The Road to Wellness

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School districts are stepping beyond the traditional boundaries of employee health care.

Salinas, Calif.

In a dimly lighted room in a hospital basement, two teachers tuck their legs beneath them and arch their backs into a "lion's roar" posture as yoga instructor Stephen Cade prods the class to "push out those emotional toxins!"

For an hour and a half, accompanied by soft, syncopated music, the 20 students detoxify. They fold themselves into tents, twist into pretzels, and curl into fetal positions.

Barbara Baldwin, who teaches special education at a nearby school, says her yoga sessions are a welcome refuge from daily hassles. "Now I focus better on children, and I take things a little more lightly," says the 54-year-old Baldwin, uncoiling on a pink carpet. She also likes the discount she gets.

While this six-week yoga course costs $7.50 a class, Baldwin pays only $3, a perk provided courtesy of her health plan. Baldwin's insurance also covers other less conventional services, such as acupuncture and nutritional assessments.

The added benefits are a nice bonus, but it's a smart strategy too, says Baldwin, who believes a regular yoga regimen ameliorates her arthritis by aligning her spine. "The district saves money if they have healthy people," she says.

Like a growing number of major corporations across the country, public school systems like the 72,000-student Monterey County schools here along California's central coast have set up wellness programs for their staffs. Such programs go beyond standard health care in that they aim to promote employees' general health and well-being. Traditionally, such programs teach about good nutrition, pay for smoking-cessation courses, run health fairs, and create on-site exercise areas for school workers.

And just as corporations such as IBM, AT&T, and Coors Brewing Co. have for years been building in-house gyms and assisting employees with finding day care, some health-conscious school districts see wellness programs as a way to spur recruitment and earn the loyalty of their workers. About 20 percent of school systems have some kind of wellness program, says Joanne Owens-Nauslar, the director of professional development for the American School Health Association, an organization based in Kent, Ohio, that promotes health and physical education in schools nationwide.

And in addition to traditional programs, some school systems from New York to Oregon also subsidize unconventional therapies--whether through health plans or employee-assistance programs, which typically provide such services as mental-health and drug-rehabilitation benefits.

Those services include acupuncture, massage, or even laughter therapy. One Sacramento County district hired a consultant to teach a stress-management class in which she read employees' "auras."

In general, more health-maintenance organizations now cover alternative medical techniques in response to consumer interest.

In general, more health-maintenance organizations now cover alternative medical techniques in response to consumer interest, says Donald White, a spokesman for the American Association of Health Plans, based in Washington. One-third of Americans have used unconventional medical treatments ranging from homeopathy to hypnosis at some point in their lives, according to a 1993 study by Dr. David Eisenberg, an assistant professor of medicine at Harvard Medical School. Consumers spend $14 billion a year on nontraditional medical care, and three-quarters of those expenses are not covered by insurance, Eisenberg writes in the report published in the New England Journal of Medicine.

About 20 percent of health-insurance companies in the United States offer supplemental benefits that cover nontraditional care, according to Gary Frazier, a health-care analyst for Bear Stearns, a New York City brokerage firm. And the AAHP reports that 45 percent of managed-care plans now reimburse members for chiropractic care.

"We as a society are starting to find out that there is a mixture of physical and psychological elements in most medical conditions, and that the most effective treatments often address both," White says.

Here in the Monterey County schools, wellness programs grew out of widespread interest in alternative approaches to health care.In the early 1980s, as health-care costs were increasing nationwide, the Monterey County board of education found its employees pinched by medical costs and without a local health-maintenance organization to bring medical expenditures into check. So in 1982, 21 of the county's 24 districts, from the poorest rural farming districts to the wealthiest coastal school systems, chose to pool their buying power and form the Monterey County Schools Insurance Group to provide 4,100 teachers, custodians, cafeteria workers, and bus drivers better rates in an expensive medical market.

MCSIG members were able to leverage lower payments at doctors' offices and hospitals and could set their own premiums for service, says Arthur F. McLoughlin Jr., a regional representative for the California Teachers Association who helped broker the deal. "We were no longer at the mercy of the insurance companies, who need a profit," he says.

But while the MCSIG health plan offered coverage equivalent to or better than some leading medical plans, many school leaders felt the program's prevention services were weak.

Gene Martin, the superintendent of the 2,000-student Soledad school district, was among the first to seek a wellness program from the MCSIG. In 1991, Martin says, the district had employees who wanted to quit smoking but had little money to pay for nicotine patches. He thought smoking-cessation kits ought to be free. "You can detect problems early and nip it in the bud instead of waiting for illness to advance, when it'll be costly to treat," he says.

The prevailing health consciousness of this coastal California area also greatly helped the wellness cause. Healthful living is almost a religion in this 400,000-resident county that extends from the white sands of Pebble Beach to the Carmel hills blanketed by cypress trees, to the green fields of Salinas Valley, an area known as "America's salad bowl." Masseurs, health spas, and homeopathic healers are as common as health-food stores.

But turning this regional sensibility into a personal health ethic for school employees was another matter.

So the MCSIG board formed a wellness committee composed of school leaders and union and staff members from across the 3,300-square-mile county region. The committee reviewed cost-benefit analyses conducted by other health plans and reviewed literature on acupuncture and chiropractic.

On average, districts in Monterey County spend about 20 percent of their budgets on employee health care.

Many school workers were attracted by the equity of the plan, which was designed to provide wellness services to employees regardless of individual district wealth. After reviewing the options, the MCSIG board adopted the wellness program in 1994.

The plan allows members to see an acupuncturist up to 18 times a year at no cost or go to 20 chiropractic appointments for $10 a visit. As part of the wellness plan, the MCSIG offers annual flu shots for employees for $2 each and conducts health fairs where school workers can get free massage demonstrations, cholesterol and blood pressure screenings, computerized cancer assessments, and healthful cooking demonstrations.

It also provides cut rates on tai chi classes, discounts at fitness clubs, and nutrition-oriented supermarket tours conducted by a registered nurse. The health plan also reimburses employees for 80 percent of the cost of nicotine-replacement aids. And though the plan offers a base of services, which are covered by collective bargaining agreements reached with school employees' unions, each district can subsidize additional benefits if it chooses. The district pays for the insurance, and most single employees have a $150 deductible per year and are responsible for any copayments for medical services. But the plan sets a $650 ceiling on individual employees' out-of-pocket expenses for medical care each year. The maximum out-of-pocket expense for a family is $1,300 a year, according to the MCSIG.

On average, districts in Monterey County spend about 20 percent of their budgets on employee health care.

While district leaders sometimes fret about the cost to school budgets and worry that not enough employees are using the wealth of services to justify the expense, many Monterey County school workers who indulge in the plan's various offerings rave about the plan.

The MCSIG's health package is less expensive and offers more services than did many previous insurance plans, county education officials say. Previously, health insurers would frequently raise premiums, but now the districts and employees can collectively set their own premiums because they sit on the MCSIG board.

In an examining room decorated with charts of the human spinal column, Suzanne du Verrier leans back on a padded table as her chiropractor manipulates her neck and back muscles. Doctors prescribed medication to treat her chronic back and shoulder problems, but du Verrier, the food-service manager for Salinas' Alisal Union school district, decided to come to Kenneth Oikawa for treatment instead.

"I don't want to be taking pills," says du Verrier, as the chiropractor makes an adjustment that ripples through her spine. "This is a way of taking care of my body," she says. And without the side effects of medications, du Verrier says she is better able to manage 36 cafeteria workers in eight kitchens and pick food menus for the multitudes of hungry students the district serves every day.

"If you're not in pain or uncomfortable, you are productive," she says.

Du Verrier is pleased with the wellness program from a manager's standpoint as well. Apart from the health plan, the countywide incentive program that rewards county workers for reducing the rate of on-the-job injuries has kept many cafeteria workers on the job.

"Congratulations for having no injuries this month. It's fantastic!" says Donovan J. Brown Jr., greeting four elementary school cafeteria workers as they slip pink sugar cookies into wax paper bags one recent morning.

Vol. 17, Issue 34, Page numbers-->

Published in Print: May 6, 1998, as The Road to Wellness
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