Can one county be model for health?

If leaders in health care had their way, Washington County‘s 132,000 residents would be the healthiest in the nation and in Wisconsin.

That’s an ambitious goal, though the county already ranks in the top fifth of Wisconsin’s 72 counties for health. That said, we are not living in nirvana. A recently completed survey of residents showed some less-than-thrilling metrics:

• Obesity – 29% of county people were rated as obese in 2015, which means they are prone to diabetes, high cholesterol, hypertension and joint problems. The state level is the same.

• Excessive Drinking – 28% of county residents self-report drinking too much, compared to 24% in Wisconsin and 10% in the best performing states. Binge drinking is biggest issue.

• Smoking at 14% in the county is better than the state average of 18% and right on the national average. It is generally regarded as the most negative factor for long-term health. (Note: there are some pockets of improvement; in the West Bend School District, only 4% of employees smoke; at West Bend Mutual, it’s 6%.)

• Diabetes runs at 9% among county residents, equal to the state average. It can cause nasty outcome, like blindness and amputation.

These behaviors and conditions have obvious negative consequences for a person’s well being. They also have negative economic consequences. Each can double health costs per employee from about $6,000 for person to $12,000 per year.

So, there are plenty of reasons to aim high in cutting down the pernicious percentages. But, how to go about getting to higher grounds for health?

Keeping the statistics and broad educational programs have been the traditional strategies. They are pretty hands off. Some progress has been made on smoking, while heavy drinking and obesity, an epidemic, have been more impervious to improvement.

New thinking and fresh strategies are needed. In that vein, a coalition of county leaders and managers from the public, private and non-profit sectors has convened to tackle the stubborn, negative metrics.

There is reason for optimism for making Washington County a model for the state and nation. About a dozen employers in the county are in the vanguard for making workforce health a strategic priority in their organizations.

In the face of out-of-control health costs, they have learned that they can only gain leverage on the hyperinflation if they deal directly with the well being of their employees and their families.

These leading organizations, which include QuadGraphics, West Bend Mutual, the West Bend School District and the Wendorff companies in Hartford, have installed on-site or near-site clinics so they can be strategically serious about primary care, prevention and wellness. Serigraph has a part-time clinic, too. Their own medical teams get very hands-on with every employee family.

Their goal: keep their people out of dangerous and expensive hospitals. By doing so, they have been able to bring in total health costs at about $13,000 per employee – far less than the $20,000 that is around the national average.

It’s a virtuous circle: keep people well and save major dollars. Note that the savings help all parties, because employees usually pay about 25% of the medical bill.

There will have to be lots of players in a countywide health campaign – hospitals, clinics, doctors, nurses, the YMCA, other non-profit agencies, employers and families. But the lynchpin is that all organizations are employers. If each and every employer gets strategic about workforce health, a big part of the challenge can be met. Reform can happen employer by employer.

Other strategies will have to be used for the unemployed and people on public programs like Medicare and Medicaid. Government programs are slow to reform themselves, but at some point will have to conform to the successful practices of employers.

Employers have obvious advantages when it comes to behavior change. Sermons from doctors and nurses produce some results, but employers have the ears of their people 40 hours or more per week, and they can deploy carrots and sticks to get the attention of employees.

Many, for instance, charge higher premiums for smokers and offer free cessation programs. A few companies will not hire smokers and terminate employees who indulge.

Some offer free insulin to diabetics who are under control, measured by three blood tests, along with their intensive education programs. They make 100% under control a company goal.

Some employers make primary care and health risk assessments free. Some require the annual assessments.

You get the picture. Employers have leverage that they can bring to bear on workforce health.
Further, their leaders can create a culture of health and fitness.

The county strategy, then, could be to educate employers to engage their people in a regimen of well being — physical, mental and financial.

We know it can be done, because pioneer companies are already well down the field on such reforms.

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