Maricopa County's employee health-care initiative.

• Author: Schaiberger, Mike

A major concern for finance officers is how to significantly and continuously reduce the organizations medical expenditures and simultaneously increase employees' satisfaction with their health-care benefit. Maricopa Court, Arizona, has done just that. Since the county embarked on its employee health-care transformation in 2001, it has held employee and employer medical and pharmacy cost increases to 6.2 percent and 8.3 percent, respectively, which are below national trends, while increasing employee satisfaction with their health benefit to 94 percent for two consecutive years, despite plan design changes and increased premium costs.

ORGANIZING THE INITIATIVE

Continuously improving the county's $144 million employee health-care program, which covers 12,000 employees and 18,000 dependents, required strong top-down leadership. Senior executive management gave considerable thought to organizational structure and strategy, including taking practical and noteworthy steps to demonstrate that employee health care would have high organizational visibility and significance.

To ensure that the appropriate healthcare focus and financial stewardship would be provided, the county manager and deputy county manager in charge of the Office of Management and Budget (OMB) decided to create a single, stand alone employee health-care department. The department, called Employee Health Initiatives, would report directly to the county manager through the deputy county manager in charge of OMB. This structure demonstrated to the organization and to the community that employee health care is a vital part of Maricopa County's strategic vision and mission, and a critical part of the organization's business and financial plan.

Vision and Mission

The Maricopa County Employee Health Initiatives Department vision is for employees to enjoy a healthy lifestyle so they can live well into the future.

The department's mission is to provide competitive health benefit programs and promote healthy lifestyle and wellness so that Maricopa County can have a healthy and productive workforce.

It was seen as imperative that the employee health-care unit not be embedded within other complex competing operating areas such as compensation, pensions, recruiting, employee relations, diversity, training, payroll, etc. The latter approach could diminish the importance of the health-care initiative, making it one of many sometimes competing duties. Most organizations put employee health care within the massive agenda of the human resources department, and they hire human resources professionals to manage the health-care unit. Some jurisdictions make health care part of risk management, where the effort is often led by lawyers or finance professionals. Maricopa County's employee health-care program owes much of its success to deciding to emphasize employee health care as a high-visibility, stand-alone organization.

Another significant decision was that the members of the Employee Health Initiatives team should have extensive executive public- and private-sector managed health-care backgrounds. Health-care professionals such as those found in HMOs or similar organizations have the health-care operation skill sets needed to manage a health-care unit effectively The members of the health-care team also need to build and maintain a strong operating partnership with like-minded experts in the procurement, legal, budget, finance, facilities, technology, communications, research, and public health departments. The synergy generated by this type of partnership creates tremendous leverage for a campaign to improve health-care costs and outcomes. It also allows the health-care specialists to focus on what they know...