1. The Vermont Department of Health Commissioner Harry Chen, MD November 1, 2012 The Business Case for a Healthy Workplace

2. 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.

3. The Vermont Department of Health Vermont Health Care Expenditures Set to Double This Decade

4. 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

5. 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

6. The Vermont Department of Health Wellness Saves $$$ Corporate wellness magazine, 7/12

7. 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

8. The Vermont Department of Health Just telling people how to be healthy doesn’t work, we need to change the environment

9. 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

10. Determinants of Health Factors influencing Health Status

11. Improvements in Longevity 100 years of Progress

12. The Vermont Department of Health

14. 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…

15. The Vermont Department of Health …Obesity is going in the wrong direction

16. 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’

17. The Vermont Department of Health What Can You Do? 1. Implement healthy food purchasing and/or healthy vending machine policies. (VDH can help)

18. The Vermont Department of Health What Can You Do? 2. Create a healthy foods/beverages “at meetings” policy. (VDH has samples)

19. The Vermont Department of Health

20. 3. Go tobacco-free. (VDH has Free Counseling/NRT Services) 1-800-QUIT-NOW What Can You Do?

21. 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.

22. 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?

23. 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

24. 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

25. 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

26. 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 17 th, 2012 Review past winner’s programs and apply at http://vermontfitness.org/ http://vermontfitness.org/

27. 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.

28. 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

29. 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

30. 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

31. The Vermont Department of Health The Logic of Health Reform: Expanded Insurance Coverage Medicaid & CHIPMedicaid & CHIP ExchangesExchanges Expanded Access to Care Emphasis on primary care and preventionEmphasis on primary care and prevention Seeks to increase supply to meet demandSeeks to increase supply to meet demand High Value CareCare High QualityHigh Quality Delivered Efficientl y Delivered Efficientl yEffective CareCare In and out of clinical environment In and out of clinical environment Patient self- efficacy, health literacy, adherence Patient self- efficacy, health literacy, adherenceImproved Health Outcomes Conditions are amenable to care Conditions are amenable to care Social determinant s of health addressed Social determinant s of health addressed Reduced Health Spending Population health and spending are the sum of individual health and spendingPopulation health and spending are the sum of individual health and spending

32. The Vermont Department of Health 12/8/2015 32 Unified Health Care Budget Health insurer rates Payment reform pilots Hospital budgets All-payer provider rates Certificates of need Data analysis Benefits standards Data analysis Benefits standards Green Mountain Care Board Can planning, policy and regulation be coherent and coordinated?

33. 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

34. 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.

35. 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

36. Payment reform goals Move away from fee-for- service Build on the Blueprint Include all payers Incorporate performance measurement for cost and quality

37. Practices and Populations with Access to Team-Based Services Thru June 2012

39. 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

40. 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

41. Eat Well Move More Work Better Live Longer