1. City of San Angelo Wellness Update January 2014

2. 2013 Wellness Update 99% of employees completed their HRA’s this year. (795 employees compared to 698 in 2011) Weight, nutrition and control of blood pressure are the top 3 priorities based on identifiable health risks. There is opportunity for improvement, however, the employees and the city are to be commended.

3. Overall Wellness Rating Average wellness score for city employees is 68 (out of 100). New employee score is 67 (135 employees). 676869

4. 80/20 Rule Generally, 80% of health care costs come from 20% of the people. As the number of health risks go up, so do the health care costs. _________________________________________________ Currently, there are 110 employees with 5 or more risk factors. (a decrease of 9% since 2011)

5. Economic Impact Estimated Excess Health Claims Cost # of employeescost per employee 201120122013 no risks776785$0 1 risk137168145$861 2 risks214166201$1,764 3 risks159164149$2,690 4 risks10596105$3,788 5 risks61 60$4,821 6 risks342923$5,919 7+ risks282227$6,995 13.8% of employees (110 people) have 5+ risk factors, influencing quality of life, as well as health care costs. 2011 – 15% 2012 - 14.5% 2013 – 13.8%

6. Chronic Diseases

8. Diabetes Diabetes is increasing rapidly in the U.S. One third of people do not know they are diabetic. Type 2 diabetes is largely preventable. Action Steps Anyone 45 or older should be tested for diabetes. Persons younger than 45 with a BMI of 30+ and another risk factor should be tested with a blood glucose test. 78% of city employees are at risk, 42% at high risk. (decrease of 3% of high risk since 2011) Major risks CityNational Norm Obesity (BMI 30+) 40.7% (324 people) 32% Nutrition 65.5% (521 people) 59% Low HDL (<39.9%) 33.7% (268 people) 17% National

9. Heart Disease Major risks CityNational Norm Obesity (BMI 30+) 40.8% (324 people) 32% Low HDL (<39.9%) 33.7% (268 people) 17% Metabolic syndrome (3+ indicators) 37.6% (299 people) 23% 70 – 80% of heart disease is linked to modifiable risks. Action Steps Actively eliminate any known risk factors such as poor diet and lack of exercise. Pay attention to warning signs of a heart attack. 53% of city employees are at risk, 31.6% at high risk. (decrease of high risk by 3.4% since 2011)

10. Cancer Major risks CityNational Norm Smoking/tobacco 11.1% (88 people) 21% Obesity (BMI 30+) 40.8% (324 people) 32% No or low phy. activity (< 5 days/wk) 69.7% (554 people) 83% 2/3 of all cancer deaths can be prevented. Action Steps Actively eliminate any known cancer risks such as smoking. Get proper checkups as recommended for a person’s age and gender. 50.5% of city employees are at risk, 20.3% at high risk. (2.7% decrease in the high risk since 2011)

11. Cancer Screenings In 2012, the City began paying all cancer screenings at 100% without a deductible. (Formerly at 80% after deductible had been satisfied.) Pro-active screenings have not yet increased, however, these are high percentages of compliance indicating a level of awareness.

12. Modifiable Risks of Chronic Diseases

13. Modifiable Risks Top Six Priority Health Recommendations Good nutrition (613 people have 6+ risk factors; 342 have 10+) Weight management (327 people overweight; 324 obese) High blood pressure (401 pre-hypertension; 203 high bp) Physical activity (554 less than 5 days/wk; 75 have no PA) Sleep (436 people get inadequate sleep - less than 7-8 hrs/night) Osteoporosis (401 have 2+ risk factors; 0 has 4+ risk factors)

14. City of San Angelo Chronic Disease Risk Factors (Smoking drops off list of being in the top 6)

15. Nutritional Statistics Choosing unrefined, plant-based, low-calorie, low saturated- fat foods can greatly decrease risk of heart disease, diabetes, and many cancers. In the City of San Angelo: 77.6% of employees (599) compared to 82.9% (675) last year are at increased risk with 6+ nutritional risk factors. 42.2% of the people (325) compared to 51.8% (422) last year are at high risk with 10+ nutritional risk factors.

16. Employee Weights BMICityNational Norm Healthy weight18.5 - 24.917.4% (138 people) 33% Overweight25 - 29.941.1% (327 people) 34% Obese30 - 34.924% (191 people) 20% Very Obese35+16.7% (133 people) 12%

17. Estimated Excess Cost per Risk Factor (7 of 15 risks reported) 201120122013Excess Cost / per risk High Stress Score (3+ stress indicators) 7870$129,469 ($1,850) Physical Inactivity (no regular exercise) 6983$152,375 ($1,836) High BP (140/90+) 309282326$586,323 ($1,799) Smoking (11 completed class) 1009688$156,873 ($1,783) Overweight (BMI >27.5) 515502489$746,611 ($1,527) Seat Belt Use (<100%) 130115122$162,758 ($1,334) Low HDL (<40mg/dL) 326300276$276,291 ($1,001) Overall Estimated Excess Health Claims: Estimated excess cost for 2012$2,940,272 Estimated excess cost for 2013 $3,063,733 Source: University of Michigan. Study of 205,000 employees showing relationship between risk factors and healthcare costs. EMPLOYEES

18. 2013 Accomplishments Increased the numbers of employees completing HRA’s by 14% since 2011. 2011 = 698 employees 2012 = 763 employees 2013 = 795 employees Improved overall Wellness Score in 42% of employees (261). Reduced estimated excess health claims by reducing risk factors: decrease of $122/employee since 2011: 2011 = $2,502/employee 2012 = $2,426/employee 2013 = $2,380/employee Reduced employees with 5 or more risk factors by 9% (123 to 110). Improved the nutrition of 249 people. Reduced obesity percentage by 3% - (lost 334 lbs). 281 people lost 2+ lbs 73 people lost 10–19 lbs 29 people lost 20+ lbs

19. 2013 Programs Implemented Global Health & Fitness Month program Walk with a Doc walking program Added A1c diabetes screen and PSA prostate screenings Saturday Shape-up program Fruit & Vegetable Challenge Bountiful Basket Program Smoking Cessation classes Flu Shots (500) Biggest Loser Contest

20. What Do Employees Want? Employee Perception Health Interests Nutrition Weight Management Stress Reduction Help with medication costs Lifestyle Change Desired Be Physically Active Practice Good Eating Habits Avoid smoking or using tobacco Lose weight or maintain a healthy weight Perception of COSA Creating a Healthy Workplace Excellent – 22.3% Good Interest – 49% Fair Interest – 20.6% Poor, little Interest – 8.2%

21. 2014 Programs Proposed Wellness Incentive Program – point system Create a Wellness Committee with “Wellness Champions.” Become a Well Business; Well City. Extend Health Club discount program of 50% to city employees Weight Management Get Lean in 2014 challenge Choose to Lose challenge Maintain, Don’t Gain holiday challenge Classes Diabetes Education Classes Label Reading class with dietitian Sodium Swap Challenge Smoking Cessation Class Stoptober Quit Smoking challenge Downsize - fitness class for overweight/obese employees Exercise 70,000 Steps in 7 Days national challenge Walk Across Texas program Mile Per Day challenge High Nooners Noon Walking Club 1 st Annual City Managers Walk to Wellness 5k (Employee Wellness Month – June)

22. Health Management Utilize the city clinic, primary care providers and the wellness program to manage health of COSA. Continue one-on-one counseling with employees. Monitor employees with 5+ risk factors. (110 employees) Monitor employees with high risk of diabetes. (42%) Encourage employees to get recommended cancer checkups. (mammograms, prostate, PAP, colon) Develop clinical protocols with physician for chronic diseases.

23. Thank you. We appreciate leading your wellness effort and applaude you for making San Angelo a healthier place to live.