2012 State of Reform Health Policy Conference January

2012 State of Reform Health Policy Conference January 4, 2012 KING COUNTY EMPLOYEE HEALTH AND WELL BEING PROGRAM

AGENDA � Overview of King County Employee Health and Well-Being Program � Results/Program Effects � Lessons Learned � Next Steps 2

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 3

SUPPLY SIDE Employers, physicians, hospitals, patients, health plans working together to measure and report Best Care + Least Waste 4

DEMAND SIDE--Healthy Incentives. SM � Improve employee health �Healthy Incentives program—annual wellness assessment and individual action plan �Worksite health promotion—Eat Smart, Move More, Stress Less � Increase employee health consumer skills �Own Your Health Campaign �Community Checkup Report on provider quality 5

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Comparison of original Gold, Silver and Bronze Member Out-of-Pocket Expenses 7

New Out-of-Pocket Expense Levels in 2010 Item King. Care. SM Gold 2006 -2009 King. Care. SM Gold 2010 -2012 Group Health Gold 2010 -2012 (No Change from 2009) 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 8

WORKSITE WELLNESS � Health Matters website � Health Matters Newsletter � Health Promotion Leadership Team � Leadership � Annual Forums surveys/focus groups � Employees and s/partners 9

WORKSITE WELLNESS � � � Gym discount program Live Well Challenge Weight Watchers at Work Farmer’s market Farm to Work fresh produce delivery Employee Demonstration/Giving Garden Healthy vending Choose well consumer education/Own Your Health campaign Flu shots Health Heroes Lunch and Learn sessions on timely topics 10

Employees Improved 12 out of 14 health risk factors. 11

Average Annual Growth Rate of Medical and Prescription Expenditures per Member, 2001 -2005 & 2006 -2010 12, 0% 10, 0% 11, 0% 8, 0% 6, 2% 4, 0% 2, 0% 0, 0% 2001 -2005 (Pre-Healthy Incentives) 2006 -2010 (During Healthy Incentives) 12

King County Benefits Cost Actual vs. Budget Projections $300 2010 -2012 Actual Total Exp. $250 $200 Actuary's 2011 3 -Yr Financial Plan Actuary's 2012 3 -Yr Financial Plan $150 $100 $50 $0 2007 2008 2009 2010 2011 2012 Based on results in medical and prescription drug claims in 2010 and early 2011, King County was able to reduce the overall Employee Benefits Budget projections for 2011 by $23 and 2012 by $38 M. 13

King County Benefits Cost 2010 -2012 Actual vs. Budget Projections Per Employee Per Month $1 800 $1 600 $1 400 Actual PEPM $1 200 $1 000 Actuary's 2011 PEPM $800 Actuary's 2012 PEPM $600 $400 $200 $0 2007 2008 2009 2010 2011 2012 14

Group Health HMO Costs 37% Less Than King. Care SM PPO per Employee per $14 000 $13 128 Year $11 819 $12 000 $10 000 $7 504 $8 000 $8 021 $6 000 $4 000 $2 000 $1 309 $517 $0 Out-of-Pocket Employer King Care Total Group Health 15

More Information on Group Health Compared to King. Care. SM for the King County Employee Population � No significant difference in the age, gender, education level, smoking, body mass, ethnicity, salary or general health status between members in Group Health and King. Care. SM � Group Health provides the most fully integrated staff model health care in the Seattle metropolitan area � Analysis shows less use of brand name drugs, surgery, diagnostic radiation and other preference sensitive treatments in Group Health compared to providers in the King. Care SM plan 16

Healthy Incentives. SM Participants Lost More 28, 2 Weight Than a Comparison Group Body Mass Index (BMI) 28, 1 28, 0 27, 9 27, 8 27, 7 27, 6 27, 5 Healthy Incentives. SM 5 -year Cohort 27, 4 27, 3 27, 2 2006 2007 2008 2009 2010 2011 17

Weight Loss by Obese Members 40% 35% % of Obese Cohort 30% 25% 20% 15% 10% 5% 0% ≥ 5% Weight Loss MEPS 1 -yr ≥ 10% Weight Loss KC 1 st-yr KC 5 -yr 18

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 19

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. ” 20

NEXT STEPS New benefit plan � RFP for new wellness vendor � 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 Continue to engage Leadership � Study causes for reduced PEPM costs 2005 -2012 � 21

FOR MORE INFORMATION � � � Programs: http: //kingcounty. gov/employees/Health. Matters. aspx Toolkit: http: //kingcounty. gov/employees/Health. Matters/Visitors/HRIToolkit. aspx Contacts: � Karleen Sakumoto, Manager, Employee Health and Well-Being, Human Resources Division, Department of Executive Services, karleen. sakumoto@kingcounty. gov � John Scoggins, Health Care Economist, Office of Performance, Strategy and Budget, john. scoggins@kingcounty. gov 22