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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
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.
Controlling health care costs
4
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
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
King County Work Force
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
Goals
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
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?
NOYES
Did you take the wellness assessment
by June 30?
SILVER BRONZE
9
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
11
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
12
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
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
Results: Financial Impacts
14
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)
15
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.
16
Supportive Environment Culture of Wellness Leveraging Social Change Dynamics
Engaging Employees
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
Supportive Environment
18
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.”
19
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
20
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 [email protected]
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.htmlCommunity Checkup Report on Quality Care: http://www.pugetsoundhealthalliance.org/about/index.html
23
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
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
25
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