More than four years before the Affordable Care Act was signed into law, a county government in the state of Washington took action on its skyrocketing health care costs, becoming one of the first counties in the country to tie out-of-pocket health care expenses to participation in wellness activities. Today, more than 90% of King County employees have taken ownership of their health through the Healthy Incentives program, and the county serves as a model for other local governments across the nation.

Martin Luther King, Jr. County, Wash., or King County as it’s more commonly known, has approximately 14,000 employees in many different departments, from law enforcement to the parks department. It first embarked on its Healthy Incentives program in 2006. At the time, King County executive Ron Sims, now the deputy secretary for the U.S. Department of Housing and Urban Development, said the county government needed to take drastic measures.

“An effort like this requires an incredible culture change and resources to do the amount of outreach and education that are necessary,” says Brooke Bascom, the health reform program manager for the county. “We were really lucky to have a county executive who was very committed to the program and very committed to the approach.”

When first introduced, Bascom explains that King County was one of the “first [counties] in the country to tie out-of -pocket expenses to participation and wellness activities.”

Also see: How to make wellness work

The emphasis on care quality was a goal that King County and its new executive, Dow Constantine, were willing to fight for. Before fully implementing the tiered program, Bascom says county officials spent about a year talking to employees, as well as negotiating with labor unions. Initial projections pointed to a 60% participation rate, which was achieved in just a few short weeks.

“We were very open about the health care cost problems and what it was going to mean to county operations,” Bascom explains. “We were looking at service cuts, we were looking at job cuts. We explained why health care costs were going up as fast as they were, and what would be the solution.”

According to an assessment from 2003, Sims said that King County’s health care costs were slated to double by 2012 to $300 million. The RAND Corporation added fuel to the fire in a 2004 study that found 41% of the health care options available to employers and consumers in Seattle did not contribute to better health outcomes.

“Traditional cost-cutting approaches of premium sharing or cutting benefits will not help solve the problem in the long term, because neither actually addresses the underlying cause of the problem – quality of care,” Sims said in 2006.

The program seeks to improve individual health and improve quality of life in the region, which includes the cities of Seattle, Bellevue and Redmond. As its focus on “total health” remained front and center from 2007 to 2011, record results were reported for weight loss. Employees shed 19 tons more than a comparison group and smoking rates decreased to lower than the national average. In total, a total $46 million was saved on employee health, and the county says it experienced decreases in medical claims related to related to respiratory illness. 

King County recently beat out more than 600 other applicants for the 2013 Innovations in American Government Award as part of the Harvard Ash Center.

“The health savings represented a real and meaningful reduction in health spending,” says Daniel Harsha, associate director for communications at the Harvard Ash Center. “The results we have seen in King County have the potential to produce significant savings for local jurisdictions.” 

An employee who participates in a wellness assessment as well as enrolls in an individual action plan (programs range from six to 16 weeks) is eligible for the gold level plan, which has the lowest level of out-of-pocket expenses. Employees who participate in the wellness assessment, but not an individual action plan, are placed in the silver plan. With no participation in either option, employees then are responsible for the highest level of out-of-pocket expenses.

“We always want to make the healthy choice the easy choice,” says Bascom. Individual action plans include everything from options to track exercise and nutrition to fitness challenges and diabetes prevention.

Along with a yearly employee survey report, as well as regular outreach events, King County uses feedback and data to continually assess the Healthy Incentives program so that it lines up with the workforce’s need. But, according to Bascom, employers looking to replicate the county’s feats have to personalize their own health and wellness options.

“There are a lot of wellness programs out there that sort of sell themselves as they can sort of lay over your environment,” Bascom tells EBN. “But each workforce has its own personality and its own values and you really need to tailor your program to your audience and to your corporate or workplace culture; that means it has to become a living, breathing part of who you are, engaging employees and having leadership involved and continually evolving your program to be more responsive to your customers.”

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