As San Francisco struggles to control the cost of its health care obligations for government workers and retirees, it is putting more emphasis on actually improving its employees’ health.
New data suggest this emphasis is overdue.
A recent analysis of Kaiser Permanente users covered by The City’s Health Service System — the group of government employees considered healthiest — found that a staggering 66 percent of adults were obese or overweight. Meanwhile, 35 percent of dependent children were overweight or obese.
“We should all be astonished,” Health Service board member Jean Fraser said. “We just have to start looking at how do we get ourselves out of cars and onto our two feet, how do we get 30 minutes a day of exercise, how do we change our food systems. We are not going to solve the health care crisis in here. We are just arguing over how we are going to spread the ever-increasing costs.”
The City Controller’s Office and labor leaders are trying to craft a comprehensive wellness plan that could include giving financial incentives directly to employees for being healthier, Health Service System Director Catherine Dodd said. The details of how that might work have not been released.
After all, The City has little control over several drivers of the escalating cost of providing health coverage — such as the cost of labor and health technology, and the loss of competition from hospital consolidation.
“We do have some control over the health status of our employees,” Dodd said during a recent meeting of the system’s board. “And that’s the new focus on wellness.”
Dodd’s agency manages health care plans and funding for some 108,027 current and former employees of the city and county of San Francisco, the San Francisco Unified School District and City College of San Francisco — as well as their dependents. Last fiscal year, The City spent $728 million on health care, of which $109 million came from the paychecks of workers or retirees.
Fraser said improving the health of city workers could go a long way.
“The reality is that we are just getting sicker,” Fraser said. “The estimates are 50 to 75 percent of the costs of medical care now are driven by chronic diseases that are driven by lack of exercise, and what we eat and stress. It is the underlying illness burden in our community that is really driving these costs.”
Next month, the Health Service System will begin a five-month rate-setting process with The City’s three medical providers, which is expected to result in an increase in premiums for Kaiser, Blue Shield and United Healthcare.
Union leaders are calling for health care providers and insurers to release employee claims data so they can gauge the fairness of rates and quality of care.
Larry Bradshaw, vice president of the Service Employees International Union Local 1021, the largest city employee union, said instead of asking city employees to shoulder “staggering increases,” more accountability should be demanded of health care providers.
“Commercial plans and providers have very powerful lobbies that resist change,” Bradshaw lamented.
Dodd said her agency is “demanding transparency” and would like to see legislation requiring any provider doing business with San Francisco to agree to disclose such user data.
Meanwhile, Supervisor Mark Farrell is working to craft a long-term financial plan to pay for The City’s ever-growing retiree health care cost liability, which is $4.4 billion during the next 30 years.