County creates comprehensive, regional solution to health care
If an ounce of prevention is worth a pound of cure, King County, Wash. is making tons of progress with its revolutionary approach to its health care system.
The county has gained national exposure for its comprehensive, regional approach to restructuring the way health care works for both county employees and Seattle-area residents. Now in its third year, the large-scale reform contributed, in part, to County Executive Ron Sims’ selection as one of Governing magazine’s public officials of the year in its November 2006 issue.
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Photos courtesy of King County, Wash.
These public health employees became “Health Heroes” by losing weight and lowering their cholesterol through an emphasis on eating healthier lunches.
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King
County’s new approach to health care stems, in part, from a 2004 Rand Corp. study. It found that Seattle-area patients received the wrong care, too much or too little care from their doctors 41 percent of the time.
King County’s Health Reform Initiative uses a two-pronged strategy, addressing the supply and demand sides of the health care industry.
The first part of the county’s strategy was to implement the Healthy Incentives program — an effort to reward participants for taking steps to better their own health and that of their spouses or domestic partners.
The second part of the plan involved the Puget Sound Health Alliance, an independent nonprofit organization that strives to improve health care in the Puget Sound region.
“Individual employers need to restructure their benefits packages so that employees are encouraged to use preventative care,” said Rachel Quinn, King County’s liaison to alliance. “This is especially important when it comes to high-cost, chronic medical conditions,” Quinn said. “We need to see how we can restructure it [the benefits plan] to get people to be more proactive about exercising and eating healthy.”
Healthy Incentives
The heart of King County’s Health Reform Initiative is the Healthy Incentives program — a benefit-design program that gives employees, as well as their spouses and domestic partners, a greater stake in improving their health.
The more involved a participant becomes in improving his or her health, the more savings that person will see. To begin receiving monetary benefits, employees can take a health assessment online that rates individuals as high, moderate or low risk. The questionnaire, which is administered by a third party, asks participants everything from their smoking habits to body mass index to cholesterol level.
To receive further out-of-pocket discounts, participants can enroll in individualized action plans. Those who have higher risk assessments can take three or more “coaching calls” from another third-party entity that guide participants in their efforts to lead healthier lifestyles.
Dow said that King County employees who choose to participate aren’t penalized for the answers they give.
“We work extra hard to remove any feeling that by filling something out you’re jeopardizing your benefit,” Dow said. “Just your participation in the program qualifies you for the lower out-of-pocket expense, it’s never your health condition or the progress of your health condition.”
The county hopes to reduce the rate of growth for its current medical plan’s cost by one-third, saving the government $40 million between 2007 and 2009.
Puget Sound Health Alliance
A direct outgrowth of the task force’s report, the Puget Sound Health Alliance (PSHA) addressed the “supply” side of the health care equation. Established in December 2004, the independent entity is funded by grants and support from its more than 140 members.
Wastewater Division employees used their Healthy Workplace Funding Initiative budget to purchase exercise and spin classes at a local gym. |
The multi-stakeholder group focuses on quality improvement in health care through two primary methods: providing the public with information to make informed decisions and examining the motivations and barriers to having people make positive health decisions.
In terms of information supply, the alliance collects data from physicians, doctors and natural medicine practitioners to create a performance report for the entire region looking at the efficiency of health care.
“We want to support and encourage improvement in the percentage of people who are receiving this effective care,” said Diane Giese, communication and development director for PSHA.
“It’s not just making information available, but it’s creating that community agreement about what’s effective and getting the medical community taking the lead on getting us to define what that quality care is. And then providing the public information so that everybody across the community is on the same page and understands how we are doing as a community in ensuring that quality care is provided.”
As far as creating incentives for health care consumers, the alliance examines how employers and health insurance providers can be more engaged in helping people make healthy choices. These choices include improving personal health and managing chronic conditions.
PSHA encourages increasing use of information technology and making sure health benefits cover effective treatments.
“You can put all the information out there in the world, but there are potential barriers all over the place,” Giese said. “Taking that person who has been told by their doctor to quit smoking, if they don’t have a smoking cessation benefit or they can’t afford the medication they’ve been told to take or if their insurance doesn’t cover it, those (factors) undermine what should be the effective care that the person should have.”
Healthy Incentives is King County’s response to this part of PSHA’s goal of having employers encourage healthy lifestyles.
“They’ve done an amazing job in really looking at how they influence the behavior of their employees and their employees’ families,” she said. “It’s clear that employers can have a big influence on the choices that an employee makes.”
Giese recommends incentives such as having lower prices for healthy options in cafeterias and encouraging employees to use the stairs instead of the elevators.
“It’s those little things that can create a culture of health in a work environment,” she said.
In just over two years in existence, the Alliance has grown steadily, and its members include Starbucks Coffee Company, Washington Mutual, Boeing, the State of Washington and King County itself.
Positive results
After two years of operation, the county boasts positive results for its initiative. More than 90 percent of the county’s employees (as well as employees’ spouses and domestic partners) took the wellness assessment — a dramatic increase for the 30-percent rate typical of the vendors running the program. Of that 90 percent, nearly all enrolled in individual action plans.
Furthermore, 75 percent of patients classified as high-risk who took coaching calls reported improving or eliminating one or more risk factors, including weight, smoking, cholesterol or hypertension. Fifty-seven percent of the 7,343 coaching call participants reported an elimination of at least one risk factor.
Dow said that King County’s programs are highly replicable.
“I think the thing folks might want to remember is that the solution for health care has to start locally,” he said. “There are things governments can do to encourage their employees to take over their own health care and that will have positive benefits for the organization as well.”
County officials should consult with experts and meet with local stakeholders, advises Quinn, the county’s liaison to regional health alliance.
“It’s best to start conversations with pubic and private employers in the area and maybe do individual meetings to see what their approaches [are],” she said. “Don’t be afraid to make mistakes.”
King County, Wash. Healthy Menu
In an effort to help its employees take steps to improve their health, King County has launched a number of successful programs.
• Weight Watchers at Work — Between February and September of 2006, more than 230 participants lost an average of 7.8 pounds while enrolled in the 13-week sessions. To date, the program has helped employees shed more than 3,879 pounds. According to the Partnership for Healthy Weight Management, a weight loss of 5 to 10 percent can measurably improve health outcomes.
• Gym Discounts — Twenty-two fitness organizations offer employees an average 20 percent discount at 119 locations throughout the Puget Sound region.
• Healthy Workplace Funding Initiative — Using a $25 per employee credit, departments purchased goods and services to engage in healthy workplace activities including fitness training, exercise videos and nutrition information. For example, the Wastewater Treatment Division began a series of yoga classes once a week for six weeks.
• Live Well Challenge — Nearly 1,200 participants on 172 teams competed for fun and prizes in the first annual Live Well Challenge — an effort to raise awareness and build healthy communities throughout King County. Participating teams earned points by making positive lifestyle decisions. This year’s grand-prize winners were Waist Management (from the Solid Waste division of the Department of Natural Resources and Parks). The Fabulous Fruit Cups (Assessor’s office) finished as first runners-up.
• Health and Benefits Fair — Organizers reported a 20-percent increase in attendance at this year’s King County Health and Benefits Fair, which drew thousands of employees and featured many new health vendors. The county reports that 63 percent of attendees plan to make changes to their lifestyle because of something they learned at the fair.
• Flu Shots — Last November, 3,100 employees (30 percent the county’s targeted workforce) turned out at worksites across the county to receive free flu shots.
• Healthy Vending Machine Pilot Program — King County partnered with vendors to stock vending machines with healthy snack options in county buildings.
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(For more information, please contact Karleen Sakumoto, King County Health Reform Initiative project director, at karleen.sakumoto@metrokc.gov or 206/296-8579. Or contact Barnaby Dow, communications director, at barnaby.dow@metrokc.gov or 206/684-2062.)
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