6
Do Businesses Have a Role Improving Communities or Improving Children’s Lives?

In this session of the workshop, representatives from the business sector discussed their interests and investments in health, and the role of business in improving communities and children’s lives. Although it may not be intuitive that private businesses would be interested in child health, the presenters offered an important perspective on why non-healthcare companies might be interested in investing in child health.

Sandra White, medical director for WellPoint, Inc., presented the perspective of a major health plan. She described how WellPoint works to foster better health not only for the community composed of their plan members, but also for the community at large, and how they developed member and state health indices to track the success of health initiatives. Michele Courton Brown, senior vice president of charitable management services with Bank of America, also discussed a company’s role in improving health in two different communities, the internal community that is the employees and the external communities where the employees live and where the company does business. Examples of children’s health issues addressed by programs supported by the Bank of America include after-school care, exercise and nutrition, and oral health. Maureen Kelly, director of sponsorships at ING in the United States, described ING’s initiative to combat childhood obesity by sponsoring school-based running programs. Courton Brown and Kelly both provided perspective on why a non-health care company would invest in health.



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6 Do Businesses Have a Role Improving Communities or Improving Children’s Lives? I n this session of the workshop, representatives from the business sector discussed their interests and investments in health, and the role of busi- ness in improving communities and children’s lives. Although it may not be intuitive that private businesses would be interested in child health, the presenters offered an important perspective on why non-healthcare companies might be interested in investing in child health. Sandra White, medical director for WellPoint, Inc., presented the per- spective of a major health plan. She described how WellPoint works to foster better health not only for the community composed of their plan members, but also for the community at large, and how they developed member and state health indices to track the success of health initiatives. Michele Courton Brown, senior vice president of charitable management services with Bank of America, also discussed a company’s role in improv- ing health in two different communities, the internal community that is the employees and the external communities where the employees live and where the company does business. Examples of children’s health issues addressed by programs supported by the Bank of America include after- school care, exercise and nutrition, and oral health. Maureen Kelly, director of sponsorships at ING in the United States, described ING’s initiative to combat childhood obesity by sponsoring school-based running programs. Courton Brown and Kelly both provided perspective on why a non-health care company would invest in health. 

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6 FOCUSING ON CHILDREN’S HEALTH WELLPOINT, INC., BLUE CROSS/BLUE SHIELD As an independent licensee of Blue Cross or Blue Cross/Blue Shield plans, WellPoint serves 35 million members across 14 states (California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin). Well- Point provides a catalyst for planning, facilitating, and improving health care through support of the patient–physician relationship, aligning incen- tives to support patient quality outcomes, and designing benefit plans to meet consumer and employer needs. A variety of specialty medical services are provided through brands such as WellPoint NextRx, which manages pharmacy benefits, and WellPoint Behavioral Health. Lumenos provides consumer-driven health solutions; disease and integrated care management is provided through Health Management Corporation (HMC); HealthCore conducts health outcomes and health services research; and American Imag- ing Management (AIM) provides radiology management. The mission of WellPoint, White said, is “to improve the lives of the people that we serve and the health of our communities.” To measure suc- cess in meeting this mission, WellPoint launched two health indexes, the Member Health Index and the State Health Index. The Member Health Index monitors prevention and screening, case management, clinical out- comes, and patient safety of WellPoint plan members. The State Health Index provides a comprehensive look at the health of the population in the areas of maternity and prenatal care, preventive care, lifestyle, and morbid- ity and mortality. The State Health Index includes the entire population for that state, not just the members of a WellPoint health plan. Measuring Success: The Member Health Index The Member Health Index was created to measure WellPoint’s success in its mission of improving the lives of the people it serves, those who are members of WellPoint health plans. Areas that have potential to affect the quality of care that members receive are assessed, such as product design, quality management, disease management, or provider contracting. Clinical areas included in the Member Health Index are grouped into four domains of health care services: screening and prevention, care management, clini- cal outcomes, and patient safety (Box 6-1). The index builds on informa- tion management capabilities and partnerships with employers, physicians, hospitals, and members. The index is reported as a single enterprise-wide number that reflects the overall care WellPoint members receive.

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7 DO BUSINESSES HAVE A ROLE BOX 6-1 WellPoint Member Health Index: Domains of Health Care and Clinical Areas Screening and Prevention • Breast cancer screening • Cervical cancer screening • Colorectal cancer screening • Screening adults for high cholesterol • Childhood immunizations Care Management • Diabetes compliance • Hypertension compliance • Rate of behavioral health follow-up within 7 days • Long-term controller medication prescribed to asthmatics • Appropriate treatment for upper-respiratory infection • HMC disease management participation rate • MC-managed diabetic and CAD members with controlled blood H pressure Clinical Outcomes • ED visits per 1,000 for short-term diabetes complications • ED visits per 1,000 for congestive heart failure • ED visits per 1,000 for uncontrolled asthma • ospital admissions per 1,000 for heart attack, stroke, and TIA H (“prestroke”) • 0-day readmission rate for congestive heart failure, diabetes, and 3 asthma Patient Safety • Patient Safety Hospital Structural Index (AHRQ safety measures) • Patient Safety Outcome Index (LeapFrog safety measures) • Annual monitoring of patients on persistent medications NOTE: AHRQ, Agency for Healthcare Research and Quality; CAD, coronary artery disease; ED, emergency department; HMC, WellPoint Health Management Corporation. Measuring Success: The State Health Index The State Health Index tracks eight measures (chosen out of a total of 23 measures as established by CDC) of public health. These eight measures were selected for focused efforts to improve statewide outcomes, and to be the basis for measuring WellPoint’s success in the 14 states where WellPoint

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8 FOCUSING ON CHILDREN’S HEALTH holds a Blue Cross or Blue Cross/Blue Shield license: Prenatal care in the first trimester; low birth weight infant rate; adult influenza immunization rate; adult pneumococcal immunization rate; physical activity rate; cigarette smoking rate; diabetes in the adult population; and heart disease death rate. The WellPoint Foundation provides support for the State Health Index through the “Healthy Generations” initiative, which funds programs to improve the health across the lifespan. Healthy Generations is a multigen- erational approach to improving public health and is focused on improving the measures included in the State Health Index. White presented data from the host state, Georgia, to highlight why these eight particular measures were selected as focus areas of the State Health Index. With 1 being the best and 51 being the worst, Georgia ranks • 33rd in the country for low birth weight, • 26th for prenatal care in the first trimester, • 46th for meeting recommended levels of physical activity, • 34th for cigarette smoking rate, • 44th for adult influenza immunization rate, • 39th for adult pneumococcal immunization rate, • 41st for diabetes in the adult population, and • 39th for heart disease death rate. Clearly, these areas require improvement, and WellPoint initiatives are focused on • ncreasing the percentage of mothers in the state who engage in i prenatal care during the first trimester of their pregnancy; • he percentage of adults age 65 and over who receive influenza and t pneumococcal vaccines; • he percentage of the population meeting the CDC recommenda- t tion of at least 30 minutes of moderate physical activity 5 or more days a week, or at least 20 minutes of vigorous activity 3 or more days per week; and • ecreasing the percentage of newborns who weigh less than 5.5 d pounds, the percentage of adults in the state who smoke cigarettes, the prevalence of adult diabetes, and the death rate from coronary artery disease. With the exception of adult immunization rates for influenza and pneu- mococcal vaccines, all of the focus areas affect children’s health. Box 6-2 highlights WellPoint State Health Index activities focused on children.

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9 DO BUSINESSES HAVE A ROLE BOX 6-2 WellPoint State Health Index: Activities Focused on Children Prenatal Care in the 1st Trimester and Low Birth Weight Infant Rate (Colorado, Connecticut, Georgia, Kentucky, Missouri, Ohio, Virginia) • Parent Partnership: Prenatal care for at-risk pregnant teens • March of Dimes prematurity education and awareness campaigns • entucky State Health Department and Western Kentucky University: K Prenatal, primary care, and smoking cessation programs for pregnant women • March of Dimes “Stop Smoking, Stop SIDS” program Cigarette Smoking, Diabetes, Heart Disease (Multistate programs and partnerships) • Last Cigarette for Young Adults, ages 18–30 • merican Heart Association “START!” program: Calls on Americans and A employers to create a culture of health and physical activity for longer heart-healthy lives • Health MPowers” brings programs and technology into kindergarten “ through 8th-grade classrooms to promote healthy behaviors among students, faculty, and families Compliance with CDC Recommended Levels of Physical Activity (California, Colorado, Georgia, New Hampshire, New York, Ohio) • overnor’s Council on Physical Fitness “Live Like a Champion” program: G City-to-city tour teaching elementary school children importance of eating healthy and outdoor physical activity • Fit4Colorado” and “America on the Move”: Promotion of healthful eating “ and active living • MCA family fitness and “Granite State Fit Kids”: Statewide teaching New Y Hampshire 5th graders about healthy eating and activity habits • dopt-a-School with New York Road Runners Foundation “Mighty Milers” A program: Promotes physical activity in school-age children in the five boroughs of New York City • hio Association of Free Health Clinics: Supports “Free to Be Healthy” O project addressing obesity and related health problems Another reason why these particular focus areas were selected, White said, was because of the rising costs associated with obesity, tobacco, sed- entary lifestyle, and stress. Between 1987 and 2002, there was a 62 percent increase in private health insurance costs due to population risk factors and treatment of these particular conditions. An average 10 percent of total claims costs are attributable to obesity, with 60 percent of Americans exceeding the ideal body mass index (BMI) and 60 percent performing no

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60 FOCUSING ON CHILDREN’S HEALTH substantial activity or exercise. Twenty-five percent of Americans smoke, and an average 10 percent of total claims costs are attributable to tobacco. Two-thirds of all office visits to family physicians are due to stress-related symptoms, and more than one in four workers has taken a day off to cope with stress, costing U.S. businesses $300 billion annually in direct and indirect costs. The WellPoint Foundation The WellPoint Foundation and the Blue Cross/Blue Shield of Georgia Foundation provide grants to nonprofit organizations whose efforts sup- port the goals of the State Health Index. In 2007, the WellPoint Foun- dation granted $10.8 million to 76 organizations, and $23 million was pledged through the Annual Associate Giving Campaign to support 9,600 not-for-profit agencies. The Blue Cross Blue Shield of Georgia Foundation made $1.6 million in grants to 20 organizations. In addition to grants for programs, both organizations engage in social responsibility giving, for example, providing funding for adult flu and pneumonia vaccinations, or supporting the American Cancer Society’s Relay for Life. WellPoint’s social responsibility giving totaled $4.8 million with 76 percent supporting state health measures, healthy lifestyles, and major diseases. Blue Cross/Blue Shield gave $320,000, with 86 percent supporting these three areas. The WellPoint Foundation has also committed $30 million over 3 years to reduce the number of uninsured through support of such organizations as the Foundation for Healthcare Coverage Education (FHCE). FHCE raises awareness of no-cost and low-cost coverage options, simplifies public and private health insurance information in easy-to-use pamphlets and an educational website (coverageforall.org), and operates the U.S. Uninsured Helpline, which provides information in several languages about federal and state programs. White noted that some of the uninsured have chosen to be so (in some cases because they are young and healthy and don’t believe they need insurance), but many others are simply not well informed about what is available to them. WellPoint Health Plan Programs: Reducing Disparities WellPoint is a leader in working to eliminate health disparities among its members, White said. To help reduce health disparities, WellPoint pro- vides cultural competency training for all clinical associates within the organization. In addition, WellPoint provides member materials translated into 12 different languages at a 6th-grade reading level. Member focus groups are used to identify behavioral drivers of disease and to develop

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6 DO BUSINESSES HAVE A ROLE culturally and linguistically sensitive member educational materials and disease management programs. WellPoint also analyzes quality measures by race and ethnicity, which allows them to address health disparities at community levels, White said. By linking race and ethnicity data to geographic data, local “hotspots” can be identified. These hotspots can be used to focus WellPoint’s interventions with regard to both location and approach, aiding the development of culturally sensitive programs. For example, using the ZIP code map laid out across the counties of Georgia, WellPoint identified areas where the mammography screening rates are lowest (Figure 6-1). Meshing that with information about the regions (e.g., rural or urban, racial breakdown) they can develop interventions, or provide materials and support to providers, in order to help them improve the screening rates. Analysis can be done at many different levels, including by provider group. By identifying the demographics of provider groups, WellPoint is able to work closely with FIGURE 6-1 Mammography screening rates for Georgia, by ZIP code. SOURCE: HHS, 2006. Figure 6-1.eps bitmap image

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62 FOCUSING ON CHILDREN’S HEALTH those providers to ensure that they have the tools to help them serve their multicultural patient population. In conclusion, White said that WellPoint is working to put all the pieces of the puzzle together to improve health, including foundation support (community giving, social responsibility, reducing the number of uninsured); health systems (physician quality, hospital quality, health infor- mation technology), community initiatives (collaboratives, public health programs, WellPoint State Health Index); and health plan programs (care management, disease management, disparities reduction programs, Well- Point Member Health Index). BANK OF AMERICA The business community has a significant role to play in the lives of the communities we work in, said Courton Brown, based on her experiences as a corporate donor and as an advisor to foundations. Businesses have long been engaged in the lives of their communities through employee work/life programs as well as through local community involvement. The Employee Community There are many ways in which companies can add value to their community of employees, both directly as employers and by providing opportunities for their employees to add value to the workplace. Some of the common work/life programs include flextime and part time, employee assistance programs, paid volunteer days, company matching charitable gifts, tuition reimbursement, and backup child care. These programs com- plement the suite of traditional health insurance and dental insurance programs offered by companies. There are also employee-led initiatives. At Bank of America, for example, a resource group focusing on issues affecting employees with disabilities held a number of workshops around the country on the issue of children with learning differences. This brought value to our employee population, Courton Brown said, helping our employees navigate the sometimes complex world of supporting children who have learning style differences. Traditional Community Outreach One of the primary attributes of a large company is the ability to pro- vide financial resources, through grants or other programs, to help address social issues. But another treasured resource at the company, Courton Brown said, is the employees, who have both the propensity to give and the willingness to bring their individual talents and skills to the nonprofit com-

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6 DO BUSINESSES HAVE A ROLE munity. Bank of America, like other companies, has a volunteer network. It also seeks to place its employees on the board of directors of nonprofit organizations, and offers in-kind support as well. The corporate community serves a wide variety of constituencies beyond their primary customers. Other key corporate stakeholders include employees and the community, as well as good stewardship of the environ- ment, human rights, and diversity. In the last 15 years, Courton Brown said, there has been a movement from simple corporate philanthropy to a focus on being a responsible corporate citizen. Companies are addressing the way in which they conduct business and supporting public policy changes to enhance communities. Companies have moved away from transactional “checkbook philanthropy,” to more proactive, strategic, and outcome- oriented grant making, often in partnership with others in the community. In addition, the Internet provides round-the-clock news, which enhances transparency and helps keep companies accountable. Investing in Health There are many good reasons why a non-health care company, such as Bank of America, should focus on health, Courton Brown said. There is documented evidence that good health outcomes are linked to long-term productivity. Businesses understand that having a healthy community is helpful to their bottom line, whether it is developing the next generation of the workforce or making their work locations attractive to new employees. Prospective employees today are looking for healthy communities, and companies have a role to play in supporting community health, not only to sustain their workforce, but also to improve the quality of life in those communities. There is obviously a vested self-interest on behalf of the com- panies, which is a good thing, Courton Brown asserted. Corporations are demonstrating their commitment to health care in a variety of ways. One example is the “After-school for All” partnership in Boston, Massachusetts. In 2001, a group of civic and business leaders came together to address the critical need for after-school care, a priority that had been articulated by Boston’s mayor, Tom Menino. Boston, like many cities, has a school system that does a good job, but is stressed, Courton Brown said. Many middle schools in Boston run from 7 a.m. until 1 p.m. That gap between when school lets out and when parents arrive home from work presents a real challenge. Business community and civic leaders joined forces to make an initial $1 million commitment in support of after- school programming. Interestingly, the funders decided to make this a real learning opportunity, first conducting research to determine exactly where funding was needed. Bank of America, and other companies, chose to fund individual after-school programs, improving the quality and the number of

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6 FOCUSING ON CHILDREN’S HEALTH after school slots in company hometowns, but there was also the oppor- tunity to pool resources and fund some programs collectively. Ultimately, 130 organizations were funded through this program, with $26 million invested in after-school programming. Another task of the partnership was to find a way to sustain this program after the initial 5-year commitment. A new program called “Boston After-school and Beyond” is now in place that allows for streamlining of both city and private resources to continue the momentum on after-school care. Another Boston-based program is “Jump Up and Go,” which was ini- tiated by Blue Cross/Blue Shield of Massachusetts. According to the 2001 Massachusetts Youth Risk Behavior Survey, one quarter of Massachusetts high school students were either overweight or at risk for becoming over- weight. Inactivity and poor diet contributed significantly to this problem. Blue Cross/Blue Shield took the lead in this effort, helping organizations that serve youth, including community-based organizations, health care centers, and clinicians, to create a healthier environment for Boston’s chil- dren. Among the key initiatives of the multidimensional Jump Up and Go program is the creation of the “5-2-1” campaign. The key messages are to eat five or more servings of fruits and vegetables a day, limit screen time for children to no more than 2 hours a day, and get at least 1 hour of physical activity each day. There has been a 5-2-1 media campaign, and clinicians now have a resource kit that supports their dialogue with patients about healthier lifestyles. Blue Cross/Blue Shield also initiated the Healthy Choices Program, which has engaged, to date, 55 percent of the state’s middle schools, working with physical education and health teachers to create healthier school environments. One of the outputs has been a change in the vendor mix in the schools, replacing carbonated sodas with healthier bever- ages and adding more healthy food choices to school lunch programs. The third example Courton Brown described was the “Watch Your Mouth” campaign, a private-public partnership focused on children’s den- tal health. Tooth decay is a disease, and poor dental health affects children’s performance in school. Watch Your Mouth helps educate families about the need for proper oral care and provides community resources to assist in obtaining preventive services, such as sealants. Strategic Corporate Community Involvement All of these strategic corporate alliances have several things in com- mon. First, they leverage corporate expertise. The rigor that companies apply to the analysis of data is helpful in these kinds of projects. Second, these projects are public-private partnerships, and there is real value added to these programs because companies sought the expertise of practitioners to help shape the programs. Third, the funding community is becoming

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6 DO BUSINESSES HAVE A ROLE increasingly focused on outcomes, and the ability to measure outcomes is built into the programs. Finally, Courton Brown said, while it is great to have a good idea and execute a successful program, long-term sustainability is a common key goal. ING FOUNDATION Corporate sponsorships, Kelly said, are able to help draw attention to societal problems. The ING “Run for Something Better” program is helping ING to draw attention to the serious problem of childhood obesity. ING became involved initially through its sponsorship of marathons. Now the program provides funding for school- and community-based youth run- ning programs across the country. The Run for Something Better program introduces kids to the benefits of running and encourages them to embrace physical fitness and healthy lifestyle choices. The program in New York City maintains partnerships with the New York Roadrunner’s Club and the Mighty Milers after-school program. With funding from ING, additional schools were able to be added to the program. ING also works with the city parks foundation in New York to support the city parks and recreation programs, allowing the program to continue year-round. In Miami, Florida, ING has created partnerships with the Fit Miami Foundation, the Miami-Dade County public schools, and a local company, PR Racing, which runs the Miami marathon. At the 2007 marathon, 1,700 children in orange ING T-shirts crossed the fin- ish line as part of a 25-week program where children run 1 mile a week. Then on marathon weekend they run their last 1.2 miles on the final leg of the same course as the full marathon runners, completing a total of 26.2 miles, and everyone receives a medal. In Denver, Colorado, ING is the lead sponsor of “Kids Running America,” a program similar in structure to the Miami marathon, with children completing their final mile at the Denver marathon. The inaugural ING Georgia marathon was held in March 2007, and ING launched a pilot program with the Atlanta Public School System, starting with four schools and now including close to 20 schools. In San Francisco, California, the ING “Bay to Breakers” is a 12k Race, in partner- ship with AEG, the Staples Center Foundation, and others, along with the San Francisco Unified School District. ING has offices in Hartford, Con- necticut; Minneapolis, Minnesota; Minot, North Dakota; and Philadelphia, Pennsylvania, and will be expanding to include partnerships with the local schools in those communities.

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66 FOCUSING ON CHILDREN’S HEALTH Benefiting the Community and the Business There are multiple reasons why ING developed this program. As a global financial services company, ING believes it has a responsibility to be an outstanding corporate citizen, especially in communities where its employees live and where it conducts business. Clearly, the childhood obe- sity statistics are startling, Kelly said, but the good news is that increased awareness is prompting teachers and parents, as well as communities, busi- nesses, and concerned individuals, to step up and take action. ING’s pri- mary goal was, and continues to be, to increase public awareness of obesity and the associated health risks and to raise money to fund track and field programs for children in underserved schools and communities. The race sponsorships also help ING establish itself in the community. In the corporate world, there has to be a business reason for taking any sort of action, a way to tie it back to the business of the company. In the case of the Run for Something Better program, ING is one of the largest providers of retirement plans for teachers. Run for Something Better makes ING a visible part of the community and raises awareness of ING among the teacher community and boards of education. Kelly concluded by noting that while ING can give a certain amount of money to the organizations involved in Run for Something Better, it is never enough, and the ING Foundation funds many other programs as well. In the interest of sustainability, ING recognized the need to get the public involved and, in 2006, created the Orange Laces program. For a $10 donation, donors receive a pair of orange shoe laces to demonstrate their support of this cause. Donors can visit the website (www.orangelaces.com) and designate the city that will receive their donation. In 2007, ING raised almost $400,000 in laces donations alone, and it is expected that this will increase in 2008 as awareness of the program expands. OPEN DISCUSSION In her presentation, Kelly noted the need for a “win-win” situation when a company decides to fund a program or establish a partnership. Expanding on this during the open discussion, White said that whether or not a particular program is funded is guided by the primary health condi- tions that WellPoint focuses on in support of the State Health Index. Cour- ton Brown noted that companies are often inundated with proposals, and there needs to be a framework to assess and identify the proposals that are synergistic with the corporate organization. She said that many companies build their philanthropic strategies around their corporate expertise. Bank of America has an overarching set of philanthropic priorities, and a bank can choose to prioritize their funding for their own community. If health is

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67 DO BUSINESSES HAVE A ROLE an issue in one market, for example, that local branch can choose that as a priority. There is typically some sort of connection to the business of Bank of America with regard to what proposals are funded. Another topic of discussion was the various compensation components that corporations provide to employees, specifically health benefits. Large companies often provide health benefits and are therefore a major con- tributor to addressing some of the socioeconomic determinants of health. A participant suggested that in many cases, however, lower-income employees do not receive such benefits, nor do employees of small companies, and that companies could do better at addressing disparities in health benefits. Brown said that benefits can exponentially add value to the compensation of the lowest paid employees. The ability to provide benefits is related to scale, and she questioned whether national organizations, or large regional organizations, would be able to bundle groups of employees to the point where the provision of some of these benefits could be offered.

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