King County is a model for strategies to contain health-care costs

ONE feature of the national health-care debate not getting enough attention is a particular strategy, embraced by many Northwest employers, to contain health-care costs. Though uncontroversial compared with issues like how to pay for broader coverage, it is still noteworthy.

It is a tax incentive for employers with robust employee-wellness programs. U.S. Sen. Tom Harkin, D-Iowa, introduced the Workforce Wellness Act, and our own Sen. Patty Murray signed on as a co-sponsor before it was rolled into the health-reform package working its way through the Senate Finance Committee.

I recently sat on a peer-review panel charged with evaluating King County's employee-wellness program, which has garnered national attention. Its program results, being reviewed this week by the King County Council, have implications for the potential impact of such efforts if implemented by more employers.

According to a 2008 Kaiser Family Foundation report, 80 percent of all workers are eligible for employer-provided health insurance and 65 percent of all workers are covered by health insurance provided by their employers. This scope and the county's results suggest that providing incentives for more employers to adopt this approach could have a significant impact on people's health and on health-care expenditures over time.

According to the county's report, its aggressive wellness program has reduced the trend of annual growth in employee health-care expenditures from 11 percent to 9 percent, resulting in the county spending $18 million less than projected since the program began in 2005. In addition, county employees and their spouses or domestic partners have made statistically significant improvements in 12 out of 14 health indicators including body weight, cholesterol and blood pressure. The decrease in smoking rates is particularly impressive, going from 10.1 percent to 6.2 percent.

The county achieved these results by offering employees lower out-of-pocket expenses if they participate in an annual health-risk assessment and follow-up action plan. It has also taken steps to create a workplace that is supportive of health goals by such measures as providing Weight Watchers and annual flu shots on-site and disseminating large amounts of information on nutrition and exercise. With 90 percent of employees actively engaged, the county's participation rates are among the highest in the nation for employee-wellness programs.

The county's results are part of a growing body of evidence that employee-wellness programs work to reduce health-care expenditures by providing financial and behavioral incentives instead of simply shifting rising costs to employees. Employers are getting the message. According to a 2008 national survey of employer health plans conducted by Mercer, at least 65 percent of employers will offer employees a health-risk assessment this year, one starting point in developing a wellness program.

A caution is that there can be unintended consequences of this approach. Certain subgroups of the population may be less able to understand and take advantage of the programs because of barriers like language or lack of access to computers. These individuals and their families end up paying more for their care and missing the health benefits associated with participation.

King County's Equity and Social Justice Initiative attempts to address this issue. As part of the initiative, the county did special outreach to roads crews, maintenance workers and others to increase their understanding of the program and their ability to participate.

With such a large portion of our population gaining access to health care through their employers, the incentives that benefit plans give consumers not only in terms of seeking care but also in terms of behaviors that affect health are critical to reaching our goals for health reform.