Total Health Assessment

An imaginary friend of mine smokes, is decidedly chunky, and has high blood pressure and high cholesterol. His kids nag him about the cigarettes and weight; his wife worries more about the hidden conditions.

This fellow could be any one of many of us, and if he wanted to track his efforts to improve his health, he could use the “cloverleaf” graphic introduced in this issue of Hank—a visual summary of the four measures of health at the heart of the new Total Health Incentive Plan.

The cloverleaf has a lot in common with the Value Compass, which illustrates the interconnectedness of service, quality, affordability and the workplace environment. The Value Compass reminds us that improving in one area at the expense of another isn’t progress—and that improving in one area frequently leads to improvements in other areas.

So it is with health. If I take up smoking and have a cigarette each time I’m tempted to eat something sweet, I may improve my Body Mass Index, or BMI—but I won’t have improved my health. If my imaginary friend starts to make better food choices and ups his exercise, however, he’s likely to see improvement across the spectrum of health issues he’s facing. By measuring improvement in several areas, the new incentive plan puts the emphasis on bringing the whole person into better balance.

And by putting the focus on collective improvement, the plan recognizes that all of us are making decisions as individuals in a social system—a system that can make it harder, or easier, to make better choices. Losing the dougnuts at a breakfast meeting may seem like a small gesture, but many such gestures add up to powerful change.

Colorado

When the region revamped how it assesses unit-based teams’ Path to Performance rankings in 2014, some teams dropped down on the five-point scale. But the National Agreement and the region’s Performance Sharing Plan motivate teams to reach high performance, and UBTs are rallying around the more objective and accurate evaluation method. The downgrades are proving to be temporary. One Level 5 team is the Cardiology department at the Franklin Medical Office, which improved access by streamlining the referral review process for patients.

Georgia

Musicians aren’t the only ones who go on tour. Loretta Sirmons, a Total Health labor lead, and Tracie Hawkins-Simpson, a contract specialist, who are both members of UFCW Local 1996, hit the road to encourage people to complete the Total Health Assessment. They were joined by their business representative, Louise Dempsey, and Russell Wise, the Coalition of Kaiser Permanente Unions national coordinator for Georgia. “We blitzed the facilities,” Wise says. “For those who hadn’t taken the THA, we explained its importance.” They visited during the work day, dropped in on farmers markets and held cyber cafés. Wise credits the collaboration for increasing regional participation in the THA: In May, it stood at 37 percent. By September, it had increased to 63 percent.

Hawaii

The Hawaii region is partnering with 25 local labor trusts to enhance its members’ benefits and build loyalty to Kaiser Permanente. The new benefit, called Well Rx Hawaii, makes drugs for high blood pressure, high cholesterol and diabetes available free of charge for enrolled members. “Union leaders like it because it shows the value they bring to their members,” says Harris Nakamoto, KP’s director of labor and trust sales for Hawaii. “We like it because it emphasizes the strength of KP's integrated delivery system—and helps members with chronic conditions save money and stay healthier.” KP is funding the program through expected savings in future medical costs and is tracking enrolled members’ compliance with medication, follow-up care and any decrease in emergency room visits or hospital stays.

Mid-Atlantic States

The supply closets for the Physical Therapy department at the Woodlawn Medical Center in Maryland were “in disarray,” admits Dexter Alleyne, materials coordinator and member of OPEIU Local 2. “The overabundance of supplies was money not being used.” Using the 6S method, the inventory operations team took responsibility for the closets—organizing them and setting par levels while preparing to use OneLink for ordering supplies. The team created a spreadsheet for surplus supplies and sent an “up for grabs” email to colleagues at its own medical center and beyond, says Jennifer Hodges, inventory operations supervisor for the Baltimore area. Purging four closets over the summer is yielding savings. The team plans to spread the success throughout Woodlawn and to three nearby medical centers.

Northern California

Concerned by the slow pace of growth in the number of high-performing unit-based teams in the first part of 2014, both the Northern and Southern California regions piloted a SWAT team approach to accelerate the development of Level 4 and 5 teams. The results were impressive. In June, Northern California temporarily reassigned UBT consultants and union partnership representatives from high-performing service areas to assist the consultants and UPRs working in three struggling service areas. As a result, from June to September 2014, the region moved 42 UBTs in the targeted service areas to Levels 4 and 5, out of a total of 90 teams that moved up to high-performing status. During the same period in 2013, 15 UBTs had become Level 4 and 5 teams in those same areas.

Northwest

The Northwest is the only KP region to offer dental services to health plan members—and its dental program is celebrating its 40th anniversary. The idea for the program, which launched in 1974, came from Mitch Greenlick, then director of the Center for Health Research, KP’s medical research unit. Today, Greenlick is a state representative in Oregon—and more than 800 KP dental staff and dentists provide more than 234,000 people with dental care and coverage. The program is home to 19 unit-based teams, almost all of them high performing. Sunset Dental UBT reduced unfilled appointments by creating a wait list and calling patients when a spot opened up. Unfilled appointments improved by 22 percent in 2013, and team members have sustained the result. Get some quick facts and figures on the dental program.

Southern California

Taking a SWAT team approach to boost the number of high-performing unit-based teams, Southern California concentrated resources on several strategically selected facilities. By October, the percentage of UBTs at Levels 4 and 5 was 59 percent, up from 34 percent in January. A key component of the approach was hiring seven new union partnership representatives, including Elsie Balov, an SEIU-UHW member who is aiding teams at the South Bay Medical Center. “It is really important that labor is helping with this work,” Balov says. “We are pulled from the front line to help, so we know the obstacles and the challenges and can work with the UBT consultants on those.

Maureen “Moe” Fox, RN, is a member of the UBT Resource Team in the Northwest region, helping teams with process improvement, and also teaches regional LMP classes. She credits her exercise routine with giving her the energy to keep up with her busy life as a working woman, wife and mother of three boys. She was interviewed by LMP communications consultant Jennifer Gladwell.

Q. Moe, you have a ton of energy. Where does that come from?

A. Like most working moms, my life is busy. I try to eat foods that will fuel me, drink lots of water and exercise. I’m a Jazzercise instructor two days a week, and the other days I run. Exercise helps me keep up my energy level as well as maintain strength and balance. I think I’d be less optimistic and more stressed out if it weren’t for my daily exercise routine.

Q. I notice you have a lot of ribbons and medals—what are those from?  

A. I always wanted to run but thought my size would be a problem. As I began my weight-loss journey a few years ago, I added running as an extra way to burn calories. A new friend and fellow novice runner convinced me to sign up for my first 5K (3.1 miles). Finishing that race was such a huge accomplishment. It took months to train for and required a lot, both physically and mentally. I was hooked. Since then, I’ve done multiple 5K to 15K races, 16 half-marathons (13.1 miles) and finished my first marathon (26.2 miles) on Dec. 31, 2012. The problem with running is that it’s addictive!

Q. What started you on your wellness journey?

A. I’ve been active my whole life, lettering in high school sports and playing on teams as an adult. I’ve also been “bigger” my whole life. I started doing Jazzercise in 1999 and became an instructor seven years ago. Despite my best efforts, it seemed that the weight I gained with my last son was not going to budge. I had actually come to accept it—the whole “as long as I can buy cute clothes, I’ll be fine” thing.

About five years ago, I found that I couldn’t keep up with the students in my Jazzercise class. I would get to the most intense part of the workout and feel like I was dying. I knew something had to change. I made a plan and set a date to start. I started counting calories and recording everything I ate with an online journal. I also took the total health assessment and that prompted me to get my labs done, which is how I found out about my elevated cholesterol level.

We are at an advantage at Kaiser Permanente because the labor unions and the health plan are willing to put their money where their mouth is—pun intended. I joined a Mix It Up team in the spring, and the weekly emails are full of helpful and positive tips. If the total health assessment and accompanying healthy living programs can help an employee get interested in getting healthy, it’s a step in the right direction.

Q. What was it like to lead the flash mob at the 2012 Union Delegate Conference in Hollywood?

A. Oh my goodness, that was the best thing ever! I was so in my element. I love dancing and I love getting other people to dance. It was a bit of a game changer for me, because up to that point, I hadn’t ever thought of myself as a leader for physical fitness and healthy living. I had people coming up to me by the end of the conference who were vowing to make life changes. I spoke with some of them at this year’s conference and some have stayed true.

Q. What advice would you give someone who is trying to get healthy?

A. Get help and support. If you have a friend who understands and your family’s on board, it really helps, even if they aren’t changing anything. Make a (food) plan. Know what you’ll do for weekends, family events, parties and nights out. If you bite it, write it—all of it—even on a bad day. Also, I have to have something sweet every day—just a little something sweet. Know when you’ll exercise and what you’ll do and for how long. It’s important to move every day, even if only for a few minutes. You need to have an exercise plan that is realistic and fun. If you love to dance, dance. If you love to ride a bike, ride a bike. Cheat a little. I don’t count calories on the weekends or for special occasion meals. Reward yourself for reaching milestones. Lastly, find ways to de-stress and be kind to yourself. You’re not ready for the journey if you’re going to punish yourself through it. It’s hard enough on its own. Don’t make it harder by not rooting for your own team.