King County’s Health Reform Initiative

Collaborative solutions to the

health care crisis

SCI - July 31, 2008

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

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

Health Reform Initiative

Healthy IncentivesSM benefit 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

Did you take the wellness

assessment by June 30?

NO

Did you take the wellness assessment

by January 31AND

complete your individual action plan

by June 30?

YES

GOLD SILVER BRONZE

YES

NO

Healthy IncentivesSM - how it works

Healthy IncentivesSM Design

Out-of-pocket level (KingCareSM)

Annual deductible Co-Insurance

Gold $100/person

$300/family

10% network/

30% non-network

Bronze $500/person

$1,500/family

20%network/

40% non-network

Supportive Environment

Supportive EnvironmentEat 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

95.0%

86.5%

60.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Best PracticeParticipation

King CountyParticipation

Typical ProgramParticipation

Percent of Members Who Completed Both a Wellness Assessment and Individual

Action Plan in 2007

Results

Results

51%

58%

5% 4%

44% 38

%

0%

10%

20%

30%

40%

50%

60%

Low Moderate High

WELLNESS ASSESSMENT PARTICIPATION - 2006 & 2007

2006

2007

Results

0.8% 0.9%

34.6%36.0%

36.6% 37.2%

23.6%22.0%

4.4% 3.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Perc

en

t of

Resp

on

den

ts

Below18.5

18.5 -24.9

25 - 29.9 30 to39.9

40 +

BMI

Percents of Employee & Dependent Population By Body Mass Index (BMI)

Percent in 2006Percent in 2007

Results

53. 6% 57. 2%61. 0% 63. 9%

70. 0%

0. 0%

20. 0%

40. 0%

60. 0%

80. 0%

2005 2006 2007 Q1 2008 T ar get

Generic Fill Rate 2005 - Q1 2008

Results

0. 0%

45. 0%

84. 0%100. 0%

0. 0%

50. 0%

100. 0%

2005 2006 2007 T ar get

Healthy Workplace Funding Initiative 2005 - 2007

Results: At-Risk Health Behaviors

Aggregate All Respondents

Risk Factor% Change (2006-2008)

Alcohol Use -1.1*

Depression -2.5*

Injury Prevention -5.0*

Mental Health -5.6*

Nutrition -9.0*

Physical Activity 2.8*

Sun Damage Behavior -5.9*

Smoke Behavior -3.8*

Stress Behavior -5.1*

Source: Thompson Reuters

* p-value <0.05, using McNemar’s chi square test

Aggregate All Respondents

Risk Factor% Change (2006-2008)

BMI Risk -2.7*

Cholesterol -7.2*

Blood Glucose 2.7*

Systolic BP -2.5*

Diastolic BP -1.6*

Results: At-Risk Health Behaviors

ResultsCost Increases in KingCare Total Claims During HRI

(All Active Employees; Excludes Claims for COBRA & Early Retirees)Showing 2004-2006, 2004-2007, & Target

10.7%9.6%

8.9%

0%

2%

4%

6%

8%

10%

12%

Incr

ea

ses

in T

ota

l Cla

ims

Co

sts

Actual Increase 2004-2006 Actual Increase 2004-2007 Target Increase

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

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

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

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Cervical Cancer Screening Breast Cancer Screening Chlamydia Screening Colon Cancer Screening

Screening Received by Age-Eligible Patients Screening Not Received

Puget Sound Health AlliancePrevention Services in the

Five-County Region

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

Questions?

http://www.metrokc.gov/employees/hri_toolkit