King County’s Health Reform Initiative

1. King County’s Health Reform Initiative Collaborative solutions to the health care crisis SCI - July 31, 2008

2. Health care environment • 13,000 employees • 30,000 plan members • Strong Labor Unions – 95 separate bargaining units • Dwindling tax base, rising public expectations • Comprehensive medical, dental, vision • 2012: Health costs double under status quo to $300+ Million

3. Health reform strategy • Address both demand and supply side market failures • King County’s efforts with employees reduce demand for health care by improving employee health • King County works with Puget Sound Health Alliance to improve the quality of care in the region, reducing costs that come from ineffective treatment

4. Health Reform Initiative

5. Healthy IncentivesSMbenefit design • Focused on individual employees and family members • Wellness Assessment • Individual coaching to change risk factors • Disease management resources • 24/7 Nurse line • Quit Smoking programs • Workplace programs

6. Healthy IncentivesSM - how it works Did you take the wellness assessment by January 31 AND complete your individual action plan by June 30? NO Did you take the wellness assessment by June 30? NO YES YES SILVER GOLD BRONZE

7. Healthy IncentivesSMDesign

8. Supportive Environment

9. Supportive Environment Eat Smart, Move More, Stress Less, Quit Tobacco, Get a Flu Shot • Gym Discount Program • Weight Watchers at Work • Healthy Workplace Funding Initiative • Healthy snacks in vending machines • Onsite flu shots • Onsite workout facilities • Education: newsletter, website, poster campaigns • Organizational support • Health Leadership Forum • Management training • Health Promotion Leadership Committee

10. Results

11. Results WELLNESS ASSESSMENT PARTICIPATION - 2006 & 2007 60% 58% 51% 50% 44% 40% 38% 2006 30% 2007 20% 10% 5% 4% 0% Low Moderate High

12. Percents of Employee & Dependent Population By Body Mass Index (BMI) 40.0% 37.2% 36.6% 36.0% 34.6% 35.0% 30.0% 23.6% 25.0% 22.0% Percent of Respondents 20.0% Percent in 2006 15.0% Percent in 2007 10.0% 4.4% 3.9% 5.0% 0.9% 0.8% 0.0% Below 18.5 - 25 - 29.9 30 to 40 + 18.5 24.9 39.9 BMI Results

13. Results

14. Results

15. Results: At-Risk Health Behaviors Source: Thompson Reuters

16. Results: At-Risk Health Behaviors * p-value <0.05, using McNemar’s chi square test

17. Results

18. Puget Sound Health Alliance • King County Health Advisory Task Force: Quality = Value • Alliance formed December 2004 • Public and private employers, unions, clinics, hospitals, consumers, health plans, and more • >160 organizations, >50 individuals • >1.5 million covered people (not counting health plan enrollees) • Focus: 5-county socio-economic region

19. Puget Sound Health Alliance Major Initiatives • Community agreement on evidence-based treatment • Better information about health care • Public reports comparing quality and efficiency • Useful information for decision-making • Encourage use of health information technology • Aligned incentives to reward quality care Better results than any one organization, group or individual can achieve by themselves

20. Puget Sound Health Alliance Community Check-up Report • 14 volunteer clinic systems • 150 clinic locations • 21 performance measures • Data on 70 percent of the insured, non-Medicare population in the region

21. Puget Sound Health Alliance Prevention Services in the Five-County Region

22. Lessons • Early lessons—success built on • Comprehensive strategy that includes supply and demand-side • One full year of outreach and education before the wellness assessments/individual action plans began • Large enough financial incentive • Collaborative process with the unions

23. Questions?http://www.metrokc.gov/employees/hri_toolkit