Summary of King County, Washington Health Reform Initiative's Measurement and Evaluation Report

King County's Health Reform Initiative, developed in 2005, publishes an annual Measurement and Evaluation Report. In its first year, King County recognized that the development of its measures would be based on a multi-year timeframe that would, in sequence, develop a baseline, produce indicative findings, identify guiding principles, suggest early trends, and finally confirm trends over a five year period.

King County Evaluation Timeline

Source: King County 2005 Measurement and Evaluation Report

Following a comprehensive industry review and literature research, the county identified the following key lessons:

• Longitudinal studies of best practice health productivity programs show savings ramp up over time.
  
  
• There will be some increase in costs even with programs that successfully reduce the overall risk level of the target population because even low-risk individuals need more medical care as they age.
  
  
• Research indicates that programs that address multiple risks (e.g., high blood pressure, high cholesterol, large waist measurement) may be more effective than programs directed at single risks (e.g., high cholesterol only).
  
  
• Productivity is a significant part of the cost-benefit equation and should be measured.
  
  
• Improvement in health is directly tied to increased employee productivity.

Key steps in King County's first year in determining data measures included:

1) Determining the evaluation approach and logic models for the measurement of the health risk assessment incentive program and the health promotion and education programs.

2) Determining sources for data.

3) Establishing the database and the process for obtaining, normalizing and integrating the data from multiple sources.

4) Developing and testing the measurement methodology.

5) Calculating first year baseline information.

The specific measures that King County has focused on:

1) Medical claims year to year trend.

2) Pharmacy claims year to year trend.

3) Opinions of and satisfaction with the overall the Health Reform Initiative, including importance of managing one's own health and satisfaction with the Health Reform Initiative information and assistance.

4) Percent of members who completed health risk assessments and categories of risk for the entire population pool.

5) Health Fair assessments

Second year measures included utilization, management culture, and self-assessment measures:

1) Percent of members who completed health risk assessments year to year.

2) Change in group risk profile for employees in health risk categories.

3) Change in self-reported body mass index.

4) Change in generic prescription rate.

5) Number and percent of employees receiving flu shots at work.

6) Self-reported levels of employee awareness of resources available through King County to reduce personal health risks and maintain or increase health behaviors in the upcoming year.

7) Self-reported levels of employee agreement that supervisor supports health and maintaining healthy behaviors.