Download - King County’s Health Reform Initiative
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