New health-benefits plan prompts county workers to diet, head for the gym

Brooke Bascom is an obese new mother who is married to a doctor and fitness buff. But it was Bascom's employer, not her nagging husband, who finally jolted her into making serious improvements to her health.

Bascom is one of nearly 20,000 King County employees and their spouses or partners who next year will be switched into the county's new Healthy Initiatives health plan, which carries financial penalties for people with unhealthy lifestyles who won't change their behavior.

As part of the program, Bascom recently took a 13-page health assessment. The results weren't pretty. Her "lifestyle score" — a rating of health and habits — was 70 out of 100. Her body-mass index was 36.8 (30 and above is considered obese). Her cholesterol was high at 200. In a nutshell, she was considered at high risk of developing serious health problems and dying young.

"It scared me. There it is on paper," said Bascom, 40, the chief spokeswoman for the program. "Sometimes it's better to hear it from a third party than from your spouse."

And Bascom isn't alone. A full 90 percent of all eligible workers have taken the survey for the Healthy Incentives program, which King County adopted last year as a cost-saving measure. And despite the fact that it's done on the honor system, 44 percent were honest enough — or perhaps simply unwitting enough — to earn high-risk ratings.

Of the others who took the survey, 51 percent rated low risk and 5 percent were deemed moderate risk.

The results of the survey have triggered something of a health kick among many county workers. Office fridges now hold healthier lunches. Spandex sightings are increasing. Demand for lockers at the county gym downtown has shot up. Bascom has taken up yoga, three-mile walks and a new determination to gain control of her weight.

Even County Councilman Larry Gossett, who says he has been perhaps the least fitness-conscious council member, is walking seven days a week and has banished sugared soft drinks from his office.

"There is just a ton of people walking at lunch hour," said Stephanie Warden, director of King County's Department of Development and Environmental Services in Renton.

Even so, officials aren't about to forecast a drop in health-care costs. The county rewards employees not so much for being healthy, but for trying to be healthy. So a perfectly healthy person in a stressful job, no time for exercise and a penchant for fast food could be deemed just as high a risk as an obese person with uncontrolled high blood pressure and cholesterol who is trying to get healthy.

Healthy Incentives is a key piece of King County's wide-ranging plan to reduce health-care spending by $40 million over three years starting in 2007. The county is one of the first employers in the nation to try to slow the rise in medical costs by linking workers' out-of-pocket expenses to their health habits.

To pay the lowest out-of-pocket costs, workers must take the survey and fulfill a personal-action plan to be rated in the "gold" level. About 90 percent who took the survey will make the July 31 deadline to be in this group, said Kerry Schaefer, the county's manager of compensation and benefits. The county originally expected only 60 percent of people to hit the gold level.

To earn gold status, high- and moderate-risk employees have to complete at least three telephone calls with health coaches as part of their personal action plan, which could also spell out specific steps to improve their health. Even low-risk employees are required to log for two months either their fruit and vegetable consumption or their physical activities.

Taking the survey was a condition for reaching at least silver status.

About 2,000 county employees and their partners did not take it, so they were relegated to the "bronze" level.

Depending on their health plan, bronze-level workers will have the highest out-of-pocket costs, including co-pays of $50 or family deductibles of $1,500, versus $20 co-pays and $300 annual deductibles for the gold level.

The county does not track the employees' progress; there are no penalties for a lack of actual improvements in their health or habits, and no safeguards against cheating. Rather, the program is intended to get workers thinking about their health.

Schaefer said it could take several years to see whether workers' healthier lifestyles will lead to real decreases in claims. It's also unknown how many employees will drop spouses or partners from the county health plan because they fail to earn gold status, meaning higher out-of-pocket costs for the whole family.

Warden, the county director, said some seemingly-healthy employees have been baffled by their high-risk classifications.

"At first, some people misunderstood what the high-risk factors were," Warden said. Poor nutrition and high stress were often the culprits.

Increased awareness

Dr. Jim Krieger, chief of the epidemiology, planning and evaluation unit of Public Health — Seattle and King County, said he was not surprised that so many county employees were in the high-risk group. In King County as a whole, 54 percent of residents are overweight, 30 percent have high cholesterol, 21 percent have hypertension and 14 percent don't exercise at all.

Krieger, who was rated a low risk, chose to keep track of his produce intake, an exercise he considered "kind of pointless" because he has a balanced diet.

While he thinks Healthy Incentives will help make county workers more aware of the importance of good diet and fitness, "we know it's hard to start a behavior, but it's harder to keep it up," he said.

"A single intervention will not make it."

Bascom knows that better than most. Though she was an equestrian in high school and a rower in college, Bascom started seriously gaining weight in her 30s. She had a demanding job. She lost 30 pounds once, but it came right back.

Now Bascom is pregnant again. In hope that she won't gain weight this time, she walks five days a week, she hasn't tasted ice cream in recent memory, and she's looking forward to kayaking, backpacking and otherwise staying active into her 50s and beyond.

Bascom credits Healthy Incentives for making her realize that she can't afford to neglect her own health.

"As a full-time working mom, you don't want to give up any time with your child," Bascom said. "But I am the cornerstone of this family."

Kyung Song: 206-464-2423 or ksong@seattletimes.com