Multi-Stakeholder, Community-Wide Collaborative Prevents Disease and Promotes Health

Problem Addressed

• High death rates: County residents had higher than average death rates for cancer, diabetes, and cardiovascular disease.¹
• High prevalence of disease, risk factors: Health risk appraisal data (including measured biometrics) for Allegiance Health employees and select local employers indicated high prevalence of heart disease and depression. The same assessment found that many residents had risk factors for these and other diseases, including body mass index more than 27.5 (53.5 percent), high blood pressure (36.1 percent), high levels of stress (33 percent), physical inactivity (25.8 percent), smoking (more than 25 percent), and dissatisfaction with their lives (23.3 percent). Results from a community wide health assessment in 2008 also showed that roughly 70 percent of county residents were overweight or obese, with the vast majority of residents not following recommended guidelines related to diet and physical activity.   
• Rapidly rising premiums: Premiums for employers insured under Allegiance Health's locally owned health plan were increasing by up to 40 percent per year.

Description of the Innovative Activity

• Employer-based health management program activities (It’s Your Life): This workplace-based program includes comprehensive health-risk appraisals with blood work, personalized health coaching and planning, and wellness education.
• Chief executive officer roundtable “call-to-action” forum: This roundtable serves forward-looking Jackson area business leaders who recognize that their organization’s sustainability is inextricably linked to employee health. Participants meet periodically to discuss investments in workforce health and the business case for health and productivity management.
• Employer health management consortia: These hands-on sessions allow employers to share strategies, information, tools, and resources to help businesses better manage employee health and productivity.

• Youth obesity prevention: The collaborative offers interactive school-based sessions for youth and parents, along with the F.I.T. (Families in Training) for Health initiative, an 11-week program in which families meet on a weekly basis with a registered dietitian, exercise specialist, and behavioral health specialist to set, reach, and maintain their goals.
• Adult weight management – A NEW You: This 13-week weight loss and weight management program offers the latest technology and is based on the latest evidence-based research. Led by a registered dietitian, the program focuses on healthy lifestyle changes including nutrition, behavior modification, eating awareness, and exercise. Throughout the program participants receive
  • Opportunities for customized analysis of body composition and resting metabolic rate
  • A personalized weight-loss plan
  • Cooking demonstrations
  • Access to a registered dietitian
  • Ongoing peer support
  • Weekly weigh-in for accountability
• Tobacco treatment services: The collaborative provides inpatient and outpatient tobacco treatment services, including general information, education, behavioral counseling, and corporate programs.
• Faith community nursing: The collaborative includes “faith community nurses” who focus on caring for spiritual needs as a part of the process of promoting holistic health and preventing or minimizing illness in a faith community. The faith community nurse works in partnership with the faith communities to promote a healthy lifestyle, including all components of physical, emotional, and spiritual well-being.
• Infant mortality initiatives: The Jackson County Prenatal Task Force is an ongoing partnership between local health and human services groups and individuals in the community, led by Allegiance Health and the local health department. 
• Community Health Assessment: Community stakeholders developed and completed a community health assessment for Jackson County. This assessment provides a mechanism to better align efforts among community partners and create a more strategic framework for activities.

References/Related Articles

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Results

• Reduced risk from workplace wellness program: In 2006, nearly 5,000 individuals from more than 70 local businesses participated in the workplace wellness program It’s Your Life, including a 78-percent participation rate among eligible employees and spouses at the health system. An evaluation of this program indicates that it has helped participants to manage stress better, avoid weight gain, control blood pressure and cholesterol, avoid sick days, and reduce overall health risk.
  • The overall proportion of participants at risk due to lack of physical activity has decreased by almost 50 percent.
  • The percentage of program participants with an overall health risk profile that is characterized as “low” increased by almost 13 percent.
  • Many program participants report better self-image and greater job and life satisfaction.
• Weight loss: Participants in the weight management program lost a cumulative total of 667 pounds and lowered their body mass index during 2006.
• Higher awareness, satisfaction: The program has spurred a community conversation on improving health and has raised awareness of the importance of prevention. Acceptance and satisfaction have been high among employers, physicians, and participating individuals.

Evidence Rating (What is this?)

Context of the Innovation

Planning and Development Process

• Setting up the foundation: To carry out the operational activities of the Health Improvement Organization, the Foundation for a Healthy Community was organized in 2000 as a 501(c)(3) public foundation affiliated with the health system (operational activities have since been transitioned to Allegiance’s new Department of Prevention and Community Health). The organization’s initial charge was to engage stakeholders in implementation of programs and strategies to improve the general health and welfare of Jackson area residents.
• Creating governance structures: The Foundation for a Healthy Community Board was created to serve as the formal governance of this initiative, reporting to the Allegiance Health Board. The foundation board included a mixed representation of Allegiance Health board members and community members. 
• Developing oversight: The Health Improvement Oversight Committee, created as the next level of governance, consisted an even broader representation of community stakeholders, including local physicians, health and human service agencies, employers, the local health department, and other community stakeholders.

Resources Used and Skills Needed

• Staffing: The Allegiance Prevention and Community Health Department has 16 full-time employees, including several health educators, 1 nurse, 4 coordinator, and 1 physician supporting the Health Improvement Organization.
• Costs: The annual budget is approximately $1.4 million.

Funding Sources

Allegiance Health

Getting Started with This Innovation

• Secure financial commitment: This type of effort requires the commitment of an organization willing to provide sustained financial support for planning, development, and ongoing operations. 
• Engage stakeholders: The program will not succeed without buy-in from key stakeholder groups, such as employers and physicians.
• Start small, expand over time: New populations and services can be added over time as needs and interest become apparent.

Sustaining This Innovation

• Monitor and share results: Stakeholders will remain interested if they see demonstrated value from the program. 
• Maintain appropriate staff and resources: A range of skills and expertise is required to run a comprehensive community health and wellness program, including clinical, operations, educational, and behavioral health expertise and support.
• Continually seek funding: The fees raised from program operations do not cover costs, creating the need for an ongoing source of funding. Would-be supporters should be approached by emphasizing the potential reductions in costs that will occur over the long run due to improved community health.
• Be patient: Success takes time and requires patience and commitment.

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