Colorado is America's healthiest state, right? Wrong, says Andrew Sykes, chairman of Health at Work Wellness Actuaries. It's a myth and was one of the biggest challenges Sykes had to overcome when he was hired by Brighton School District - a school district northeast of Denver - to help implement a wellness program at Brighton's 18 schools and other worksites.

"The only thing we can say about Colorado is that [it is] the least fat state in America," he told attendees at the 24th annual Benefits Forum & Expo in Dallas in September. "If you're a school district, looking after kids, what's much more worrying is that Colorado is in the lower half of states for healthy children and newborn infants. So they are far from the healthiest state."

In fact, he said, Colorado is in the bottom half of all states when it comes to physical activity among school children. "So it's completely a myth that we don't have issues to deal with in Colorado," he said. "If anything, we are just lucky enough that the state is just a little bit behind the obesity trend in the rest of the United States."

Brighton School District 27J jumped into wellness for three main reasons: Fit kids get better grades, fit teachers are better teachers - with more stamina - who make better decisions with fewer mistakes, and fit people cost the health care system - and employers - less money.

Citing data from the California Standards Testing and Reporting program and similar data from Texas, Sykes said that there's a relationship between how fit students are and their performance in math, English and every other subject. "If your kids are fit, they will outperform kids who are unfit by about 30%," he said.

There is just as strong of a relationship between how much exercise adults get and how well they perform. "People who exercise each day make 60% to 70% better and faster decisions with a 25% lower error rate," he said. "Our brains function 20% better when we exercise during the day than when we don't exercise." In addition, fit people have a lower prevalence of disease.


Significant plan redesign

Brighton School District introduced an exercise-focused wellness program as the base of its health care strategy. Next, it invested in preventive screenings by covering all such screenings at 100%, even before it was required to do so by the Patient Protection and Affordable Care Act. Then, it converted both non-HMO plans to high deductible health plans with 100% coverage above the deductible.

"Because teachers' pay is notoriously low, we need to make sure that if they did need extensive health care - beyond the deductible - the coverage is comprehensive," said Ruth DeCrescentis, chief human resources officer for Brighton School District 27J, acknowledging that the new benefit design is much cheaper than the PPOs it had in place, which saved more than it needed to keep the district's spend at 0% in the first year of this strategy. The district reinvested those extra savings in employees in the form of a health savings account.

By the second year, savings were high enough (even after a second year of a 0% increase in the allowable budget) to afford a $1,400 contribution (for single-employee coverage) into an HSA.

Brighton School District adopted this strategy coming into the 2010 plan year and is now in its second year. Costs per employee per month are currently below the levels they were in 2009, even though the district's budget has remained flat for two years. Moreover, compared with renewals at the time and projections for two years out, the district saved $700,000 in year one and $1.4 million in year two.

After year one, employees had a total of $500,000 in their HSAs unspent, which translates into approximately $700 per employee.

"We're headed for $1.1 million in balances by July 2012, or more than $1,400 per employee per month," said DeCrescentis. "That means that, going into year three, with the same base funding of $1,400 from the district, the average employee will have cut their maximum self-funding amount in half. By July 2013, we expect a growing number of employees to have enough in their HSAs to fully fund their deductibles and have, essentially, 100% coverage."

So while the benefit changes are working to control costs so far, DeCrescentis realized it wouldn't be enough. "That's where our exercise-based wellness program comes in. But we also knew that simply having a program wouldn't solve our problem unless we really understood how to get and keep people involved."

Health-habit change is one of the hardest things to do, said Sykes. It requires getting people (in this case, teachers) to answer two fundamental questions: Should I change this habit and can I change this habit? "It's a simple model but those questions aren't always asked and answered in a conscious way," he said.

Recognizing that most teachers would not respond to an invitation to be part of a wellness program if the only benefit, as they saw it, was their own personal health, "we looked for the things that teachers find meaning in, and really, it's one thing: Being great teachers and helping kids learn," said DeCrescentis. "Based on this, we changed our message about wellness to link to this meaning."

First, she shared with teachers the data about how fit students get better grades and have better discipline records. Then, she conveyed how being healthy themselves could make them better teachers. She also reminded them how influential they are for their students and how students copy what they see more than do what they're told. Finally, she asked them to imagine the possibilities that might come from teachers and students working together to be healthier and, in this way, "we made the connection for teachers between being healthy and being great teachers, [and] between their students being healthy and getting good grades," she said.

The district implemented a verifiable walking program with shoe-based accelerometers that count steps, miles, calories burned and time in motion. Small, wireless receivers pick up the data every day when teachers attend school, removing the self-reporting element. And, instead of setting enormous goals, the district chose a vendor - Sonic Boom - that could help employees take small, easy steps every day and measure their progress over time.

Every six to eight weeks, teams of teachers within each school and across the district compete in various challenges. So far, teachers have walked 140,000 miles and burned over 13 million calories. The school that wins each challenge gets access to a conference exercise bike - a bicycle that seats seven and allows people to get some exercise while they're meeting.

The school district was able to hire a coordinator through a grant from the Centers for Disease Control and Prevention, and she's recruited at least one super-champion at each school. Super-champions help enroll others and spread the wellness message. And part of their role is to find other champions so each school has a core group of motivators to support and encourage other teachers.

And the school district's wellness efforts are paying off for the community at large. Brighton was recently recognized by America's Promise Alliance as one of the nation's 100 best communities for young people. "Brighton is especially deserving of this recognition due to their efforts to ensure their young people graduate high school and go on to lead healthy, productive lives," said Marguerite W. Kondracke, president and CEO of America's Promise Alliance.

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