Part of Value Based Benefit Design in Value Based Purchasing

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Part of Value Based Benefit Design in Value Based Purchasing Andrew Webber, President and CEO National Business Coalition on Health Integrated HealthCare Association Mini-Summit VII February 29, 2008

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Mini Summit Objectives To characterize esteem based advantage outline To better comprehend the part of significant worth based advantage outline as a key segment of significant worth based obtaining To present reasoning behind and spearheading cases of significant worth based advantage plan

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Membership of 60 business and wellbeing coalitions National system of a huge number of bosses and 25 million representatives and their wards Mission: Health and medicinal services change, through esteem based acquiring, group by group National Business Coalition on Health (NBCH)

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Coalitions in Different Markets Pacific Business Group on Health New York Business Group on Health Buyers Health Care Action Group Midwest Business Group on Health Florida Health Care Coalition Greater Detroit Area Health Council Puget Sound Health Alliance

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NBCH from an optimistic standpoint Practice Distribution Network: - eValue8 – Common RFI for wellbeing arranges -Leapfrog Survey, Bridges to Excellence, Asheville Model -College for Advanced Management of Health Benefits National Advocacy: - Congress, CMS, CDC, AHRQ, NQF, QASC, HQA, AQA, NCQA

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Value Based Purchasing

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Four Pillars: Standardized Performance Measurement Public Reporting Payment Reform Consumer Activation/Consumer Choice Must be Driven by Purchasers/Payers. Makes Impetus for System Transformation Value Based Purchasing: Measure, Report, and Reward

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VBP's Aim: Behavior Change Principally at supplier and buyer level Payment Reform : evolving supplier (i.e. supply side) conduct through repayment motivators – essential center of this meeting Consumer initiation: evolving purchaser (i.e. request side) conduct through blend of bolster systems including utilization of motivators – center of this Mini-Summit

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Consumer Activation and the Role of Value Based Benefit Design

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Consumer Activation/Consumer Choice The Goal: To impact the individual customer to settle on educated decisions at numerous levels: to carry on with a solid way of life; to look for preventive administrations and care when debilitated; to partake in, and make the right, treatment choices; to agree to treatment regimen and self-oversee, especially interminable malady; to choose an arrangement, healing facility, doctor.

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A Few Sound Bites Consumer Activation/Consumer Choice: Area of most noteworthy impact for bosses; Change the qualification mindset; Focus on front end wellbeing not simply medicinal services; Establish a standard of self-obligation however with strong support; Support procedure incorporates imaginative blend of financial motivations, peer bolster, opportune data, guiding/directing

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Consumer Activation Strategies: The Beat Goes On unendingly: The Healthy Corporation Worksite Wellness, the Healthy Cafeteria Onsite Clinics Disease Management and Employee Assistance Programs Internet Education and PHRs and Value Based Benefit Design

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What is Value Based Benefit Design? A NBCH Working Definition: "The utilization of motivating forces , through the outline of representative advantages , to urge customers to pick solid practices , to look for high esteem wellbeing administrations , and to choose superior arrangements and suppliers ."

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What is Value Based Benefit Design? Some Underlying Principles: Individuals have a basic part to play in creating great wellbeing results; Individual cost sharing is both inescapable and required in wiping out the shopper privilege mindset. Be that as it may, limit cost moving can be counterproductive; Incentives impact shopper conduct and ought to be adjusted to results we need to accomplish; Consumer impetuses ought to be adjusted to financial motivators for suppliers and different providers of wellbeing and social insurance administrations.

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VBBD Applied to Health Insurance Basic medical coverage advantage engineering ought to level therapeutic administrations by proof of viability - and suppliers by confirmation of execution Co-pay levels ought to differ by levels in an approach to guide people toward viable administrations and high performing suppliers. What's more, the other way around. Monetary motivating forces, through esteem based advantage outlines, can impact better shopper decisions yet ought to be joined with opportune data, drilling, and companion bolster

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Examples of VBBD Choosing Healthy Lifestyles: Destiny Health – Vitality Awards Program -Accumulate focuses for wellbeing exercises/results reclaimed for endowments/trips United HealthCare – Health Promotion Plan -Meet certain wellbeing upkeep objectives, month to month protection premium brought down

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VBBD Example: Seeking High Value Medical Services HealthMapRx (otherwise known as The Asheville Model): Reinvention of group drug store through purchaser guiding/advising With forgoing of copays for high esteem prescriptions for certain incessant diseases Led by American Pharmacists Association Foundation Supported by NBCH through national dissemination assention

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Asheville Program Results Over 1500 patients from 10 bosses enlisted for diabetes, asthma, hypertension, lipid treatment administration, and wretchedness Patients acknowledge enhanced results & expanded solution adherence half diminishment in wiped out days Zero specialists comp guarantees in the City diabetes amass more than 6 years Average net investment funds of $1,600-$3,200 per individual with diabetes every year from year 2 on Employers spared over $5,000,000 in human services costs

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VBBD Example: Choosing High Value Health Plan General Motors Health Plan Steerage Program: Measurement of Health Plan execution Using eValue8, NCQA, and near cost information arranges Measures add up to arrange commitment to quality and cost administration Results used to control workers to superior arranges through premium share differentials

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Health Plan Scoring Table HMO A HMO B HMO C HMO D Raw Score Flex Score (25) 211 24 221 25 176 16 129 5 eValue8 RFI Results Raw Score Flex Score (20) 13 7 14 13 HEDIS/CAHPS (CARS assessment) Commendable 2 Accredited 1 Excellent 5 Excellent 5 NCQA Accreditation Raw Score Flex Score (5) 14 44 42 30 Total Quality Score (50) 24 23 47 20 13 33 19 12 31 22 14 36 National Rate Rankings Relationships of rates to Local Indemnity Total Cost Score (50) Total Quality + Cost (100) 61 77 73 66 Rating Below Avg Benchmark Strong Good Sample Employee Contribution $100 $20 $40 $55

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In Summary Value Based Benefit Design (VBBD) is a key component of Value Based Purchasing concentrated on affecting customer conduct VBBD is characterized (by NBCH) as the utilization of buyer impetuses, through representative advantage plan, to impact decision of sound practices, high esteem medicinal administrations, and elite suppliers. To be ideally successful, VBBD ought to be joined by other customer bolster components.

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Contact information Andrew Webber, President & Chief Executive Officer National Business Coalition on Health 1015 18 th Street, N.W., Suite 730 Washington, DC 20036 (202) 775-9300 SAVE THE DATE: NBCH 13 th Annual Conference November 9-11, 2008 JW Marriott Pennsylvania Ave, Washington, DC