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Nov 30, 2013 (3 years and 7 months ago)

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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



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.


3

Controlling health care costs

Strategy



4

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



13,000 benefits
-
eligible employees



Average age

50 years


Average age has increased .44 years for each calendar year of the
Healthy
Incentives
SM

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



5

King County Work Force


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




6

Goals


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



7

Elements

8

How It Works

GOLD

YES

NO

Did you take the wellness
assessment

by January 31

AND

complete your individual
action plan

by June 30?


NO

YES

Did you take the wellness
assessment

by June 30
?

SILVER

BRONZE

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


9

Item

KingCare
SM

Gold

2006
-
2009

KingCare
SM

Gold

2010
-
2012

Group Health Gold

2010
-
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 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

10

New Member Out
-
of
-
Pocket Expense Levels in 2010

Lower copays to
drive generic use

No

Change from
2009 to
encourage more
enrollment


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

11

Individual Action Plans

0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Gold
Silver
Bronze
Total
2007
2008
2009
2010
2011
12

Results: P
articipation

Participation has been at or
above 90% every year

Gold + Silver


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




13

Results: Financial Impacts

27.2
27.3
27.4
27.5
27.6
27.7
27.8
27.9
28.0
28.1
28.2
2006
2007
2008
2009
2010
2011
Healthy Incentives
SM

5
-
year Cohort

Healthy Incentives
SM

5
-
year Cohort

National Control Group


14

Healthy
Incentives
SM

Participants Lost More
Weight Than a Comparison Group

Body Mass Index (BMI)

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


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 Incentives
SM

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

15

Study report available @
J
Occup

Environ Med. 2011
Nov
;53(11):1215
-
20.



Supportive Environment


Culture of Wellness


Leveraging Social Change Dynamics

16

Engaging Employees


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

17

Supportive Environment

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.”



18

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


19

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


20

Appendix


22

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.html

Community Checkup Report on Quality Care:
http://www.pugetsoundhealthalliance.org/about/index.html


23

Results: $46 Million Decrease in

County Expenditures, 2007
-
2011

$14.6

32%

$24.7

54%

$6.5

14%

Health Improvements
Plan Design Changes
Enrollment Switch from
PPO to HMO
24

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

0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
2006
2007
2008
2009
2010
2011
National Control Group
Healthy Incentives
Healthy
Incentives
SM

5
-
Year

25

Healthy
Incentives
SM

Participants Smoke Less
Than a Comparison Group

National Control Group