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.  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. 3 Controlling health care costs

4. Strategy 4 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 Incentives SM 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 5 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 6 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 7 Elements

8. 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? NO YES Did you take the wellness assessment by June 30 ? SILVERBRONZE

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

10. Item KingCare SM Gold 2006-2009 KingCare SM Gold 2010-2012 Group Health Gold 2010-2012 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 family Out-of-network services $1,600 per individual $3,200 per family No change from 2009 In network services $800 per individual $1,600 per family Out-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 10 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 11 Individual Action Plans

12. 12 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 13 Results: Financial Impacts

14. 14 Healthy Incentives SM 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 Incentives SM 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 15 Study report available @ J Occup Environ Med. 2011 Nov;53(11):1215-20.

16.  Supportive Environment  Culture of Wellness  Leveraging Social Change Dynamics 16 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 17 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.” 18

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 19

20. FOR MORE INFORMATION  Toolkit: http://www.kingcounty.gov/employees/HealthyIncentives/Toolkit.aspx http://www.kingcounty.gov/employees/HealthyIncentives/Toolkit.aspx  Results: http://www.kingcounty.gov/employees/HealthyIncentives/Results.aspx 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 kerry.schaefer@kingcounty.gov 20

21. Appendix

22. 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.htmlhttp://www.pugetsoundhealthalliance.org/about/index.html Community Checkup Report on Quality Care: http://www.pugetsoundhealthalliance.org/about/index.htmlhttp://www.pugetsoundhealthalliance.org/about/index.html

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

24. 24 King County Employee Health & Well-Being Program Costs 20052006200720082009201020112012 $1.35$5.48$4.69$3.27$2.04$0.97$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 20052006200720082009201020112012 $6.11$5.34$4.76$4.28$3.53$2.89 $2.76 20052006200720082009201020112012 $6.64$17.25$18.48$17.35$16.84$13.82$6.11 20052006200720082009201020112012 $12.75$22.59$23.24$21.63$20.38$16.71$8.99$8.87

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