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Item C05Co unty of Monr M l� 4C BOARD OF COUNTY COMMISSIONERS Mayor David Rice, District 4 The Florida Keys Y Mayor Pro Tern Sylvia J. Murphy, District 5 Danny L. Kolhage, District 1 George Neugent, District 2 11.1 5 Heather Carruthers, District 3 County Commission Meeting February 21, 2018 Agenda Item Number: C.5 Agenda Item Swnmary #3779 BULK ITEM: Yes DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Maria Fernandez- Gonzalez (305) 292 -4448 N/A AGENDA ITEM WORDING: Approval of a resolution of the Board of County Commissioners of Monroe County, Florida approving and establishing the 2018 Wellness Program which includes health and wellness events (lunch and learns, health and wellness fairs, exercise and nutrition classes), Health Designs, Inc./Wellness Consultant, wellness exam and age- appropriate screenings with a participation incentive that now includes a tobacco cessation plan, community organized event reimbursement (walks, runs, bikes, swims), and purchases of related goods (gym equipment and sit -stand workstations); and Approval of the 2018 Wellness expenditures which are consistent with the items described in the 2018 Wellness Program. ITEM BACKGROUND: The goal of the Wellness Program is to encourage healthy lifestyle choices in the interest of disease prevention and provide opportunities for early detection and illnesses before major medical treatment is required. This contributes to a healthier workforce and seeks to reduce long -term claims cost. As part of the County's ASO agreement renewal with Florida Blue in 2015, Florida Blue paid the County a $100,000 wellness contribution in 2015; a $75,000 wellness contribution on January 1, 2016 and January 1, 2017; and a $50,000 wellness contribution on January 1, 2018 and January 1, 2019 provided the agreement remains in force. The County has implemented programs from 2011- 2017 using funds from Florida Blue to encourage health plan enrollees to participate in wellness programs and educational opportunities. The 201712roUam included: • Community Organized Event Reimbursement up to $100 annually per enrollee for participation in marathons, walkathons, etc. • Lunch and Learns Health & Wellness Fairs (canceled in 2017 due to Hurricane Irma) Funding of exercise classes (Yoga, Zumba, etc.) held at Government Centers (Lower, Middle and Upper Keys) • Health Designs Wellness Champion • Purchases of Goods: Gym equipment at the Gato Building (delayed in 2017) and Sit -Stand Workstations Preventative Screenings (Age- appropriate wellness examinations) — participation incentive of $25 per month /$300 per year discount on health insurance premiums; tobacco users excluded. • Annual Biometric Screenings and Online Personal Health Assessment - BOCC and participating Constitutional Officer (Property Appraiser, Court Administration, and Land Authority employees (those covered and not covered by the County Health Insurance) receive 4 hours personal time. 2017 Program Participation and Results: Health Fairs were scheduled for September but canceled due to Hurricane Irma. However, based on scheduled employee reservations /appointments, the 2017 Health Fairs would have exceeded previous years' participation levels. Employees still had the option to have a personal health assessment by their primary care physicians and enter those results into an online center to receive 4 hours paid time off for 2018. The following table shows, for 2016 and 2017, the number of total eligible employees and both the number and percentage who participated in the Wellness Preventative Screenings for the BOCC and each participating Constitutional Office. 2016 total participation was 108 of 1236 total eligible employees, or 8.7 %. 2017 total participation was 493 of 1235 eligible employees, or 39.9 %. Participation in the Preventative Care (Age- Appropriate Wellness Exams) has increased by 31 % year- over -year. PREVENTATIVE SCREENINGS 2016 2017 2016 2017' TOTAL 2016 2016 '' TOTAL 2017 2017 EMPLOYEE Employee Employee EMPLOYEE Employee Employee EMPLOYERS S Participation 'Percentage S Participation Percentage Benefit given for participation $25 /Month - $300 /year savings on health MCSHERIFFOFFICE 532 17 3% 511 175 34% ', insurance $25 /Month - $300 /year savings on health COUNTY CLERK 33 10 1 14% 76 31 1 41% 6insurance $25 /Month - $300 /year savings on health TAX COLLECTOR 52 8 15% '' 53 ' 36 68% ' insurance $25 /Month - $300 /year savings on health PROPERTY APPRAISER 38 5 13% '' 1 37 21 57% insurance $25 /Month - $300 /year savings on health SUPERVISOR OF ELECTIONS 9 4 44% >s 9 7 77% insurance PLUS 8 hours time off $25 /Month - $300 /year savings on health COURTADMINISTRATION 21 3 14% '' 22 12 1 55% insurance $25 /Month - $300 /year savings on health LAND AUTHORITY 3 2 67% '1 3 3 100% linsur ance BOARD OF COUNTY $25 /Month - $300 /year savings on health COMMISSIONERS 1 508 59 12% 1 524' 208 40% insurance Total 1 1236 1 9% 1 1235' 493 40% 2016 total participation was 108 of 1236 total eligible employees, or 8.7 %. 2017 total participation was 493 of 1235 eligible employees, or 39.9 %. Participation in the Preventative Care (Age- Appropriate Wellness Exams) has increased by 31 % year- over -year. (Attached file: Wellness Screening participation) Florida Blue reports that the County has spent $1,254,792.39 in claims on Wellness screenings over a 3 -year period ending September 2017. For the same period Florida Blue estimates that the initiatives of the Wellness Program saved the plan $7,528,752 (as cost avoidance). Based on this estimate, every $1.00 spent on Wellness Preventative Screenings saves $6.00 as avoided claims cost. (Attached file: Florida Blue 3 -year wellness claims cost and estimated ROI) Florida Blue suggests that the 4 top risk areas for the County are: 1) Diabetes 2) Body Mass Index (BMI) 3) Nutrition 4) Blood Pressure (Attached file: Florida Blue Monroe Better You Slide) The 2018 program includes: • Community Organized Event Reimbursement up to $100 annually per enrollee for participation in marathons, walkathons, etc. • Lunch and Learns (Topics will address the top 4 risk areas: Diabetes, BMI, Nutrition, Blood Pressure) • Health and Wellness Fairs • Funding of exercise (Yoga, Zumba, etc.) and nutrition classes (healthy cooking, etc.) held at Government Centers (Lower, Middle and Upper Keys) • Health Designs Wellness Champion (Will address the top 4 risk areas: Diabetes, BMI, Nutrition, Blood Pressure) • Purchases of Goods: Gym equipment at the Gato Building and additional Sit -Stand Workstations. • Age- appropriate wellness examinations — participation incentive $25 per month/$300 per year discount in health insurance premiums for members of the Traditional Plan and a $300 deposit into the Health Savings Account for members in the High Deductible /Health Plan; tobacco users will now be included in the eligibility for this incentive provided they complete an approved tobacco cessation program, in addition to the other requirements (blood panel, wellness exam, and verification form). List of approved tobacco cessation program(s) to be maintained by Employee Benefits staff and regularly communicated to employees. • Annual Biometric Screenings and Online Personal Health Assessment: BOCC and participating Constitutional Officer (Property Appraiser, Court Administration, and Land Authority employees (those covered and not covered by the County Health Insurance) who: A. Attend the annual Health Fair and participate in biometric, blood pressure, cholesterol, blood sugar level and body mass index screenings OR B. Visit their personal physician and obtain biometric, blood pressure, cholesterol, blood sugar level and body mass index screenings (on or between the dates of 11/1/17 to 10/31/18) and complete the on -line personal health assessment by 2/1/19. Will receive 4 hours of personal time. Program Expenditures The 2017 program has an ending balance of $179,095.68. The program is scheduled to receive $50,000 from Florida Blue, per agreement, in the first quarter of CY2018. Total 2018 beginning balance: $229,095.68. Total projected expenses for the 2018 program are $186,125.12. PREVIOUS RELEVANT BOCC ACTION: Resolution No. 049 -2017; Resolution No. 173 -2017 (see attached copies of both resolutions) CONTRACT /AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval DOCUMENTATION: Resolution 049 -2017 Resolution 173 -2017 2018 65 + Preventive Care Guidelines - 2018 Adult - Child- Preventive Guidelines 2018 WELLNESS PHYSICIAN FORM Florida Blue 3 -year wellness claims cost and est ROI Tobacco Cessation Programs 2018 Florida Blue - Monroe Better You Slide Wellness Preventive screening participation 2017 Wellness Program Funding Chart 2018 2018 Wellness Program - Resolution Summary Wellness Resolution for Jan 2018 - 1.21.18 FINANCIAL IMPACT: Effective Date: 11/1/17 Expiration Date: 1/31/19 Total Dollar Value of Contract: N/A Total Cost to County: $186,125.12 Current Year Portion: $186,125.12 Budgeted: Yes Source of Funds: Florida Blue Wellness Contribution, per contract CPI: Indirect Costs: 4 Hours annual leave per employee who participates in the Personal Health Assessment Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: If yes, amount: Grant: County Match: Insurance Required: Additional Details: The 2017 program has an ending balance of $179,095.68. The program is scheduled to receive $50,000 from Florida Blue, per agreement, in the first quarter of CY2018. Total 2018 beginning balance: $229,095.68. Total expenses for the 2018 program are budgeted at $186,125.12. $186,125.12 for the 2018 program to be spent from the existing Wellness Program Budget 01/17/18 502 -08005 • WELLNESS PROGRAM $0.00 REVIEWED BY: Bryan Cook Completed Assistant County Administrator Christine Hurley 02/01/2018 11:3 6 AM Cynthia Hall Completed Budget and Finance Completed Maria Slavik Completed Kathy Peters Completed Board of County Commissioners Pending 02/01/2018 11:29 AM Completed 02/03/2018 4:13 PM 02/06/2018 12:48 PM 02/06/2018 12:49 PM 02/06/2018 1:10 PM 02/21/2018 9:00 AM RESOLUTION NO. 049 _2017 WHEREAS, currently, the balance of funds contributed by Florida Blue toward wellness prog ra.n s st.knds at approx i mate ly $2 7'),770 f"'We I I ties s Fun d"), and WHEREAS, the County has received the results from the personal health assessments A bv the fall 2015 health fair participants, and the results indicate that the top four at-risk areas 4 1'(N' participants are diabetes, hypertension, cancer and obesity; and , AL " , RESOLU'TION OF"THE BOARD OF COUNTY COMMISSIONERS OF NROE COUNTY, FLORIDA APPROVING AND ESTABLISHING THE 2017 WELLNESS PROGRAM; REPEALING PRIOR RESOLUTION NOS. 369-2011 AND 147-2013; AND PROVIDIN(', FOR AN EFFECTIVE DATE. '*'vHEREAS, it is in the best interests of Plan participants and the plat) that Monroe County adopt a c(,iordinatcd program designed to improve and promote the health of its Plan participants (orou;-rh earN assessments, intervention, education, information, and incentives. particularly targetc;"J - again the top four at-risk areas for health fair participants; and WHEREAS, the Counry desires to use the Weliness Fund on the activities described NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COI.�NTY COMMISSIONERS OF MONROE COUNTY, FLORIDA that: E Packet Pg. 121 Recurnwig Events: ` I Packet Pg. 122 1 Purchases of Goods- R lutio , -20 and 147- are inconsistent with this resolution and are uson 'Nos 269 "Wreby repealed, I D I - — I" '-- ivsolution shall take effect upon adoption. Packet Pg. 123 1 * Mayor George Neu gent Yes Mayor Pro Tem David Rice Yes Commissioner Danny Kolhage Yes Commissioner Heather Carruthers Yes Commissioner Sylvia Murphy Yes ----------------- BOAJOU OF COVITY COMMISSIONERS ■ MONROE COUNTY, FLORIDA B 16 h Mayor W � �� ,��, \�� M 0 1 W � �� ,��, \�� M RESOLUTION NO. 173 _2017 WHEREAS, the County desires to use the Wellness Fund on the activities described 1 - to addition to the items previously authorized by Resolution 049-2017, County staff is authorized to expend up to ninety-thousand dollars ($90,000M) in calendar year 2017 as part of the COUnty'S We] Iness Program in order to create a gym in the Gato Building (Cato zm� Building (i This amount will include any expenses associated with the gym tip to the 1 amount, This resolution shall take effect immediately upon adoption. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the 19"' day of July, 2017. Mayor George Neu gent Yes Mayor Pro Tent David Rice Yes Commissioner Danny Kolhage Yes Commissioner Heather Carruthers Yes Commissioner Sylvia Murphy Yes RUNINLAIX00K. Clerk By: Deputy Clerk BOARD OF COUNTYCOMMISSIONERS OF MONROE COUNTY, FLORIDA k/N 11 mayor w 0 i'- I CZ j re U- Cz BOARD OF COUNTYCOMMISSIONERS OF MONROE COUNTY, FLORIDA k/N 11 mayor Preventive Care Guidelines for ages 65+ F&PPaa B&I Schedule an Annual Wellness Visit or your Welcome to Medicare Preventive Visit with your doctor to discuss preventive screenings and the flu vaccine. Before you go, make sure that your Medicare plan benefits cover these services. Routine Health Guide Welcome to Medicare Preventive Visit Once per lifetime, within 12 months of � first having Medicare Part B coveracie Vision Exam, Glaucoma Screening and Dental Exam I Annually Recommended Diagnostic Checkups & Screenings for At-Risk Patients Annually for ages 55-80; with a 30-pack per year smoker history, current smoker or those who have quits okin within the oast 15 nears Ages 50-75; Screening Colonoscopy every 10 years, FOBT (Fecal occult blood test) every year or FIT-DNA every 2 years, CT colonography every 5 years or Slamoldoscoov every 5 vears M, Ed N nwN 01.1 a I Mammogram (Women only) I Once every 5 years; more frequently if at risk, di scuss with your doctor Skin Cancer Screening. Early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer Discuss with your doctor in the adult aeneral nonulation. Fall Risk/Unintentional ln'ury/Domestic Violence Every visit, or as indicated by Prevention/Urinary Problems your doctor FISMOTIT4 • Immunizations (Routine Recommendations) Ad u It (age 1 Wellness Schedule Be sure to review your plan benefits to determine your costs for these services. CbesitvScreeninci:' Diet/ PhvsicalActivity /BMI'Counseli'na lAnnuallv'> I' Bone Mineral Density Screening and prescribed medication for Oste000rosis I Women beginning at age 65 or older; and in younger women who have an increased risk rnInrorbi'( Cerooninn ;inrl r niincaIinn I Ana ;,1`1-7'S• fnInnncrnnv nr'farad nrnilt hlnnd toct nr cimmnirinrmnv I Pap Test /Pelvic Exam 21 -65 should have PapTest every 3 years or women age 30 -65 should have fnmhlnPd tPetinn PvPn/ 5 vaarc• Qnwz 1)5 +' r)irrijCC with vnlir rinrtnr Luna Cancer Screenina and'Counselina lAaes 55 -80; 30 oack smoker history; current smoker /quit within oast 15' >vears f Skin Cancer Screeninq I Discuss with vour doctor Fall Risk/Unintentional Inj u ry/Domestic Violence Prevention /Seat Raft I Ica I Discuss exercise, home safety and vitamin D supplementation with your doctor ❑nro nimrtntncll ivinn 1M11 I Annirollv'' Flu (Influenza) lAnnually during flu season' Shinnies (7oster) I Aoes 60 +: 1 dose (ner CDC)- Aries 50 +:1 Anse (Florida Rlue Renefits) > Human Papillomavirus (HPV), Measles /Mumps /Rubella (MMR), Physician recommendation based on past immunization or medical history Varicella (Chickenpox) & Hepatitis C (HCV) Infection Screeninq '> * Some immunizations are contraindicated for certain conditions, discuss with your doctor. Children & Adolescents (Birth ~~18 years of age) Wellness Schedule Body Mass Index (BM I): Height and Weight ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Every visit, BMI beginning at age 2 ��| ~~~~~~ ~~~~ ~~-R�"u�H"� "^°~ ~",^°~^^°^°^"�'~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|` annually 'Dental: " ~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ � Diet/PhVsical [We ------un*eJ � = °These are routine immunizations base cdc.gov recommendations. Range of recommended ages for catch-up or certain high-risk groups is at the doctor's discretion base on the member's family history and personal risk factors. °° Dosages determined Uy doctor with the type of brand vaccine used. County of Monroe The Florida Keys in Employee Health Preventive Care - Assessment Acknowledgment Form Effective January 1, 2018 Services provided between: 11/1/2017 through 10/31/18 Employee Name: (Please Print) Male: Female: EMPLOYER: Physician Name: (Please Print) Completion Date: (Please Print) Physician Acknowledgement: My signature below indicates that the following tests, assessments, clinicals indicated, pertain to the employee identified above, have been measured, if I deemed appropriate . The results of which have been reviewed with the employee in accordance with established treatment protocols. Biometrics Information: Check if completed Recommended tests (Not required) if applicable at Ph sicianIs discretion: Wellness checkup/ Physical Comprehensive Metabolic Panel (CPT Codes 80053, 84436, 84479) The below health fair can be done at the County's annual or with your personal physician Vitamin B Height/Weight CBC Blood Pressure: 'Systolic/Diastolic CMP Cholesterol : LDL /HDL /Tri I'cerid+es TSH Blood Sugar Level Bilirubin screenin Body Mass Index BMI HBA1c if diagnosed diabetic Required Preventive Screenings discussed with Physician. If screening is recommended and done at a different office (such as a hospital), proof of procedure /visit with name of patient and date of procedure must be attached to this form. Mammogram: Annually at ages 40+ OR Not required at this time (age, screening given within past year, etc.) Pap Test /Pelvic Exam: Women age 21 -65 every 3 years or women age 30 -65 Pap Test/HPV combined every 5 year Ages 65+ discuss with doctor OR Not required at this time ME Screening for Colorectal Cancer: Ages 50 -75 with either a colonoscopy, fecal occult blood test or sigmoidoscopy Not required at this time Page 1 of 2 Approved BOCC 2/21/18 Abdominal Aortic Aneurysm Check: One -time men ages 65 -75 who have ever smoked or history of AAA OR OR Not required at this time Lung Cancer Screening: Ages 55 -80; 30 pack smoker history, current smoker /quit within past 15 years Not required at this time Bone Mineral Density Screening and prescribed medication for osteoporosis: Women beginning 65+ and in younger women who have increased risk OR Not required at this time Prostate Cancer Screening: Discuss with doctor Skin Cancer Screening: Discuss with doctor HIV and other Sexually Transmitted Infections (STIs): Discuss with Doctor Doctor: I have given the patient the results of these tests and the employee has been counseled on the results and necessary follow up to prevent further health issues: Physician Signature: Date: Physician Address: Physician Phone #: Please give patient a copy of this form, completed by physician and mail completed, signed form to: Monroe County Employee Benefits Office Gato Building, 2 nd Floor, Room 268 1100 Simonton Street Key West, FL 33040 EMPLOYEE SIGN BELOW: I hereby certify that I do not currently use tobacco products and agree to remain tobacco free while participating in the Wellness Program. Tobacco products are defined as cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, dip, electronic or e- cigarettes that contain nicotine or any other product that contains tobacco or nicotine. Nicotine replacement products such as gum and patches are also considered tobacco products. I further understand that I may be subject to testing to verify non -use of tobacco products. A refusal to submit to a test is considered "positive" for tobacco use. I hereby certify that I currently use tobacco products, and have completed a qualified tobacco cessation program during the wellness program period and have attached a copy of documentation verifying my participation (certificate /letter). Tobacco products are defined as cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, dip, electronic or e- cigarettes that contain nicotine or any other product that contains tobacco or nicotine. Employee Name Employee Signature Date Submitted to County on: Date Received by Employee Services Employee Name /Signature: Date: Page 2 of 2 Approved BOCC 2/21/18 Summary of Wellness/Cancer Preventive Screenings incurred: 10/01/2014 -09/30/2017 Report Date: 01/15/2018 Report contains Florida Blue proprietary & confidential information Grand Total 4,821 $1,254,792.39 Estimated R01 over the 3 year period $7,528,752 OCT14-SEPT15 ADULT WELLN ESS EXAM 460 $75,874.34 BREAST CANCER SCREENING 262 $98,808.22 CERVICAL CANCER SCREENING 62 $3,513.06 . CCILCIRECTAL CANCER SCREENING 160 $174,612.79 OCT14-SEPT15 Total 1,468 $352,808.41 OCT15-SEPT16 ADULT WELLN ESS EXAM 530 $87,987.02 BREAST CANCER SCREENING 302 $139,858.10 CERVICAL CANCER SCREENING 58 $3,443.90 COLORECTAL CANCER SCREENING 182 $240,353.24 OCT15-SEPT16 Total 1,788 $471,642.26 OCT16-SEPT17 ADULT WELLN ESS EXAM 556 $95,435.33 BREAST CANCER SCREENING 304 $145,250.46 CERVICAL CANCER SCREENING 62 $3,344.61 COLORECTAL CANCER SCREENING 152 $186,311.32 OCT16-SEPT17 Total 1,565 $430,341.T2 Grand Total 4,821 $1,254,792.39 Estimated R01 over the 3 year period $7,528,752 Monroe County Employee Services — Employee Benefits Approved Tobacco Cessation Program Effective 1/1/2018 AHEC — Area Health Education Centers — Quit Smoking Now program http: / /ahectobacco.com/ 6 -week in- person group sessions held in Key West, Big Pine Key, Marathon, Tavernier http : / /www.ahectobacco.com /calendar -2/ (select Monroe County from the drop down — other programs available throughout Florida) 877 - 848 -6696 No cost to employees Note: Phone and web -based coaching quit programs are not approved to qualify for the health insurance premium discount or health savings account deposit defined in the Wellness Program. Employees wishing to submit other tobacco cessation programs for potential inclusion in the Wellness Program should contact: Maria Gonzalez, Benefits Administrator, at 305 - 292 -4448 / gonzalez -maria @monroecounty - fl.gov or Bryan Cook, Employee Services Director, at 305 - 292 -4458 / cool< -bryan @monroecounty- fl.gov Is .................... 0 .................... Irwyeawe in overad wKirms swe and PsTsonk AW Ansessmen (PHAJ pankiyukhan ow"he QBt 3 ypwv 0 3 6 M in 201s in 2016 longer Cvs, 2 -3 1 0." 11 dicin't out of the wilho wittemind the event vvere ry) of the! h;-'�d � attend, 6 Offer [Tobetes Preventkw 8, Towgeted BP Pnjywn Ar all wRh hQh blood pressire 140/90 and greaterviz wellronss presentations/ NIS RNI Program, FPacket I L,TW inambes to WwWor change sund outcorncms PREVENTATI 2016 EMPLOYERS 2016 TOTAL EMPLOYEES 2016 Employee Participation 2016 Employee Percentage MC SHERIFF OFFICE 532 17 3% COUNTY CLERK 73 10 141 TAX COLLECTOR 52 8 15% PROPERTY APPRAISER 38 5 13% SUPERVISOR OF ELECTIONS 9 4 44% COURT ADMINISTRATION 21 3 14% LAND AUTHORITY 3 2 67% BOARD OF COUNTY COMMISSIONERS 508 59 12% Total 1236 1081 9% BOARD OF COUNTY COMMISSIONERS 2017 Participal DEPARTMENT PARTICIPATION Guardian Ad Litem 1 County Administrator 9 Project Management 8 Budget & Finance 8 Planning & Env Resources 27 Roads & Bridges 27 Engineering 7 Facilities 67 ,Employee Services 11 Code 15 Solid Waste 15 Library Services 41 County Attorney 16 Technical Services 13 Airport Services 15 Social Services 30 Building 41 Fleet 16 BOCC 11 Veteran Affairs 7 Emergency Services 138 Extension Services 1 Total 524 LIE SCREENINGS 2017 2017 TOTAL EMPLOYEES 2017 Employee Participation 2017 Employee Percentage 511 175 34% 76 31 41% 53 36 68% 37 21 57% 9 7 77% 22 12 55% 3 3 100% 524 208 40% 1235 1 493 1 40% 1 1 ion by Department 0 0% 4 44% 5 63% 2 25% 16 59% 13 48% 5 71% 25 37% 8 73% 7 47% 7 47% 20 49% 7 44% 4 31% 8 53% 15 50% 6 15% 3 19% 5 45% 5 71% 43 31% 0 0% 208 40% Benefit given for participation $25 /Month - $300 /year savings on health insurance $25 /Month - $300 /year savings on health insurance $25 /Month - $300 /year savings on health insurance $25 /Month - $300 /year savings on health insurance $25 /Month - $300 /year savings on health insurance PLUS 8 hours time off $25 /Month - $300 /year savings on health insurance $25 /Month - $300 /year savings on health insurance $25 /Month - $300 /year savings on health insurance Wellness $ received from Florida Blue based on contract Nov 2011 - $40.000 June 2015 - $5,000 Nov 2015 - $100,000 Feb 2016 - $75.000 Feb 2017 - $75,000 Feb 2018 - $50,000 Total Description of Expenditure Lunch & Learns 2013 Health Designs 2014 Health Fair Snack /Water 2014 Health Designs added labs 2014 Health ;Fair Snack 2014 Health ;Fair Supplies 2014 Lunch & Learns 2015 EAP Snacks /Waters Health Fair Supplies/Prizes 2015 Health ;Fair Snacks /Water 2015 Snack Reimburement - Ma Passport Checklist Printing 2015 Health Designs added labs 2015 Grand Prize bike 2015 Marriott Beachside Room Rental 2016 Lunch & Learns 2016.1 Lunch & Learns 2016.2 Travel Reimbursement MM & NM Health Fair Supplies/Prizes 2016 Passport Postcard Print & Mail Hotel Room Health Fair 2016 Health ;Fair Snacks /Waters 2016 Karen Pleasant St Desk 2017 t Health Designs added labs 2016 Race Reimbursement 2012 Race Reimbursement 2013 Race Reimbursement 2014 Race Reimbursement 2015 Race Reimbursement 2016 Race Reimbursement 2017 Grand Prize Bikes; 3 2016 Lunch and Learn #1 water and boxed lunches 2017 Lunch and Learn #2 water and boxed lunches 2017' Wellness Con rats Letter Jan ''2017 Postage Gym Equipment ment (Sheriff 'Interldcal Agreement) 2017 Sit -Stand Workstations 2017 Travel and Per Diem NM & MM for Lunch and Learns 2017 Other Phone and Postage Wellness Form Mailings) 2017 Health Fair Prizes 2017 Wellness Champion Health Designs) 2017 Health and Wellness Fair Invitation mailing 2017 it t Expected Program Balance for 12/31/18 Wellness Future Pavments due from Florida Blue based on contract Feb 2019 - $50,000 Expected Proaram Balance for 2019 Revenue nditures ii • ii, 1 $42,970.561 92.970.56 Employee Benefits 2018 Wellness Program — Resolution Overview • Health and Wellness Events • Employee participation during work • Participation Incentives • Wellness Exam and Age- Appropriate Screenings • Purchases of Goods f� t t Di t January 17, 2018 Employee Benefits 2018 Wellness Program - Events f� t January 17, 2018 Employee Benefits 2018 Wellness Program - Events f� t January 17, 2018 Employee Benefits 2018 Wellness Program — Employee Participation f� t January 17, 2018 Employee Benefits 2018 Wellness Program - Incentives f� t January 17, 2018 Employee Benefits 2018 Wellness Program — Wellness Exam January 17, 2018 Employee Benefits 2018 Wellness Program — Wellness Exam (cont.) I January 17, 2018 Note: Separately, the $100 per month / $1,200 per year surcharge still applies for tobacco users until able to attest nonuse. Employee Benefits 2018 Wellness Program — Purchases of Goods f� t t Di t January 17, 2018 Gato Building Gym — $90,000 for Gato Building Gym — $90,000 for Continue' into 2018, expect to construction/renovation and purchase of construction /renovation' and purchase of complete item.' equipment — not completed equipment Employee Benefits 2018 Wellness Program Cancellation or Modification f� January 17, 2018 Employee Benefits 2018 Wellness Program — Conclusion • Questions? • Backup Slides Follow f� t January 17, 2018 Employee Benefits ; . 2018 Wellness Program — Backu t • Community Organized Event Reimbursement • Due to low interest and participation, it is recommended that this item be reduced to $2000. • Only 4 employees participated in marathons and sought entry -fee reimbursement under the 2017 Wellness Program. Total reimbursement was $189 of $5,000 budgeted. • The opportunity was publicized at least three times in 2017. January 17, 2018 Employee Benefits5 2018 Wellness Program — Backu t • Lunch and Learn Events • Twice per year • Held in lower, middle, and upper Keys • Two health and wellness topics /sessions available at each lunch and learn • Topics prepared and presented by Florida Blue with input from Employee Benefits • Early lunch session at 11:00 am; Late lunch session at 1:00 pm • Lunch provided; no more than $13 per person; one lunch per person, per day • Wellness and Exercise Classes • Exercise and fitness, nutrition, healthy choices, disease management • Upon approval we will complete instructor indemnity and participant waiver January 17, 2018 Employee Benefits ; . 2018 Wellness Program — Backu t • Health and Wellness Fair • Once per year in September • 2017 Health Fair cancelled due to Hurricane Irma • Held in lower, middle, and upper Keys • Multiple vendors provide information and activities related to: health, wellness, nutrition, exercise, healthy lifestyle choices, conduct biometric screenings • Wellness Champion • Representative from Health Designs, Inc. serves as an extension of Employee Benefits team. • Work site visits, presentations at lunch and learns and health fairs, regular information sharing via electronic and print communications. January 17, 2018 Employee Benefits ; . 2018 Wellness Program — Backu t • Health and Wellness events occurring during work • Since good health contributes to workforce readiness and lower absenteeism, it is recommended that employees be allowed to attend health and wellness events during the workday with pay and without a requirement to use annual leave. • Participation during the work day is consistent with the Personnel Policies and Procedures Manual regarding participation in Blood Drives during work. January 17, 2018 h Employee Benefits� 2018 Wellness Program — Backu t Biometric Screenings • Required: • Physician's Option • Wellness checkup /Physical • Vitamin D • Height /Weight • Vitamin B • Blood Pressure: Systolic /Diastolic • CBC • Cholesterol: LD L/H D L/Triglyce rides • CMP • Blood Sugar Level • TSH • Body Mass Index (BMI) • Bilirubin Screening • Kidney, Liver, Thyroid - new • HBA1C —if diagnosed diabetic Note: One change Kidney, Liver, Thyroid added to blood panel for 2018. i .......... P January 17, 2018 Employee Benefits5 2018 Wellness Program — Backu t Wellness Exam /Age- Appropriate Screenings • 2017 • Mammogram (Annually age 40 +) • Pap Test (every 3 years ages 21 -65) • Colorectal Screening (Ages 50 -75) • Abdominal Aortic Aneurysm Check (men, age 65 -75 if ever smoked) • Lung Cancer Screening (age 55 -80; 30 pack smoker history, or quit within last 15 years • Bone Mineral Density Screening and prescribed medication for osteoporosis (women age 65 +) • Prostate Screening (discuss with doctor) • Skin Cancer Screening (discuss with doctor) 2018 • Mammogram (Annually age 40 +) • Pap Test (every 3 years ages 21 -65) • Colorectal Screening (Ages 50 -75) • Abdominal Aortic Aneurysm Check (men, age 65 -75 if ever smoked) • Lung Cancer Screening (age 55 -80; 30 pack smoker history, or quit within last 15 years • Bone Mineral Density Screening and prescribed medication for osteoporosis (women age 65 +) • Prostate Screening (discuss with doctor) • Skin Cancer Screening (discuss with doctor) • HIV and other Sexually Transmitted Infections (as appropriate) January 17, 2018 Employee Benefits ; . 2018 Wellness Program — Backu t • Tobacco users • Tobacco users who complete both the wellness exam and complete at least one qualified tobacco cessation program within the year (documentation required) will be eligible for the $300 /year incentive. • Tobacco users would still pay the $1,200 /year ($100 /month) surcharge until able to attest nonuse of tobacco. (This is a separate benefit specification that is not attached to the Wellness Program) • Rationale: • Tobacco users are susceptible to diseases and conditions that may not be directly correlated with tobacco use. Certainly they are susceptible to diseases with a correlation to tobacco use. • Early detection of any disease can improve the outcome for the individual and reduce the overall claims cost for treatment. • The $300 provides an incentive for tobacco users to get the wellness exam done. • Requirement to complete of a cessation program increases the likelihood of the employee quitting tobacco, leading to fewer tobacco users on the plan, and eventually, lower rates of diseases caused by tobacco and reduced claims cost. January 17, 2018 Employee Benefits 2018 Wellness Program — Backup f� t t t • MCSO Gym Equipment • $35,269.54 spent for MCSO facility gym equipment, to which all County and Constitutional Officer employees and retirees have access • 70 non -MCSO employees registered to use the gym in 2017 • Project complete. Resolution closes this item. • Gato Building Gym • Project delayed from 2017 to 2018; need to roll funds forward ($90,000) • Equipment is on order; renovations underway in 2018 • Sit -Stand Desktop Work Stations • 2017: $50,000 budgeted; $40,874.88 spent in 2017 on 80 workstations. • Remaining $9,125.12 will be rolled forward into the 2018 program. • Additional 63 workstations are currently requested. • Allocate $25,000 to the 2018 program in order to complete and close the project. January 17, 2018 RESOLUTION NO. -2018 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA APPROVING AND ESTABLISHING THE CALENDAR YEAR 2018 WELLNESS PROGRAM; REPEALING PRIOR RESOLUTION NOS. 049 -2017 AND 173 -2017; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, beginning in 2015, the contract between Blue Cross Blue Shield of Florida ( "Florida Blue ") and the County, whereby Florida Blue serves as the Administrative Services Only administrator (ASO) for the County's self - insured health insurance plan ( "Plan ") has provided that Florida Blue will contribute an annual amount toward the County's wellness - related initiatives and activities, consisting of $100,000 at execution of the agreement, $75,000 on each of January 1, 2016 and January 1, 2017, with additional contributions of $50,000 on each of January 1, 2018 and January 1, 2019 (subject to a rebate of $150,000 if the County terminates the agreement prior to January 1, 2020); and WHEREAS, currently, the balance of funds contributed by Florida Blue toward wellness programs stands at approximately $179,095.70 ( "Wellness Fund "); and WHEREAS, the County has received the results from the personal health assessments completed by the fall 2015 and 2016 health fair participants, and the results indicate that the top four at -risk areas for participants are diabetes, hypertension, cancer and obesity; and WHEREAS, it is in the best interests of Plan participants and the plan that Monroe County adopt a coordinated program designed to improve and promote the health of its Plan participants through early assessments, intervention, education, inforination, and incentives, 00 particularly targeted against the top four at -risk areas for health fair participants; and WHEREAS, the County desires to use the Wellness Fund on the activities described below. NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA that: 1. In calendar year 2018, the Monroe County Wellness Program shall consist of the following items, which shall be paid for from the Wellness Funds contributed by Florida Blue pursuant to its contract with Monroe County and the existing Wellness Fund. All such purchases must be finalized within calendar year 2018. Recurring Events: a. Community Organized Event Reimbursement: All employees covered under the County's health insurance plan are eligible to be reimbursed their registration fees in an amount not to exceed one hundred dollars ($100.00) annually upon Page 1 of 6 presentation of proof that the individual has registered for and has completed community organized foot, bicycle, or swimming race that takes place in the Florida Keys, including but not limited to marathons, triathlons, run/walkathons, and bikeathons. Said requests for reimbursement shall be handled on a "first come first served" basis up to a maximum cumulative expenditure of one thousand dollars ($2,000.00). All request for reimbursements must be submitted to the Employee Benefits Department no later than January 11, 2019. b. "Lunch and Learn ": The County's Benefits office will schedule education "lunch and learn" activities throughout the Florida Keys, twice per year, offering presentations on a variety of wellness topics. Staff will purchase healthy food items for consumption by active employees who attend and complete scheduled activities. The maximum cumulative expenditure of Wellness Funds under this resolution shall not exceed thirteen dollars ($13.00) per individual per meeting, up to a maximum cumulative expenditure for all Lunch and Learn events of five thousand dollars ($5,000.00). c. Wellness and Exercise Classes: Wellness Funds will be used to provide free wellness, exercise, and nutrition classes for employees and their dependents over age 18 covered under the County's health insurance plan. The classes and events will consist of different types of wellness and exercise, including but not limited to Yoga, Zumba and Pilates, and nutrition/healthy cooking classes. These classes will be held at various County buildings with external instructors. Wellness Funds will be used to compensate the instructors and purchase supplies. The maximum cumulative expenditure for Wellness Funds used on all Exercise Classes during CY 2018 shall be twenty thousand dollars ($20,000.00). d. Annual Health & Wellness Fair: Each year, Monroe County Benefits office CO coordinates the Monroe County Health & Wellness Fair. The fair is presented in three (3) locations (Upper, Middle and Lower Keys /Key West). Any active r employees of any of the employers participating in the Plan and their covered p, dependents over age 18, retirees and their covered dependents over age 18 may R o attend. In 2015, 335 employees attended the Annual Health & Wellness Fair; an additional 32 employees filled out the on -line preventive health assessment. In 2016, 369 employees attended the Annual Health & Wellness Fair; an additional 29 employees filled out the on -line preventive health assessment. Even though the o 2017 Annual Health & Wellness Fairs were cancelled due to the impact of Hurricane Irma, as of September 4, 2017 (3 weeks prior to events), the reservations to attend the events were over 50% filled; indicating that participation was on track for its highest level to date. The Annual Health & U) Wellness Fair is a great opportunity to obtain basic diagnostic tests at no cost, as well as to obtain a flu vaccine and other health and wellness information from the Z County's health plan vendors. Wellness Funds will be used to purchase prizes that promote healthy living (i.e., bicycles, fitness trackers, smoothie makers) for 0 participants who attend one of the Health & Wellness Fairs and complete their Passport to Wellness. There will also be a cost for the use of the facilities where the Health & Wellness Fairs will be held in the lower, middle and upper keys and Q Page 2 of 6 Wellness Funds will also be used for that purpose. The maximum cumulative expenditure for Wellness Funds used on the Annual Health & Wellness Fair shall be fifteen thousand dollars ($15,000.00). e. Health Designs, Inc./ Wellness Champion: Wellness Funds will also be used to pay for a consultant with expertise in health benefits, to serve as a Wellness Champion. The consultant shall serve as an extension of Monroe County Benefits staff and shall be an advocate to explain features of the Monroe County Wellness program, provide Wellness topic presentations, and provide health and benefit information to employees of the BOCC and the constitutional officers who are members of the Monroe County health plan. The consultant will be visiting at least 50 locations at which the employees are employed, in Upper, Middle and Lower Keys, on at least a quarterly basis. In calendar year 2018, approximately $ 19,998.00 in Wellness Funds will be spent on Health Designs. The program and contract for this program ends June 30, 2018, and will be reviewed by Employee Benefits staff for renewal or bid. An amount of $20,000 shall be allocated for this item in the CY 2018 Wellness Program. Employee Participation in Wellness Events: f. To the extent that business operation allows, employees will be allowed to participate in Health & Wellness events, including but not limited to Annual Employee Health & Wellness Fairs and Lunch & Learns that are held during scheduled work hours without the use of vacation, sick or comp time. Employees should attend during normal scheduled work time /hours. Employees voluntarily choosing to attend prior to or after scheduled work hours is not compensable. Health & Wellness Rewards: g. Biometric Screenings: Four hours of annual leave to Monroe County BOCC employees and participating Constitutional Officer (Property Appraiser, Court Administration, Land Authority and Clerk of Court) employees who participate in the annual Health & Wellness Fair (minimum participation of biometrics and health coach visit) or visit their personal physician and complete the online Personal Health Assessment. Leave will be deposited the first payday in April, following the use -it or lose -it date each year. Participation in the Monroe County Health & Wellness Program is voluntary. h. Annual Wellness Exam and Age Appropriate Screenings: Participating employees on the traditional Health Plan will receive $ 25.00 per month ($ 300 per year) premium discount in 2019. Participating employees on the High Deductible Health Plan with Health Savings Account (HDHP /HSA) will receive $300 deposited into their Health Savings Account in 2019. To be eligible for the discount (BOCC and participating Constitutional Officer) employees must visit their personal physician for an annual wellness exam and obtain the required age appropriate preventive screenings, determined by staff and specified on the Employee Health Preventive Care — Assessment Acknowledgement Form. 9 Page 3 of 6 Traditional Health Plan: Employees paying $ 50.00 per month for premiums will be reduced to $ 25.00 and those paying $ 75.00 per month for premiums will be reduced to $50.00 per month. These discounts are administered on the employee direct deposit pay statements or pay checks. ii. High Deductible Health Plan with Health Savings Account (HDHP /HSA): Employees on this plan pay zero in premiums, so a monthly discount does not apply. Instead employees on the HDHP /HSA will receive $300 deposited into their Health Savings Account. Employees who attest to tobacco use are now included in the ability to earn the § employee health insurance premium discount (Traditional Health Plan) or ° contribution to HSA (High Deductible Health Plan with Health Savings Account). c To be eligible beginning 1/1/2019, in addition to the age appropriate screenings required for all participants, those attesting to tobacco use, must voluntarily participate and complete at least one approved tobacco cessation program (programs vary in length) during the wellness program period of the prior year o (November 1, 2017 — October 31, 2018) and submit a certificate or letter of - participation /completion from the facilitating program. No -cost cessation a programs are offered throughout Monroe County and South Florida by various S organizations. Employee Benefits Staff will maintain and regularly communicate a list of approved tobacco cessation program(s). Employees inside or outside of r' 0 Monroe County who are interested in another tobacco cessation program not N listed may submit the program name and contact information in writing to the ° Benefits Administrator or Employee Services Director for eligibility review. > Employees must receive approval of other tobacco cessation programs in advance in order for participation in those programs to qualify the employee for the premium discount or HSA deposit. Envision Rx Options, Monroe County's «, prescription plan provider also supports tobacco cessation and covers tobacco cessation products (patch, gum, Rx). Employees are not limited in the number of r attempts to become tobacco free during a calendar year. Participation in wellness 00 and cessation programs are completely voluntary. o Purchases of Goods: Gym Equipment - Monroe County Sheriff's Office: Close item effective 12/31/2017. Purchase completed and equipment is in use. No additional funding requested or included in CY 2018. Approximately 70 employees /retirees requested and received access to the Monroe County Sheriffs Office Gym facilities during calendar 2017. In 2017, the Monroe County Sheriff's Office proposed that the County pay thirty -five thousand, two hundred sixty -nine dollars and fifty -four cents ($35,269.54) to purchase additional gym equipment for the Plantation Key gym. In return, all employees and retirees of Monroe County Board of County Commissioners (`BOCC "), Monroe County Land Authority, and the constitutional officers (Property Appraiser, Supervisor of Elections, Clerk of Court, Tax Collector, and Sheriff) who are participants in the Monroe County Page 4 of 6 health plan ( "Employees and Retirees ") have access to the Sheriff's gyms in all three locations (Key West, Marathon, and Plantation Key). j. Sit -Stand Desktop Workstations: Over 80 BOCC employees expressed an interest in a Sit -Stand Desktop Workstations and are currently using workstations. Wellness Funds were used to make a purchase of up to one hundred (100) Workfit -TL sit -stand desktop workstations and up to one hundred (100) active mats. The maximum cumulative expenditure of Wellness Funds allocated to be used on this equipment in calendar year 2017, was fifty thousand dollars ($50,000.00). In calendar year 2017, a total of $ 40,874.88 in wellness funds were used for the purchase Sit -Stand Workstations and mats. In addition to the original request of over 80 Sit -Stand Desktop Workstations and mats, requests for an additional 63 have been received in 2017. A total of $ 9,125.12 from calendar year 2017 will be applied in calendar year 2018. In order to fulfill requests and close the program, an additional $ 25,000 will be needed to be allocated from wellness funds in calendar year 2018. k. Gato Building Gym: In CY 2017, county staff was authorized to expend up to Ninety- thousand dollars ($ 90,000.00) in calendar year 2017 as part of the u County's Wellness Program in order to create a gym in the Gato Building (Gato a Building Gym). The Gato Building Gym shall be open to all employees and � retirees in Monroe County Board of County Commissioners ( "BOCC "), Monroe County Land Authority, and the constitutional officers (Property Appraiser, N Supervisor of Elections, Clerk of court, Tax collector and Sheriff) who are ° participants in the Monroe County health plan ( "Employees and Retirees "). The o County shall purchase and have ownership of the equipment. County staff shall establish reasonable rules for use of the gym, including but not limited to hours of operation, and may condition use of the gym on execution of documents by the 00 gym users waiving and releasing the County from any liability for the voluntary activity. As project is not yet completed, these funds shall be rolled forward into r calendar year 2018 to allow for project completion. c o Cancellation or Modification of Wellness Program In 2017 the BOCC directed staff to issue separate Requests for Proposal in 2018 for 1) a Fully Insured Health Plan and 2) a Third Party Administrator (TPA) or ASO to administer the self - funded Health Plan. The annual $50,000 budgeted for the Wellness Program is contributed by Florida Blue as part of the existing ASO agreement. Should the County's Health Plan change as a result of the RFP's, it may become necessary to cancel or modify the Wellness Program. If so, staff will bring such actions before the BOCC. 2. Resolution Nos. 049 -2017 and 173 -2017 are inconsistent with this resolution and are hereby repealed. 3. This resolution shall take effect upon adoption. Page 5 of 6 PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the 17th day of January 201 S. Mayor David Rice Mayor Pro Tem Sylvia Murphy Commissioner Danny Kolhage Commissioner George Neugent Commissioner Heather Carruthers (SEAL) ATTEST: BOARD OF COUNTY COMMISSIONERS KEVIN MADOK, Clerk OF MONROE COUNTY, FLORIDA By: Deputy Clerk By: Mayor 9 Page 6 of 6