2012 State of Reform Health Policy Conference
January 4, 2012
KING COUNTY EMPLOYEE HEALTH
AND WELL BEING PROGRAM
AGENDA
Overview of King County Employee Health and
Well-Being Program
 Results/Program Effects
 Lessons Learned
 Next Steps

2
STRATEGY
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
3
SUPPLY SIDE
Employers, physicians, hospitals,
patients,health plans working together to
measure and report
Best Care + Least Waste
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DEMAND SIDE--Healthy IncentivesSM
Improve employee health
 Healthy Incentives program—annual wellness
assessment and individual action plan
 Worksite health promotion—Eat Smart, Move
More, Stress Less
 Increase employee health consumer skills
 Own Your Health Campaign
 Community Checkup Report on provider
quality

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6
Comparison of original Gold, Silver and Bronze
Member Out-of-Pocket Expenses
7
New Out-of-Pocket Expense Levels in 2010
Item
KingCareSM Gold
2006-2009
KingCareSM Gold
2010-2012
Group Health Gold
2010-2012
(No Change from 2009)
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 family
Out-of-network services
$1,600 per individual
$3,200 per family
No change from 2009
In network services
$800 per individual
$1,600 per family
Out-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
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WORKSITE WELLNESS
Health Matters website
 Health Matters Newsletter
 Health Promotion Leadership Team

 Leadership

Forums
Annual surveys/focus groups
 Employees
and s/partners
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WORKSITE WELLNESS

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

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Gym discount program
Live Well Challenge
Weight Watchers at Work
Farmer’s market
Farm to Work fresh produce delivery
Employee Demonstration/Giving Garden
Healthy vending
Choose well consumer education/Own Your Health
campaign
Flu shots
Health Heroes
Lunch and Learn sessions on timely topics
10
Employees Improved 12 out of 14 health risk factors.
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Average Annual Growth Rate of Medical and Prescription
Expenditures per Member, 2001-2005 & 2006-2010
12.0%
10.0%
11.0%
8.0%
6.0%
6.2%
4.0%
2.0%
0.0%
2001-2005 (Pre-Healthy
Incentives)
2006-2010 (During Healthy
Incentives)
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King County Benefits Cost Actual vs. Budget Projections
2010-2012
$300
Actual Total
Exp.
$250
Millions
$200
Actuary's
2011 3-Yr
Financial
Plan
Actuary's
2012 3-Yr
Financial
Plan
$150
$100
$50
$0
2007
2008
2009
2010
2011
2012
Based on results in medical and prescription drug claims in 2010 and early 2011, King County was able to
reduce the overall Employee Benefits Budget projections for 2011 by $23 and 2012 by $38M.
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King County Benefits Cost 2010-2012
Actual vs. Budget Projections Per Employee Per Month
$1,800
$1,600
$1,400
Actual PEPM
$1,200
$1,000
Actuary's
2011 PEPM
$800
Actuary's
2012 PEPM
$600
$400
$200
$0
2007
2008
2009
2010
2011
2012
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Group Health HMO Costs 37% Less
Than KingCare SM PPO per Employee per Year
$14,000
$13,128
$11,819
$12,000
$10,000
$7,504
$8,000
$8,021
$6,000
$4,000
$2,000
$1,309
$517
$0
Out-of-Pocket
Employer
King Care
Total
Group Health
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More Information on Group Health Compared to
KingCareSM for the King County Employee Population

No significant difference in the age, gender, education
level, smoking, body mass, ethnicity, salary or general
health status between members in Group Health and
KingCareSM

Group Health provides the most fully integrated staff
model health care in the Seattle metropolitan area

Analysis shows less use of brand name drugs, surgery,
diagnostic radiation and other preference sensitive
treatments in Group Health compared to providers in the
KingCare SM plan
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Healthy IncentivesSM Participants Lost More
Weight Than a Comparison Group
28.2
28.1
Body Mass Index (BMI)
28.0
27.9
27.8
27.7
27.6
27.5
Healthy IncentivesSM 5-year Cohort
27.4
27.3
27.2
2006
2007
2008
2009
2010
2011
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Weight Loss by Obese Members
40%
35%
% of Obese Cohort
30%
25%
20%
15%
10%
5%
0%
≥ 5% Weight Loss
MEPS 1-yr
≥ 10% Weight Loss
KC 1st-yr
KC 5-yr
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Impact On Obesity
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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
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LESSONS LEARNED


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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
RFP for new wellness vendor
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

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Continue to engage Leadership
Study causes for reduced PEPM costs 2005-2012
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FOR MORE INFORMATION

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Programs: http://kingcounty.gov/employees/HealthMatters.aspx
Toolkit:
http://kingcounty.gov/employees/HealthMatters/Visitors/HRIToolkit.aspx
Contacts:
 Karleen Sakumoto, Manager, Employee Health and Well-Being, Human
Resources Division, Department of Executive Services,
karleen.sakumoto@kingcounty.gov
 John Scoggins, Health Care Economist, Office of Performance, Strategy
and Budget, john.scoggins@kingcounty.gov
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