Download Dennis White - Michigan Purchasers Health Alliance

The NBCH eValue8 Initiative
Leveraging Purchaser
Standards to Improve
Performance
Michigan Purchasers Health Alliance
September 17, 2009
Discussion Topics
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NBCH
Member Initiatives
eValue8 Initiative: Review
eValue8 Themes and Direction
NBCH
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Membership of 60
employer-led coalitions
across the country
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Represents over 7,000
employers and 34 million
employees and their
dependents
Focus: Community-based
health care reform
…The Voice of America’s
employers through local
coalitions
NBCH Suite of VBP Programs
Support for Stakeholder Improvement:
 eValue8 (Health Plans)
 Bridges to Excellence (Physicians)
 Leapfrog (Hospitals)
 HealthMapRx (Consumers & Purchasers)
 Seed Grants to Members (Open)
 CDC-Supported Community Health Partnerships
(Population)
 Also: College for Advanced Management of Health
Benefits
Member Initiatives
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Community Collaboration
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Inter Plan
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AQA, HQA, Charter Communities
Disease-specific
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Diabetes
Cardiovascular (including CICV)
Health Information Technology
Provider Performance Reporting
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Physician performance measurement and reporting
Pay for Performance
Hospital – Leapfrog Plus
Physician
Data Aggregation
PPO Formation & Ownership
Other Group purchasing (Rx)
What Distinguishes eValue8?
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Evidence-based content focused on “drivers” of health
Highly interactive placing plans face-to-face with
largest customers
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Coalition led
Verified responses
Site visits with multiple purchasers discussing strengths and
weaknesses
Follow-up to track progress
Provide a data repository of benchmarking data for
over 150 health plans nationally
Provide employee decision tools and guidance
eValue8 Purpose Simply Stated
eValue8 Measures and Motivates
Use of health plan resources and information to
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Improve and maintain the health of employees
Improve health care
eValue8 Users: Coalitions
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Alliance for Health (MI)
Buyers Health Care Action Group (MN)
Colorado Business Group on Health
Employers Health Purchasing Corporation of OH
Florida Health Care Coalition
Hawaii Business Health Council
HealthCare 21 (TN)
Health Action Council of NE Ohio
Indiana Employers Health Alliance
Louisiana Business Group On Health (pending)
Massachusetts Coalition
Memphis Business Group on Health
Michigan Purchasers Health Alliance
MidAtlantic Business Group on Health
Midwest Business Group on Health
New York Business Group on Health
Oregon Coalition of Health Care Purchasers
Pacific Business Group on Health
Puget Sound Health Alliance
Rhode Island Business Group on Health (pending)
South Carolina Health Coalition
Virginia Business Coalition on Health
Wichita Business Coalition on Health Care
In the queue
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Louisiana
Rhode Island
States With Responding Plans
eValue8 Users: Employers
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3M
A-Dec, Inc
AFL-CIO Employer Purchasers Coalition
(AEPC)
Altria
American Medical Systems
Andersen Windows
Argonne National Laboratory
Barry Wehmiller
Bemis
Benton County
Bethel School District
Blount International
Bristol-Myers Squibb
Boeing
Cargill
Carlson Companies
Ceridian
Chesapeake City Public Schools
City of Corvalis, OR
City of Eugene, OR
City of Springfield, OR
City of Norfolk, VA
City of Seattle
City of Virginia Beach, VA
Comerica Bank
Constellation Energy Group
Consumers Energy
Daimler Chrysler
ELCA
EMCOR
Eugene School District
Evraz Oregon Steel Mills
Exelon-ComEd
General Mills
General Motors
First Midwest Bank
Ford Motor Company
Harris Trust and Savings Bank
Harry and David
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Honeywell
Intel Corporation
International Truck and Engine
Jewish Federation of Metro Chicago
John Crane, Inc.
Jostens
King County, WA
Land O’ Lakes
Landmark Communications
Lane County, OR
Lane Transit District, OR
Marriott International
Maryland Counties: Anne Arundel,
Baltimore, Carroll, Harford, Montgomery,
Prince Georges
Maryland Schools: Anne Arundel County,
Baltimore County, Harford County,
Montgomery County, Howard County,
Prince Georges County
McCormick and Company, Inc
Medtronic
Meijer, Inc
Merck & Co.
Minnesota Life
MN Department of Employee Relations
New York City Transit Authority
Norfolk Southern Corp
Northwest Airlines
Olmsted County
Oregon Educators Benefit Board
Oregon School Boards Association
Park Nicollet
Pfizer
Philip Morris USA
Pierce County, WA
Pitney Bowes
Port Blakely Companies
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Portland General Electric
Public Employees Benefit Board, OR
Puget Sound Energy
REI
Resource Training and Solutions
Robert Bosch Tool Corp.
Rosemount
SAIF Corporation
Sanofi-Aventis
Securian Financial
Seneca Saw Mill
SEIU Local 49
Snohomish County, WA
State of Minnesota
Starwood Hotels and Resorts Worldwide
Stanford University
Steelcase
St. Jude
SUPERVALU
Target
TCF Financial
Tektronix, Inc
Tennant
The Auto Club
The Bank of New York
The Northern Trust
TIAA-CREF
Tiffany & Co.
TOC Management Services
United Metal Trade Association Trust
University of California
University of Chicago
University of MIchigan
University of Minnesota
US Bank
Virginia Beach Public Schools
WA Health Care Authority
WAMU
Wells Fargo
Xcel Energy
Participating Health Plans
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Aetna
CIGNA Healthcare
United Healthcare
Humana
Blue Cross Blue Shield
Kaiser
Regional health plans
150 health plans assessed nationally, 100 + verified
through coalitions
Contributing Organizations
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Centers for Disease Control (CDC)
Centers for Medicare and Medicaid Services (CMS)
Agency for Healthcare Research and Quality (AHRQ)
National Committee for Quality Assurance (NCQA)
Joint Commission for the Accreditation of Health Care
Organizations (JCAHO)
URAC
American Board of Internal Medicine (ABIM)
The Leapfrog Group
Bridges to Excellence
E-Health Initiative
Pennsylvania State University
George Washington University
eValue8 Content
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Clinical Sections
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Prevention and Health
Promotion
Chronic Disease
Management (esp: Coronary
Artery Disease, Diabetes)
Behavioral Health
Pharmaceutical Management
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Non-Clinical Sections
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Plan Profile
Consumer Engagement
Provider Measurement
Patient-Centered Medical
Home
Some eValue8 Themes
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Care Coordination
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Consumer engagement
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Population health
Rx and Tx adherence (flip side of gaps in care)
Physician practice transformation: Patient Centered
Value-Based Design
Consumer support
HIT: Meaningful Use
Waste reduction & efficiency
Payment reform
Provider performance measurement and transparency
Consumer Engagement and Choice
The Goal – To influence the individual consumer to
make informed choices at many levels:
 to live a healthy lifestyle;
 to seek preventive services;
 to share in, and make the right, treatment decisions;
 to adhere to treatment and self-management
guidelines, particularly if a chronic disease is present;
 to select high performance plan, hospital, physician,
and other providers.
There are Many
Choices and Forms of Support
Benefit
Plan
Preventive Selection
Medical &
Diagnostic
Services
Provider
Selection
Beneficiary
Prescription
Drug
Options
Health &
Disease
Health Management
Coaching &
Treatment
Option Support
Healthy Lifestyle Choices
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Usually tied to rewards (offline from claims
administration)
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Maintaining good health by the numbers
Reducing health risks (e.g. smoking cessation,
weight reduction)
Pursuing healthy lifestyle (e.g. exercise)
Completing Personal Health Assessments (PHA)
Prevention Choices
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Covering and eliminating/reducing financial
barriers to
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Cancer screenings
Immunizations
Other gender- & age-specific screenings
Annual examinations
Treatment Decisions
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Instituting/mandating shared decision
support
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Evidence-based, personalized disclosure of the
benefits and risks of treatment alternatives
For illnesses with competing therapies
For (overused) preference- and supply-sensitive
procedures
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Imaging
Angiograms & angioplasty
For diagnosed illnesses (e.g. breast and prostate
cancer)
Treatment Adherence
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Covering and then waiving/lowering consumer
copays for high value, effective interventions
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Chronic care management medications
Periodic tests relevant to the condition
Copay/deductible incentives may be tied to
behavior
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Participation in coaching
Adherence to clinical guidelines
Maintainance or improvement of biometric markers?
Provider Choice
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Typically involving lowering premium
share or lower copays/deductibles for
selecting:
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High performance provider networks
Accountable Care Organizations
Primary care “medical homes”
Connecting Cost and Quality
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Collaboration with NCQA on Relative Resource Use
Making explicit the cost consequences of variable
HEDIS results
Measuring waste
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Preventable admissions
Overused procedures
Serious reportable events
Candidates under development
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Prometheus “Potentially Avoidable Costs”
Healthcare acquired conditions
Readmissions
Complications, adverse outcomes
HEDIS® Relative Resource Use Measures
The PUNCH LINE
The RRU Measures are
NBCH
working
with
Valid and Useful
Greg Pawlson NCQA
Sally Turbyville, NCQA
RRU Measures
Represent >60% Medical ‘Spend’
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Yearly relative resource use in five major cost-service categories
for people with
– Diabetes (07 & 08)
– Asthma (07 & 08)
– COPD (08)
– Cardiac Conditions (08)
– Hypertension, uncomplicated (08)
Condition & episode relative resource use for people with
– Acute low back pain (‘07 & ‘08)
RRU Measures cont.
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Cost* Service Categories Included (>70% of total costs)
– Inpatient Facility
– Surgery & Procedure
– Evaluation & Management
– Pharmacy, ambulatory
Utilization Service Categories
– Inpatient Discharges
– ED Discharges
– MRI (low back pain only)
* Reminder: Cost is estimated by applying NCQA’s standardized price
list to each health plan’s health service utilization
Displaying Plan Performance on Quality and RRU
Total Medical Costs (In Pt, Surgical and E&M) and Quality For Patients with Diabetes, Commercial
<-----Low Quality
High Quality----->
Low Resource Use------->
0.0
43 plans:
High quality,
low resource
use
0.5
0.5
1.0
1.5
<------High Resource Use
1.0
44 plans:
Low quality,
High resource
use
1.5
2.0
Nplans = 206
RRU Measures Are Actionable:
Users Can Identify Opportunities for Improvement
Map Diabetes Service Type and RRU Score
Total Opportunity
$2M
First: Consider your
plan’s relative HEDIS
quality rate: Is it
high? Low?
$1M
Then look at RRU’s
in each category
$0.5M
Diabetes–Pharmacy
RRU 0.77
0.25
Low
RRU
0.5
Diabetes–Med Total
$1.2 M
RRU 1.19
Diabetes–Inpatient
Opportunity=$828,000
RRU 1.22
Diabetes–Surgery
Opportunity=$44,000
RRU 1.03
1.0
1.25
RRU Score
Diabetes–E&M
Opportunity=$107,000
RRU 1.07
1.50
High
RRU
Cost Consequences of
Quality (HEDIS) Variation
Comparative Savings Analysis
$350
$300
$250
$200
$150
Indirect Savings
$100
Direct Savings
$50
$0
Aetna
HMO NY
CIGNA
HMO NY
United
90th
50th
PPO NY Percentile Percentile
Conclusion
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eValue8 is a cost-effective way for employers
to fulfill their fiduciary responsibilities of plan
selection and performance evaluation.
eValue8 provides a high-leverage,
collaborative mechanism to address the
underlying problems in health care that
contribute to high cost, waste and uneven
quality.
Conclusion: Closing the Quality Gap
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Using systems and information to support care
Increasing collaboration
Increasing consumer engagement in provider selection
and care decisions
Aligning consumer incentives through plan design
Expanding transparency to all levels
Structuring payment systems to reward excellence
Raise health plan awareness of purchaser
expectations supporting continuous improvement
Questions, Discussion
Further Information
Dennis White
[email protected]
202.775.9300