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

Controlling health care costs
3


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.
Strategy
4
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
Health Care
Quality &
Affordability
Support a
Quality
Workforce
Benefit Plan
Design
King County Work Force
5

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
Goals
6



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
Elements
7

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

How It Works
8
Did you take the wellness
assessment
by January 31
NO
AND
complete your individual
action plan
by June 30?
Did you take the wellness
assessment
by June 30?
YES
YES
GOLD
SILVER
NO
BRONZE
Comparison of original Gold, Silver and Bronze
Member Out-of-Pocket Expenses
9
New Member Out-of-Pocket Expense Levels in 2010
10
Item
KingCareSM Gold
2006-2009
KingCareSM Gold
2010-2012
Group Health Gold
2010-2012
Deductible (medical)
$100 per individual
$300 per family
$300 per individual
$900 per family
No Change from
None 2009 to
encourage more
enrollment
Coinsurance (medical)
90% In network
70% Out-of-network
85% In network
65% Out-of-network
$20 copay for office visits
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
$7 generic drugs
$30 preferred brand
$60 non-preferred brand
$10 generic drugs
$15 preferred brand
$25 non-preferred brand
In network services
$800 per individual
Annual out-of-pocket
$1,600 per family
maximum for member
Out-of-network services
coinsurance (medical)
$1,600 per individual
$3,200 per family
Lower copays to
drive generic use
Prescription drug copays
(at pharmacy)
$10 generic drugs
$15 preferred brand
$25 non-preferred brand
Individual Action Plans
11

WebMD online


WebMD paper:







Keep a personal health record; log exercise, stress
management, nutrition, weight management; track
biometrics; read about smart consumerism
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
Results: Participation
12
100.0%
Gold + Silver
90.0%
Participation has been at or
above 90% every year
80.0%
70.0%
2007
2008
2009
2010
2011
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Gold
Silver
Bronze
Total
Results: Financial Impacts
13



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
Healthy IncentivesSM Participants Lost More
Weight Than a Comparison Group
14
28.2
28.1
Body Mass Index (BMI)
28.0
National Control Group
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
MEPS=Medical Expenditure Panel Survey conducted annually by AHRQ (Agency for Healthcare Research and Quality)
Impact on Obesity
15






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.
Engaging Employees
16



Supportive Environment
Culture of Wellness
Leveraging Social Change Dynamics
Supportive Environment
17










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
Lessons Learned
18



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.”
Next Steps
19


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
FOR MORE INFORMATION
20




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):121520.
Contact Information:
 Kerry Schaefer, Strategic Planning, Employee Health and Well-Being
kerry.schaefer@kingcounty.gov
Appendix
Supply Side
22
Employers, physicians, hospitals, patients, health
plans working together to measure and report
Best Care + Least Waste
Find out more: http://www.pugetsoundhealthalliance.org/about/index.html
Community Checkup Report on Quality Care: http://www.pugetsoundhealthalliance.org/about/index.html
Results: $46 Million Decrease in
County Expenditures, 2007-2011
23
$6.5
14%
$14.6
32%
Health Improvements
Plan Design Changes
$24.7
54%
Enrollment Switch from
PPO to HMO
King County Employee Health & Well-Being Program Costs
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
Contributions to Puget Sound Health Alliance PEPM*
2005
2006
2007
2008
2009
2010
2011
2012
$1.35
$5.48
$4.69
$3.27
$2.04
$0.97
$0.98
$0.98
Supportive Environment PEPM*
2007
2008
2009
2010
2011
2012
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
24
*Per employee per month
2005
2006
$6.11
$5.34
2005
Benefit Plan Design/Interventions PEPM*
2006
2007
2008
2009
2010
2011
$6.64
$17.25
$4.76
$18.48
$4.28
$17.35
$3.53
$16.84
$2.89
$13.82
$2.89
$2.76
2012
$6.11
$6.11
2011
2012
$8.99
$8.87
Total PEPM*
2005
2006
2007
2008
2009
2010
$12.75
$22.59
$23.24
$21.63
$20.38
$16.71
Healthy IncentivesSM Participants Smoke Less
Than a Comparison Group
25
18%
16%
14%
National Control Group
12%
10%
8%
6%
Healthy IncentivesSM 5-Year
4%
2%
0%
2006
2007
2008
National Control Group
2009
Healthy Incentives
2010
2011