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Health Care Management System by Prevention

International City/County Management Association - 2008 - Program Excellence Award: Strategic Leadership and Governance (10,000 - 49,999)

Summary

Becoming proactive about the need for preventive care, in 2005 Lewiston entered into an agreement with Central Maine Medical Center (CMMC) to develop and implement Health Care Management System by Prevention, a cutting-edge program that assesses the health risk behaviors of employees and their spouses; educates them as to the risks of such behaviors; provides guidance to help them address at-risk behaviors; and assists them in setting reasonable, sustainable goals. Program participants receive a 15 percent discount on their health insurance premiums. This initiative has proven that, both financially and healthwise, preventive health care is far more effective than disease management.

Description

The city of Lewiston, Maine, recognized that it had virtually no control or influence over the skyrocketing costs of health care management for its employees and their spouses. But officials knew that the city could do something to help curb the development of serious diseases and conditions, which contributed to those costs.

Becoming proactive about the need for preventive care, in 2005 Lewiston entered into an agreement with Central Maine Medical Center (CMMC) to develop and implement Health Care Management System by Prevention, a cutting-edge program that assesses the health risk behaviors of employees and their spouses; educates them as to the risks of such behaviors; provides guidance to help them address at-risk behaviors; and assists them in setting reasonable, sustainable goals. Program participants receive a 15 percent discount on their health insurance premiums. This initiative has proven that, both financially and healthwise, preventive health care is far more effective than disease management.

A key aspect of the program is a city hall–based health educator from CMMC who provides counseling and follow-up; participants are required to visit the educator at least once a year. Components of the program are a physical examination by personal physician, including prescribed lab and x-rays, and a health risk assessment with the health educator; an exercise program tailored by the health care educator in conjunction with personal physician; nontobacco use; and achievement and maintenance of body fat/waist management goals. To encourage participants, the city, in consultation with the health care educator, provides monthly health-related informational sessions to coincide with confidentially tracked challenges that employees and spouses are experiencing. Lewiston makes quarterly payments of $5,409 to CMMC for these services.

The partnership also includes a one-year CMMC Wellness Center membership for up to 150 eligible Lewiston participants for a $7,762 annual fee. Membership includes orientation to CMMC equipment with a personal health counselor, use of all facilities, free admission to aerobic classes, and admission to a six-week smoking cessation program.

Lewiston’s health insurance premiums have either remained the same or, in the case of Plan Year 2008, decreased by 4.87 percent from those paid the previous year. And when the program was developed in 2004, health care premiums paid by the city/employees were $4,472,123 in comparison to $4,118,679 in 2007. Even more importantly, Lewiston employees have become more educated and participatory in their own health so that municipal sick time usage has decreased from 8.18 days in 2006 to 6.75 days in 2007.

Weight loss within Lewiston municipal government has been massive: as of February 1, 2007, 59 percent of employees and spouses lost a total of 1,962 pounds. One year later, 47 percent had lost an additional 1,402 pounds. In addition, since the start of 2007, 42 percent of participants have increased their weekly physical activity.

Other examples of how preventive care has benefited Lewiston participants include an employee who, upon being required to have a physical, was discovered to have cancer—which was promptly treated; a 30-year-old employee who learned that he had hypertension and was put on medication; an employee who is allergic to bee stings and was advised on how best to use an epi pen; an individual who was assisted during a stressful situation; an individual whose high blood pressure was found to be caused by an over-the-counter medication; and a spouse who used the employee assistance program, which helped her deal with depression and stress after the death of a family member.

Health awareness and preventive care are becoming the norm among Lewiston municipal employees and spouses; from January 2007 to January 2008, the percentage of participants who met their goals in programs targeting blood pressure control, weight reduction/diet, cholesterol reduction, tobacco use, stress, and depression rose between 6 percent and 20 percent.

Which is not to say there were no obstacles to overcome! Although some participants welcomed the opportunity to discuss health education and goal setting, others resisted even blood pressure checks, and for many spouses, the premium-reducing components of the plan were seen as a personal intrusion. But through information provided by staff and word-of-mouth advocacy by fellow employees and spouses, such reluctance is giving way. People have also been won over by the consistency and flexibility of appointment times; as the health care educator learned, it is critical to “meet them where they are.”

Employers can significantly influence health behavior change among their employees. By stressing prevention, they can sometimes prevent chronic disease. The subsequent decrease in the use of health care resources, absenteeism, and increased productivity will result in significant cost savings. Participating employees and spouses in Lewiston’s health care management program have enjoyed up to a 15 percent discount in their health insurance premiums and, most importantly, better health.

L.L. Bean, Inc., in Freeport, Maine, has adopted some aspects of the program. Praising the program’s “quality and comprehensiveness,” L.L. Bean’s wellness manager has lauded Lewiston as “truly a shining example of what we are all trying to achieve!”

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Tags: Education and Training, Health and Social Services





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