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 Incentives SM 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 31 AND complete your individual action plan by June 30? YES GOLD SILVER BRONZE YES NO Healthy Incentives SM - how it works

Healthy Incentives SM Design Out-of-pocket level (KingCare SM ) Annual deductibleCo-Insurance Gold$100/person $300/family 10% network/ 30% non-network Bronze$500/person $1,500/family 20%network/ 40% non-network

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

Results

51 % 58 % 5% 4% 44 % 38 % 0% 10% 20% 30% 40% 50% 60% LowModerateHigh WELLNESS ASSESSMENT PARTICIPATION &

Results

Results: At-Risk Health Behaviors Aggregate All Respondents Risk Factor % Change ( ) Alcohol Use -1.1* Depression -2.5* Injury Prevention-5.0* Mental Health-5.6* Nutrition-9.0* Physical Activity2.8* 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 ( ) BMI Risk-2.7* Cholesterol-7.2* Blood Glucose2.7* Systolic BP-2.5* Diastolic BP-1.6* Results: At-Risk Health Behaviors

Results

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

Puget Sound Health Alliance Prevention 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?