King County’s Employee Health and Well-Being Program

1. King County’s Employee Health and Well-Being Program Plexus Healthcare PlexusCall

2. Agenda • Overview of King County Employee Health and Well-Being Program • Results • Employee Engagement • Lessons Learned

3. Controlling health care costs • 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.

4. Health Care Quality & Affordability Support a Quality Workforce Benefit Plan Design 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

5. King County Work Force • 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

6. Goals • 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

7. Elements • 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

8. How It Works Did you take the wellness assessment by January 31 AND complete your individual action plan by June 30? NO NO Did you take the wellness assessment by June 30? YES YES GOLD SILVER BRONZE

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

10. New Member Out-of-Pocket Expense Levels in 2010 No Change from 2009 to encourage more enrollment Lower copays to drive generic use

11. Individual Action Plans • 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

12. Results: Participation Gold + Silver Participation has been at or above 90% every year

13. Results: Financial Impacts • 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

14. Healthy IncentivesSM 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)

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. Engaging Employees • Supportive Environment • Culture of Wellness • Leveraging Social Change Dynamics

17. Supportive Environment • 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

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 kerry.schaefer@kingcounty.gov

21. Appendix

22. SupplySide 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

23. Results: $46 Million Decrease in County Expenditures, 2007-2011

24. 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* • Support a Quality Workforce • Foster employee engagement • Promote a healthy workplace • Measure and evaluate programs and progress Supportive Environment PEPM* Benefit Plan Design/Interventions PEPM* • 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 Total PEPM* *Per employee per month

25. Healthy IncentivesSM Participants Smoke Less Than a Comparison Group National Control Group