Recently divorced and the mother of two young boys, Myra Taylor, an assistant principal and teacher in the Metro Nashville Public Schools district, was having a tough time making ends meet.
“I’d think, ‘Can I afford to take them to the doctor?’” she recalled. “No parent should ever have to ask that question.”
That was a decade ago. Today, Taylor, executive principal of East Nashville Magnet High School, no longer worries that health services are out of reach, thanks to an innovative teacher health plan and an award-winning wellness program implemented by MNPS in collaboration with Vanderbilt Health.
The MNPS Certificated Employee Health Plan covers 6,500 active teachers plus 11,500 retirees and dependents. According to a recent study, the coverage — which includes primary care clinics, comprehensive wellness services and a fitness center — has helped enrollees achieve positive lifestyle changes while reducing the district’s health care expenditures.
“It’s an amazing asset,” Taylor said. “It has definitely improved my quality of life.”
The cost savings result mainly from a significant drop in catastrophic claims filed for urgent care, “which tells us we’re doing well in chronic disease management,” said David Hines, MNPS executive director of Benefits. “If we focus first on health, the (savings) will come. And it’s worked.”
Since 2017, illness-related absences among teachers have declined while retention has climbed. That translates into higher-quality classroom instruction. “The teachers we are retaining tend to score higher on performance evaluations,” Hines noted. “Healthy employees are better employees.”
“When we apply lifestyle as medicine, everyone wins,” said Martha Shepherd, DO, MPH, associate professor of Clinical Medicine and Pediatrics, and medical director of Vanderbilt Health at MNPS. “It makes sense clinically. It makes sense financially. And it gives us healthier communities.”
In a paper published last year in the American Journal of Health Promotion, Shepherd and Hines describe how the teacher health plan identifies and addresses geographical and socioeconomic disparities in the occurrence and impact of chronic, debilitating conditions, including obesity and heart disease.
The varying backgrounds and circumstances of teachers are often underappreciated. “They’re on the same salary scale,” Hines said. “They all have basically the same educational background. And yet when you take a closer dive into it, you find they’re not as homogenous as you think.”
In 2012, MNPS partnered with Benegration, a Pennsylvania-based data warehousing firm that helps clients manage their employee benefits programs, to better understand the needs of its covered population.
Using census tract and other data, MNPS divided the teachers into three tiers based on factors including per capita income, neighborhood crime and unemployment rates and how far they lived from a grocery store.
An analysis of the data revealed that half of teachers lived and worked in higher-need areas. Medical records and claims data also showed, not surprisingly, that residents of these areas were more likely to have serious health problems and incur higher health care costs.
To address factors driving disparate health outcomes, the district developed a “whole health” strategy for its employees. The Metro teacher health plan was adjusted to make health services more accessible. It has a low deductible and low copays for office visits and prescriptions.
Enrollees are encouraged to go to one of five primary care clinics established by MNPS in 2009. Each clinic is located no more than 15 minutes from any Metro school or workplace. MNPS owns the clinics, which are staffed and operated by Vanderbilt Health.
The Employee and Family Wellness Center opened in 2017 at MNPS headquarters and includes a pharmacy and fitness center, offering primary and behavioral health care services, physical therapy, chiropractic care, acupuncture, sleep optimization and stress management.
Teachers are eligible for additional wraparound services, including clinical social workers, hospital chaplains and nurse navigators to triage patients and explain benefit policies. Also offered are medical and behavioral telehealth services with on-call nurse practitioners.
The plan’s “value-based benefits” include preventive care services, including health screenings and vaccinations, an $800-per-year premium discount for taking a Health Risk Assessment, health coaching, chronic pain management and more.
To address the most significant health risk for MNPS teachers, obesity, health plan coverage was increased to include surgical weight loss options, nutrition, counseling and exercise programs. The results are impressive. Since 2021, enrollees have lost a combined total of more than 7,000 pounds.
Breast cancer screening and other visits for preventive health care also have risen significantly.
Compared to community-based primary care, primary care provided through the clinics has achieved a nearly 30% reduction in overall medical costs, a 38% decline in inpatient admissions, and 23% fewer trips to the emergency room.
“People don’t want another medicine in their medicine cabinet,” Shepherd noted. “When they’re given the option of someone to walk alongside them and to help them learn and form new habits, they’re thrilled.”
The district’s integrated approach to wellness and “lifestyle as medicine” may be unique. “I don’t know of anybody who does things quite to the level that we do it,” said Hines, past president of the National Association of Worksite Health Centers. “We’re out there on the front edge.”
The MNPS approach can serve as a model for other employers, she and Hines concluded in their paper, which was cited by the American Journal of Health Promotion as among the “Best of 2024.”
Among many honors, the program has received the Cigna Outstanding Culture of Well-Being Award, the C. Everett Koop National Health Award, Honorable Mention, and “Gold Tier” status awarded by the American Heart Association for “creating a culture of health and well-being.”
Accolades aside, Myra Taylor believes she avoided serious complications from an undiagnosed gallbladder condition in 2016 because of Metro’s investment in employee health. “I probably would not have gone to the doctor as quickly,” she said if there had been a $100 copay.
Comprehensive services. Quick access. Outstanding results. “It’s unheard of,” Taylor marveled, “truly innovative for our district.”
