KING COUNTY’S EMPLOYEE HEALTH AND WELL-BEING PROGRAM

Plexus Healthcare PlexusCall

Agenda

Overview of King County Employee Health and Well-Being Program

Results Employee Engagement Lessons Learned

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2002: King County was projecting double digit growth in employee health care costs for the foreseeable future.

2003: King County convened the Health Advisory Task Force. Group of providers, economists, business,

labor and government leaders charged with developing a strategy to curb costs.

Controlling health care costs

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Strategy Health Care Quality &

Affordability

Support a Quality

Workforce

Benefit Plan Design

Supply Side: •Work with Puget Sound Health Alliance (PSHA) to improve quality of care, pay for value

Demand Side: •Improve employee health•Increase employee health consumer skills

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13,000 benefits-eligible employees

Average age—50 years Average age has increased .44 years for each calendar

year of the Healthy IncentivesSM program

Nine major lines of business—including Public Safety, Metro Transit, Public Health, Natural Resources and Parks

83% unionized 103+ separate bargaining units 70+ union contracts Benefits bargained in coalition

King County Work Force

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Improve the health of employees and their families.

Reduce the rate of cost increases for health care.

Support Quality Workforce Goal in the King County Strategic Plan

Goals

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Participation – Wellness Assessment Individual Action Plan

Financial Incentives – Lower Member Out of Pocket Expenses/Lower Costs for the County Deductible, Coinsurance, Co-pay Incentive to Choose Group Health No employee contribution to premium

Elements

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How It Works

GOLD

YES

NO

Did you take the wellness assessment

by January 31

AND

complete your individual action plan

by June 30?

NOYES

Did you take the wellness assessment

by June 30?

SILVER BRONZE

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Comparison of original Gold, Silver and Bronze Member Out-of-Pocket Expenses

10Item

KingCareSM Gold 2006-2009

KingCareSM Gold 2010-2012

Group Health Gold2010-2012

Deductible (medical)$100 per individual$300 per family

$300 per individual$900 per family None

Coinsurance (medical)90% In network 70% Out-of-network

85% In network 65% Out-of-network $20 copay for office visits

Annual out-of-pocket maximum for member coinsurance (medical)

In network services$800 per individual$1,600 per familyOut-of-network services$1,600 per individual$3,200 per family

No change from 2009In network services$800 per individual$1,600 per familyOut-of-network services$1,600 per individual$3,200 per family

$1,000/ individual$2,000/family

Prescription drug copays (at pharmacy)

$10 generic drugs$15 preferred brand $25 non-preferred brand

$7 generic drugs$30 preferred brand $60 non-preferred brand

$10 generic drugs$15 preferred brand $25 non-preferred brand

New Member Out-of-Pocket Expense Levels in 2010

Lower copays to drive generic use

No Change from 2009 to encourage more enrollment

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WebMD online Keep a personal health record; log exercise, stress

management, nutrition, weight management; track biometrics; read about smart consumerism

WebMD paper: Physical activity; nutrition

Weight Watchers at Work Weight Watchers community meetings Living Well With Chronic Conditions Live Well Challenge Parks Fitness Challenge Quit for Life tobacco cessation

Individual Action Plans

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Gold Silver Bronze Total 0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

20072008200920102011

Results: Participation

Participation has been at or above 90%

every year

Gold + Silver

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Reduced county’s costs by $46 million (2007-2011) Using health care services less often Paying higher deductibles, coinsurance and copayments Choosing less expensive generic drugs Shifting enrollment to the less-expensive Group Health

plan

$14.6 million of savings can be attributed to health improvements within the covered population. More than 800 people have quit smoking More than 2000 people have lost at least 5% of their

body weight

Additional savings $6.5 million shift of members from PPO to HMO $24.7 million from plan design changes in 2010

Results: Financial Impacts

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2006 2007 2008 2009 2010 201127.2

27.3

27.4

27.5

27.6

27.7

27.8

27.9

28.0

28.1

28.2

Healthy IncentivesSM 5-year CohortHealthy IncentivesSM 5-year Cohort

National Control Group

Healthy IncentivesSM Participants Lost More Weight Than a Comparison Group

Bod

y M

ass I

nd

ex (

BM

I)

MEPS=Medical Expenditure Panel Survey conducted annually by AHRQ (Agency for Healthcare Research and Quality)

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Impact on Obesity

Women Benefit More Than Men 20-Somethings Don’t Benefit At All African-Americans Benefit the Most College Graduates Benefit Less

Healthy IncentivesSM successfully managed weight for King County employees, spouses and partners

This is the first study to find significant benefits for a large percentage of employees over a multi-year period

Study report available @ J Occup Environ Med. 2011 Nov;53(11):1215-20.

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Supportive Environment Culture of Wellness Leveraging Social Change Dynamics

Engaging Employees

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Gym discount program Live Well Challenge Weight Watchers at Work® Healthy vending Choose well consumer education/Own Your

Health campaign Flu shots Lunch and Learn sessions Activity Centers Worksites accommodate biking Health Heroes

Supportive Environment

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Lessons Learned

Partnership with Labor is essential Engaged Leadership is critical Most effective strategy for moderating

costs requires 3-part focus Supply—Improve quality, reduce waste Demand—better health, smarter

consumers Plan design that rewards both providers

and patients to “do the right thing.”

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Next Steps

New benefit plan Work with the Puget Sound Health Alliance,

Washington State and other partners to improve quality/reduce waste in healthcare “Whether it’s the employee or the employer,

it doesn’t matter who gets stuck with the bill if the bill itself is growing exponentially.”

King County Executive, Dow Constantine

Study causes for reduced PEPM costs 2005-2012

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FOR MORE INFORMATION

Toolkit: http://www.kingcounty.gov/employees/HealthyIncentives/Toolkit.aspx

Results: http://www.kingcounty.gov/employees/HealthyIncentives/Results.aspx

Weight management study: J Occup Environ Med. 2011

Nov;53(11):1215-20.

Contact Information: Kerry Schaefer, Strategic Planning, Employee Health and

Well-Being kerry.schaefer@kingcounty.gov

Appendix

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Employers, physicians, hospitals, patients, health plans working together to measure and report

Best Care + Least Waste

Supply Side

Find out more: http://www.pugetsoundhealthalliance.org/about/index.htmlCommunity Checkup Report on Quality Care: http://www.pugetsoundhealthalliance.org/about/index.html

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Results: $46 Million Decrease in County Expenditures, 2007-2011

14.5696584613

49932%

24.6779830827

07854%

6.50012730070

97614% Health Im-

provements

Plan Design Changes

Enrollment Switch from PPO to HMO

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King County Employee Health & Well-Being Program Costs

2005 2006 2007 2008 2009 2010 2011 2012

$1.35 $5.48 $4.69 $3.27 $2.04 $0.97 $0.98 $0.98

Contributions to Puget Sound Health Alliance PEPM*

Supportive Environment PEPM*

Benefit Plan Design/Interventions PEPM*

Total PEPM*

*Per employee per month

Health Care Quality & Affordability

•Partner with Puget Sound Health Alliance & Washington State•Measure provider cost and outcomes•Pay providers for value not just volume•Improve care and care coordination

Support a Quality Workforce•Foster employee engagement•Promote a healthy workplace•Measure and evaluate programs and progress

 

Benefit Plan Design•Support Individual Health and Informed Health Care Consumerism•Personal wellness assessment•Individual action plans to change risk factors•Tools, resources and incentives to select effective providers and optimize health care

2005 2006 2007 2008 2009 2010 2011 2012

$6.11 $5.34 $4.76 $4.28 $3.53 $2.89 $2.89 $2.76

2005 2006 2007 2008 2009 2010 2011 2012

$6.64 $17.25 $18.48 $17.35 $16.84 $13.82 $6.11 $6.11

2005 2006 2007 2008 2009 2010 2011 2012

$12.75 $22.59 $23.24 $21.63 $20.38 $16.71 $8.99 $8.87

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2006 2007 2008 2009 2010 20110%

2%

4%

6%

8%

10%

12%

14%

16%

18%

National Control Group Healthy Incentives

Healthy IncentivesSM 5-Year

Healthy IncentivesSM Participants Smoke Less Than a Comparison Group

National Control Group