1. Health Promotion for Municipal
Employees – Leveraging Resources in
Tough Economic Times
HP Career Net Webinar
December 13, 2012

2. Today’s Learning Objectives
Participants will be able to:
1.Learn how the Monterey County Health Department leverages
resources, operating on a foundation of simplicity…and provides
wellness resources and programming to meet the interests and needs
of its employees.
1.Recall 3-5 ways in which Monterey County Health Department’s
employee health initiative partners/builds relationships with the County,
its employees and the community.
2.Identify ways in which Monterey County Health Department
communicates its programming components, goals, and outcomes to
its stakeholders.

3. County of Monterey
• Founded 1850—one of the original counties in California
• Industry: Local Government
• 4300 employees
• Over 80 work locations scattered
throughout 3,771 square miles of
agricultural, military, recreational/
wilderness/parks, and urban land

4. A Long Time Commitment to
Employee Wellness
• Created in 1985 by the County
Board of Supervisors as a partnership
between Management, Labor, &
Employees
• To address employee health and safety,
health insurance costs and Workers
Compensation claims
• All (4300) regular full/part time (benefited) employees
eligible to participate, select programs open to family
• Program available in 100% of work locations

5. Program Model
MC Program Today
Health & Productivity
Quality of Work Life Traditional or Conventional
Management
•Add productivity focus
•Fun activity focus
Health focus •Strong risk reduction
•No risk reduction
Some risk reduction •Strong cost management focus
•Site based
Weak personalization •Some required activity
•Minimal incentives
Modest incentives •Personalized
•No evaluation
Weak evaluation •Strong evaluation
•No personalization
•Site and virtual based
 Sample Activities
•Sample Activities
 Health risk assessments •Sample Activities
 Health Fair
 Health screenings  Health Coaching (telephone/live)
 Workshops/Classes
 Web based health information  Benefit linked incentives
 Brochures
 Wellness newsletter  Achievement incentives
 Wellness Library
 Incentive campaigns  Integrated programming
 Resiliency initiative for productivity
MC Program 1980’s
Chapman: 2006: Absolute Advantage Planning Wellness—Getting off to a Good Start Vol. 5:4. pp.17-58

6. Our Mission
•Increase employees' knowledge
about health & prevention
•Encourage employees'
involvement in their own health
decisions
•Encourage employees' adoption
of healthy habits, and
•Facilitate recommendations for
organizational change that
promote a safe and healthy work
environment

7. Program Goals
•Improve employee morale
•Increase presenteeism
•Improve productivity
•Help contain Workers
Compensation claims and costs
•Reduce absenteeism
The Health Promotion Partnership works to create a healthy
workforce and a healthy workplace for all Monterey County
employees

8. Provides Programs in 7 Areas
1. Eating & Weight Management
2. Physical Activity
3. Smoking Cessation
4. Stress /Resiliency
5. Healthy Pregnancy &Parenting
6. Managing Work and Life
7. Managing My Health

9. Delivery Approach #1: Basic
Wellness
Awareness and Education: workshops, campaigns, and interventions
constantly evolving to meet the changing needs of employees.
• Website/health portal • Resiliency Training
• Workshops • Policy Support &Technical Assistance
• Wellness Library • Health/Wellness Fairs
• Employee Wellness Newsletter • “Take the Stairs” signage and tool kits
• Monday Health Tips • Department specific trainings/workshops
• Onsite Weight Management, Smoking for employees & managers/supervisors
Cessation, and Physical Activity
programs
• Gym Discounts

10. Delivery Approach #2: “Just for
You” Wellness
• Voluntary health risk assessment s provide customized health report
& specific strategies to improve current health behaviors.
• For those with chronic health issues, confidential, specific support is
provided to help each employee better manage their condition.
– Health Risk Assessments & Screenings
– Individual health advisement/consultations and referral
– Online health improvement and chronic condition
management classes/self directed programs
– Educational self study Tool Kits on multiple health topics
–
– Nutritional Consultation from Registered Dietician

11. Objective #1
• Learn how the Monterey County Health Department leverages
resources, operating on a foundation of simplicity…and provides
wellness resources and programming to meet the interests and
needs of its employees.

12. The Foundation: Strategic
Planning
If You Don’t Know Where You’re Going, You’ll Waste a Lot of Money
Getting Anywhere
Step 1: Assessment
• Best practices in wellness industry
• Best practices in public sector wellness
• Monterey County employee health risk data
• Monterey County organizational data
• Management/HR interviews
• Employee surveys
• Employee Wellness Council

13. Step 2: Gap Analysis
1. Health risks increase risk of chronic disease.a
• MC levels are above national/regional standards.
2. Management support/buy-in critical for success.b
• Managers do not always have program/outcomes information.
3. Participation drives outcomes.c
• Current levels make outcomes difficult to achieve.
4. Work environment/culture critical(2.5x more health risk reduction).d
• Opportunities exist to make workplace more supportive of
health
a, http://www.healthypeople.gov
b. Partnership for Prevention, 2007/ www.prevent.org
c. Edington & Shultz, 2008. The Total Value of health: A Review of the Literature. International Journal of Workplace
Health Management
1:1(8-19)
d. Terry et al. 2008. Association Between 9 Quality Components & Superior Worksite Health Management Program
Results. JOEM 50: 633-641

14. Step 2: Gap Analysis
5. Marketing is crucial to participation.e
• Need for improved branding, communication
6. Employee/Department needs exceed existing staffing resources.
• Operational efficiency & scalability needs to be improved
7. Fiscal resources threaten ability to provide best in class wellness to
employees/Department.
• Address/improve fiscal sustainability
8. Evaluation key to maintaining wellness programming.f
• Some data not current, has not been recently analyzed,
Management not aware of HPP outcome metrics.
e. Wong et al 2000. The Influence of Job Stress and Supervisor Support on Negative Affects and Job Satisfaction…Journal of Social Behavior
and Personality. 15:85-98.
f. Chapman, 2005. Meta-Evaluation of Worksite Health Promotion Economic Return Studies. The Art of Health Promotion 2005 Update.

15. Step 3: Priorities
If You Don’t Have a Lot, Spend the Money Where It Counts
1. Health Risk Reduction/Condition Management
2. Management Support and Buy-in
3. Participation
4. Supportive Environment
5. Communication, Marketing, & Promotion
6. Operational Efficiency & Scalability
7. Fiscal Sustainability
8. Evaluation

16. Step 4: PLAN & Approach:
Leading in Business by Leading
in Health

17. Plan the Work….and Work the Plan

18. Business Alignment
A Critical Step to Getting & Keeping Financial Support
Monterey County Business Priorities: Wellness Alignment:
• Service provision Supports all departments/wide menu of services
• Cost reduction Fiscal Sustainability Initiative
Health Dept. Strategic Plan: Wellness Strategic Plan Initiatives:
“Improve health through programs and policy”
• Emphasize prevention Population Health/Risk Management
• Health in all policies Supportive Environment
• Integrated approach Wellness “Connect” Referral Model
• Realign/improve efficiency of programs/services Efficiency Initiative
• Evaluate systems/changes Evaluation Initiative

19. Monterey County Opportunity Index
Health Risk Prevalence Headcount # of EEs Excess Cost Excess Readiness Opportunity
Affected per Annual Cost to Change Index (Cost
(BxC) Condition (D x E) Savings)
per ee/yr** (F x G)
High Blood 26% 4543 1181 $1020 $1,204,620 20% $240,924
Pressure
High 25% 4543 1136 $712 $808,832 10% $80,883
Cholesterol
High Blood 12% 4543 545 $2271 $1,237,695 18% $222,785
Sugar
Overweight/ 74% 4543 3362 $1872 $6,293,664 20% $1,258,732
Obese
Sedentary 53% 4543 2408 $1110 $2,672,880 35% $935,508
Tobacco 9% 4543 409 $1117 $456,853 39% $178,172
Stress 45% 4543 2044 $1774 $3,626,056 30% $1,087,817
Depression 26 % 4543 1181 $1579 $1,864,799 27% $503,496
*Adjusted for 40% carve out of health costs (Goetzel et al. 1998. Health Costs Worksite Health Promotion Participants/Non-participants. 40(4): 341-346)
**Whitmar, Goetzel, & Anderson. 1999. The HERO Study on Risks & Costs: Research Findings
Source for County Data: 2009-10 Health Media Health Risk Assessment Executive Report

20. What Can YOU Expect?
Department What if ONE of Avoided Savings ROI for your
minus
Investment your cost/ investment
Department
employees…. savings/yr.*
$78/ee./yr. + Stops smoking $1117 $454.12 $1 : 1.69
12 hrs. x $48.74= Achieves normal $1872 $1209.12 $1 : 2.82
weight?
Becomes active? $1110 $447.12 $1: 1.68
$662.88
*Does not include direct health costs

21. Department of Social &
Employment Services
“The Monterey County Wellness Program is a wonderful resource for
the employees of Monterey County.
The upfront cost per employee is a worthwhile investment in the
productivity, health, well-being and morale of our employees.”
…..Elliott Robinson, Director
Social and Employment Services

22. Leveraging Senior Leadership
Lead by example:
Participate in exercise challenges Attend wellness workshops with their staff,
Schedule quarterly specific trainings for their department Champion staff participation in wellness events
Schedule time for wellness activities into trainings, staff recognition days, all department meetings
Provide recognition to employees for participating in wellness programs:
Host healthy lunches
Certificates/department provided incentives
Integrate wellness in their work environment:
12 hours Wellness work release time annually
Support healthy policies in the workplace
CAO Engagement:
Wellness included in Labor Negotiations
County PPPR Manual wellness content
Board of Supervisors Alignment:
Established program/release time
HHS Committee includes wellness reports
BOS champions wellness initiatives

23. Leveraging Middle-Management
• WC and injury/disability reviews and remedial wellness programming
• Tailored programming and activities for divisional events, employee recognition days,
training/development days
• Recognition for supporting health initiatives such as Exercise Challenge, Fitness Team events and
competitions, and daily exercise for their employees
Featured in “What’s New” and “Success Stories” on Wellness Website
Profiled in Wellness Newsletter
Trophies and certificates of recognition
• Education about association between employee health and productivity and relation to their business:
“So You Want to Be a Supervisor”
“Manager Academy”
“He pointed out that he (Probation Services Manager,
Joe Whiteford) knows he will get twice the productivity
if we stay active and keep in shape.”
……Probation Department Employee

24. Participation is Growing…
2010 2011
Yes 39.9% 58%
No 60.1% 42%
“I have been given tools to handle stress
at work and home better. I have also
been given tools to be a better parent.
Most of all I have been given a different
outlook on life.”
….2011 Wellness Survey
“I appreciate all you do, we really
don't know how lucky we are to have
a county that actually cares about it's
employee's health. Thank you.”
….2011 Wellness Survey

25. Managers/Supervisors are Making
Wellness a Priority for Their Employees!
2010 2011
Yes 35.2% 49.1%
No 34.6% 24.4%
Don’t 30.2% 26.5%
Know
“As a supervisor, I
encourage my staff
to take advantage
of any (Wellness) programs
available to them.”
….2011 Wellness Survey
“He resends the classes that he feels would be good for our department staff and
highly encourages getting out of the office for exercise.”
….2011 Wellness Survey

26. Leveraging POLICY as a Resource
Making it “easy” to be healthy at work
• Smoke/Tobacco Free
• Lactation Accommodation
• Seat Belt/No Cell/Texting (CA law)
• Drug/Alcohol Use and Screenings
• Physical Activity in Meetings, Breaks, and During the Workday
• Healthy Food at Meetings (selection and compensation for purchase)
• 12 Hours Work Release Time for Wellness Activities
• Healthy Vending
• Workplace Violence
• HIV/AIDS

27. Objective #2
• Recall 3-5 ways in which Monterey County Health Department’s
employee health initiative partners/builds relationships with the
County, its employees and the community.

28. County Wellness Referral Model
Wellness Role Referral Partners (Internal)
1. Provide health information, programs & resources Natividad Medical Center
• Wellness Workshops -Wt. loss/obesity
• Department specific trainings -Preventive physical exams/screenings
• Newsletter, Website, Library, Resource Directory -Dieticians/Cafeteria
-Physician experts, lactation support/education
2. Manage risk reduction campaigns for health/lifestyle change
• Health risk assessment/screenings Benefits/Health Plans
• Coaching/Personal Health Improvement Plans -HRAs
• Topical health information campaigns -24/7 Nurse Lines
• Motivate/support healthy behavior change -Disease Management
– Stress management/Resiliency -Speakers, e-health tools, behavior change prog.
– Nutrition/Weight control
– Smoking cessation EAP
– Physical Activity -Counseling/system of care
• Refer to MD/disease & condition management - Alcohol/drug
• Connect to internal/community resources - Stress/crisis resources
3. Support healthy work environments for employees Ergonomics
• Physical Environment - Ergonomics training/workstation assessments
– Bike to Work - RMI prevention
– Healthy Back Care -Remedial/preventive equipment
– Mother’s Rooms
– Health Work Stations Safety
– Healthy meetings - Injury prevention
– Physical Activity guidelines at work - Online training/courses
• Organizational Environment
– Manager & Supervisor/new employee training Human Resources
and New Hire Orientation - Wellness Release Time
– Work stress - Alternative/Flex Work Schedules
– Employee development - Policy (lactation, smoking, vending etc)
– Healthy foods -Training/Development/Manager Training
– Lactation accommodation

29. Building a Bridge with HR/Benefits
• Benefits provides, Wellness promotes avoiding impact on the Wellness budget, and still
providing quality services to employees.
• HR Link presentations each quarter
• One on one meetings with Department HR/Director
• HR Specific Needs and Interest Survey
• Department Specific Wellness Programming
• Cross Promotion
– Benefits links on Wellness Website
– Periodic Health Benefit Communications
– Cross functional task forces
• Wellness messaging in open enrollment packets
• Partner with “Grow Your Own” training site

30. Safety Partnerships
:
• Departmental managers include Wellness education in Safety
Meetings
Back
Working in Hot Environments/Hydration
Sleep Habits
Work Stress
• Wellness promotes annual workstation ergonomics trainings
• Wellness refers employees to annual back safety/back health trainings
• Self-ergonomics assessments, staffed ergonomics evaluations

31. Facilities & Physical Environment

32. Thinking Outside the Box
Digi-Walk: “The Stroll”, “The Hike”, “The Journey”

33. Building Relationships w/Employees
• Health/Wellness Fairs
• Leveraging existing events
• Responding to needs/interests
• Wellness Council
• Surveys
• Table tops/topic related
• Recognition
• Success stories
• Customer Service

34. Community Partners

35. Objective #3
• Identify ways in which Monterey County Health Department
communicates its programming components, goals, and outcomes to
its stakeholders.

36. Communications Matrix
Audience Vehicle Sender Communication Key Message/ Timing Status
Objective Description
All Employees Home Mailing Booklet Wellness Team Increase Awareness “Do you know” Yearly
and Utilization
Managers Managers Tool Kit Department Head Management “Management Skills Quarterly
Supervisors awareness/education and Resources”
Union Presentations Awareness, education “Do you know” Annual
Bargaining One-on-one meetings Branch Chief and buy-in Benefits for their update
Units CAO employee units
Departments Presentations at Wellness Team Increase Awareness “Do you know” Ad-Hoc
department meetings and Utilization
Executives One-on-one meetings HPC Gain buy in and Benefits to the county. Prior to
Board of HD Director support, be role Value-add/ROI launch and
Supervisors models ad hoc
All Employees Electronic Newsletter Wellness Team Targeted Awareness “What’s in it for me” Monthly
segmented by Vendors and Promotion of “Be a part of this”
areas of interest programs and
services.
All Employees General Delivery email Wellness 411 Awareness/Promotion “What’s in it for me” As
Vendors required
All Employees Wellness Web Site Wellness Team Awareness/Promotion “what’s in it for me” Daily
HPC Add names to email
lists for e-newsletter
Human One-on-one meetings HPC Awareness/promotion “Do you know” Prior to
Resources /support/buy-in Integration/support of launch,
health benefits open
packages enrollment
and
quarterly

37. Employee Communications
• All employee emails 1-2/week announcing events
• Monday Health Tips
• Wellness Council and Wellness Champions
• Bulletin boards and themed posters in departments
• Unique brand and identity (logo and tag line) on all communications
• Alignment with health and business goals included in Wellness Strategy Plan as
separate section “Marketing”
• Customized for multiple target audiences: age, gender, ethnicity, education, language, work
situation and location
• Website

38. Employee Website: http://www.mtyhd.org/wellness/

39. Employee Communications
• Aligned with preferred learning styles and
communication preferences of audience based on
Annual Wellness Survey responses
• Program and product specific surveys
• Blog: WellnessWorks4You
• Health information and resources accessible through
plan provider health portals
• Newsletter produced internally, tailored to needs from survey/input every other month
• Cross-promote using County wide publications e.g. CAO Weekly Report, Health dispatch, NMC
Newsletter and Bulletin Boards, New Hire Orientation, Timecard messaging, HR Link

40. Customize by Delivery Preference

41. Customize by Learning Style

42. “Why Wellness?”
We asked Monterey County employees, “Why
Wellness…. How has it helped you?”
Here are some of their
answers……..

43. I’ve lost 25 pounds….and dropped my A1C from
between 6.2 and 6.8 down to 5.7….Also dropped
my blood pressure from 135/80 or higher to
112/60. Simply by beginning to exercise.
…….Rich

44. I have dropped my body
fat percentage, my blood
pressure is normal
again…..
…..Anonymous Employee

45. “I will to be able to keep up with my
kids as they grow up.”
…..John

46. I am continuing to
walk, and now have a
stationary bike that I
am NOT using as a
clothes hanger, but
actually using it as I
should, worked my
way up to 20 minutes ……Arlene
and counting!
……Arlene

47. What can Wellness do for
you?
get started today……..

48. Management Communications
• Annual one-on-one meeting with Department Heads
• Annual Operating Plan/Report
• Spring Department Head/Management Council overview
• Annual Board of Supervisors update
• Manager Tip Sheets monthly, staff meeting presentations
• “Wellness as a Business Strategy” in Leadership and Supervisor
Academies
• Annual Manager Satisfaction Survey
• Technical Assistance on issues important to Departments
• Next Steps: Advisory/IHPM Council

49. Child Support Services
“I believe strongly that participation of staff in the….Wellness
Program….helps the workforce be as productive as it can be. I have
been impressed with the quality of the workshops I have attended
and the flexibility of even providing workshops on site, which has
helped…..in attitude and overall health of our employees….
The amount of money that is being charged…is very reasonable
and the direct and indirect savings…can actually save positions if
worker compensation costs go down and absenteeism is
minimized.”
….Stephen H. Kennedy, Director
Child Support Services

50. Treasurer-Tax Collector
Resiliency Post Training Evaluation
• Reported occurrence stress symptoms: average reduction of 25%
• 10% increase in productivity indicators
• 16% increase in ability to finish difficult tasks
• 5% increase in employees who thought their workload was
manageable/not excessive
• Average 6.3% improvement in job satisfaction indicators
• 6.2% increase in morale at work “We want to continue to utilize these services
because we have had nothing but success…our
department is very excited to continue this type of
training”
….Mary Zeeb, Treasurer-Tax Collector

51. Next Steps: Action
Incentivize and recognize Comprehensive data collection,
participation tracking, reporting, and
financial analyses to help
• Proposed Action: Healthy Departments understand
Lifestyle Rewards Program Wellness Program
– Annual wellness activity and incentive
tracker.
benefit/ ROI.
– Activities organized by categories such as
nutrition, exercise, screenings and checkups,
etc. • Proposed Action: “Working Well”
– Each activity has a point value. Initiative
– Employees record points once a month. – HRAs (Health Risk Assessments)
– Employees work towards reward levels- Gold, – Onsite Health Screenings
Silver, and Bronze. – Workforce Health Profile
– Incentives vary for each level. – Risk Based Predictive Modeling Identifies
Savings Opportunities
• Status: Proposal development – Quarterly Management Reports
– Department Scorecards
• Status: In progress

52. Questions & Thank You!
Judy Webster
Health Promotion Partnership
831-755-4574
or
websterja@co.monterey.ca.us