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
The Vermont Department of Health
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
The Vermont Department of Health
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 Vermont Department of Health
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
The Vermont Department of Health
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?
The Vermont Department of Health
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
The Vermont Department of Health
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
33,300 Patients53% Total Pop.
Burlington20 Practices
106,231 Patients60% Total Pop.
Barre9 Practices
52,183 Patients80% Total Pop.
Randolph5 Practices
18,739 Patients53% Total Pop.
St. Johnsbury6 Practices
20,725 Patients73% Total Pop.
Bennington8 Practices
19,521 Patients49% Total Pop.
St. Albans11 Practices
29,505 Patients66% Total Pop.
Middlebury7 Practices
23,573 Patients83% Total Pop.
Brattleboro2 Practices
8,361 Patients26% Total Pop.
Morrisville4 Practices
25,047 Patients96% Total Pop.
Upper Valley2 Practices
3,473 Patients21% Total Pop.
Springfield7 Practices
24,945 Patients87% Total Pop.
Windsor2 Practices
11,510 Patients86% Total Pop.
0
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70 80
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Patient Centered Medical Homes # NCQA Recognized Practices in Vermont
The Vermont Department of Health
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
The Vermont Department of Health
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