08/21/11 — Smoking, obesity will cost county employees

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Smoking, obesity will cost county employees

By Steve Herring
Published in News on August 21, 2011 1:50 AM

Wayne County could save up to $200,000 in health insurance costs this year because of a new program that, while targeting employees who use tobacco, is also available to other employees who want to take advantage of a $500 incentive.

The plan, which requires a higher deductible and does not provide any co-pays, went into effect July 1 and will be expanded next July 1 when overweight employees will be added.

Approximately 17 percent, about 196 people, of all county employees use tobacco, said Sue Guy, the county's human resources director. The county has slightly more than 1,000 employees, but only 700 are eligible for coverage under the county's self-insurance plan.

"Health insurance is provided free," she said. "We are self-insured. We use Blue Cross Blue Shied as our third-party administrator. We use their structure and pay them a very, very small fee for them to process claims for us. That fee also allows us to use their network of doctors at a discount. (County employees) do pay for their dependents."

There are a little more than 300 dependents covered under the county's plan, she added.

Actuaries have told the county that it saves about $1,200 for every person who goes on the higher-deductible plan because, unlike the tradition plan, the county does not pick up that other piece of the drug or doctor bill -- the employee is paying 100 percent instead of a co-pay.

The county has not really tracked how much smoking or tobacco use has attributed to health care costs, she said.

"About 30 percent of our claims are our higher claims and those are the ones that have had some impact by obesity or smoking," she said. "So as far as dollar amount, no, I couldn't tell you that. In all fairness, that entire 30 percent might not be a county employee. In some cases, it could be a dependent.

"We have not required that dependents stop smoking. There is a limit. We are hoping that if we positively impact our employees here by giving them all of these tools that are accessible by their spouses and children that it will just roll over into the family."

The new program should not be a surprise to county employees, she said.

"We had been talking about it actually for years that this was something that was coming down the pike -- that we actually were going to follow what the state had done," Ms. Guy said. "We didn't want to surprise employees and wanted to give them a chance to start working toward those goals, so last year we did roll out a different tier to our health insurance that is called the health savings plan.

"The health savings plan is not a bad plan. It is what we call a high-deductible plan which means a couple of things: The deductibles are higher, of course. It also means you have to make more choices in how you use your insurance more so than traditional where you fill a prescription you pay a co-pay, you go to the doctor you pay a co-pay. This you pay 100 percent up to $1,500. But the county will give you $500 that you can put in a health savings account. You can add more if you want, but you don't have to. We have some folks who have elected to go to this plan simply because they are never sick. They are healthy people. They are not on any type of maintenance drug."

The plan still provides a free annual physical.

"If you are on a smoking cessation or tobacco-use cessation program under your doctor's care, you still can choose which plan. But if you are not under any kind of program to stop using tobacco and you choose to smoke this (high deductible) is the plan that you are offered."

However, the choice will go away after this year.

With the smoking piece in place the county, this coming year will focus on weight control.

"There again, nobody is going to be going around the county weighing people," Ms. Guy said. "Our employees are required to have a physical every two years so the doctors are going to pay a role in that. We understand there are a lot of reasons why people are not always the ideal weight that are medical (reasons). We are looking at those. There again, if you are in a weight control program under the care of your doctor then we will give you the choice.

"We are not promising to pay less (in health care costs), but rather are working to keep inevitable increases as low as possible. You only have so much control over what those increases are. We are just trying to put some pieces in place to keep the increase from being double digit."

The countywide policy encourages employees to stop smoking as a preventive measure, says Carolyn King, health education supervisor, who often organizes smoking cessation classes for staff as well as the public.

The policy offers a provision for anyone working toward quitting smoking, she said, giving them a time period to stop to keep insurance rates down.

The effort has met with mixed reactions from employees who smoke, Ms. Guy said.

"Many people have said, 'I have been meaning to quit for years. This kind of puts me on a timeline.'

"We also have an opportunity in our insurance program -- if you have coverage for a spouse, you can opt out. Some have opted out because they don't want to address it and that's their right."

The next item up for consideration will be obesity, Ms. Guy said.

In a recent report released from the Robert Wood Johnson Foundation, North Carolina's adult obesity rate is at 29.4 percent and the state was named the 14th most obese state in the country.

Several weight control programs have been offered locally, Ms. Guy said, and Blue Cross Blue Shield has been especially supportive of the effort.

"If you do fall into the obese category -- and that will be defined by the doctors -- you'll either need to be in a program of weight control or you'll be told to move to the high deductible," she said.

Of course, she noted, just like in the case of long-term tobacco use, there are no shortcuts to losing weight and become healthier.

"It may take you years to safely lose the weight," she said.