King County's no-premium health care is a different but effective approach

King County employees might not pay a premium, but their health-care costs are being driven down by innovative approaches to help employees be healthier, write King County Council members Larry Gossett and Julia Patterson. This approach is being considered by the Obama administration as it tackles health-care reform.

The following article, written by King County Councilmembers Larry Gossett and Julia Patterson, appeared in the Seattle Times on June 17, 2009.

King County is driving down health-benefit claims and increasing employees' share of costs.

How do we control the rising cost of health care? There has been much discussion about how to answer this question. We believe King County government has made significant improvements at keeping down the cost of providing medical benefits to its 13,000 employees. We think the county's Healthy Incentives Benefit Plan has led the way. It incorporates health-care strategies for county employees that emphasize wellness and prevention and provides financial rewards for workers who fully participate.

Since 2005, our government has avoided $18 million in health-benefit cost increases by encouraging employees to concentrate on prevention, healthy behaviors and smarter health-care usage, rather than just getting treatment for their illnesses. What is different about our system is that it focuses on diet, exercise, injury prevention and other core issues that, if not managed by individuals, contribute to poor health and expensive health care. ;

Because of our efforts to encourage prevention, hundreds of county employees can be seen walking the stairs in the county courthouse or streets of downtown Seattle during their lunch hour or after work. Weight Watchers at Work programs, which employees pay for, are available at some office sites, and has resulted in 200 employees losing more than 10,300 pounds!

Thousands of others are talking to "health-care coaches" on a biweekly or monthly basis about diet, exercise and smoking-cessation goals. They are making ongoing efforts to experience healthier lives. In addition, significant reductions in 12 out of 14 health indicators, such as body mass index, cholesterol, blood pressure and smoking, have been recorded since 2005.

Knowing that prevention alone cannot, in the short term, reduce health-care costs, King County also negotiated a plan with our labor unions that, beginning in 2010, is projected to save our county an additional $37 million in health-care costs over three years. Employees will pay higher co-payments for some health services and medications, which is equivalent to each of the 13,000 county employees paying a $70 monthly premium in addition to costs they already pay now. There is no requirement in this new plan for every employee to automatically pay monthly medical premiums, they only have to share more in paying the cost of covering their health care when they use more services or need new medications.

King County has been criticized by The Seattle Times for its health-care benefit program ["County workers should pay part of health tab," editorial, June 10]. While it is true that employees do not pay monthly premiums, national studies show that cost sharing (co-payments for doctor's visits, medication, education encouraging wellness, prevention, etc.), rather than paying monthly premiums, is the best approach to reducing unnecessary use of care. King County has incorporated this strategy because it is proven to be more effective in controlling costs than a flat fee every month, whether you use health-care services or not.

The county has thought about sustainable ways to curb health-care costs. We believe focusing on prevention efforts to reduce health-care demand, as well as encouraging employees to use their health care wisely, are the most effective methods in keeping costs down and maximizing the number of healthy years lived by our employees.