Standardizing and Scoring Health Plan-Based P4P Programs
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Standardizing and Scoring Health Plan-based P4P Programs Mini-Summit V Speakers Francois de Brantes Chief Executive Officer, Bridges to Excellence Emma Hoo Director of Value-Based Purchasing, Pacific Business Group on Health Dennis White Senior Vice President, National Business Coalition on Health Phyllis Torda Vice President for Product Development, National Committee for Quality Assurance (NCQA) Edison Machado, Jr. MD, MBA Program Manager and Medical Director, Bridges to Excellence Bridges To Excellence, Proprietary & Confidential Page 2 Agenda 10:00-10:05 – Introductions Francois de Brantes 10:05-10:45 – eValue8: Setting Expectations for Health Plans in Pay for Performance Emma Hoo Dennis White 10:45-11:15 – NCQA PHQ Certification Phyllis Torda 11:15-11:30 – Scoring Health Plan-based P4P Programs Edison Machado, Jr. MD, MBA 11:30-12:00 – Panel Discussion – Encouraging P4P innovation in a regulated environment Francois de Brantes – Moderator Emma Hoo Dennis White Phyllis Torda Edison Machado Bridges To Excellence, Proprietary & Confidential Page 3 The NBCH eValue8 Initiative Leveraging Purchaser Standards to Improve Performance Presentation to P4P Conference February 28, 2008 Dennis White, NBCH Emma Hoo, PBGH Discussion Topics z NBCH z eValue8 Overview z Incentives and Rewards Broadly Defined z Selected Plan Results NBCH z Membership of 60 employer-led coalitions across the country – Represents over 7,000 employers and 34 million employees and their dependents z Focus: Community- based health care reform z …The Voice of America’s employers through local coalitions NBCH z Products and Services: z eValue8 z BTE Initiative z Leapfrog Regional Roll Outs z PBM Preferred Vendor Program z HealthMapRx (Previously Asheville Model) z College for Advanced Management of Health Benefits What is eValue8? z A national standardized health plan evaluation process z A web-based response tool that collects information for local and national comparisons… z A foundation for continuous quality improvement and value-based purchasing… z …enabling purchasers to think globally, act locally What does eValue8 Do? z Align purchaser standards and expectations – Increase the signal strength for desirable plan capabilities and investments – Reduce the chaos of hundreds of purchaser requests for information – Align with Major Stakeholders: HHS/CMS, OPM z Captures plan performance against evidence-based processes z Benchmark regional and national plan performance z For purchasers – Plan selection beyond price and network; defendable in the Board room – Basis for employee incentives (payroll contributions) – Basis for year-over-year improvements for selected plans z Highly interactive placing plans face-to-face with largest customers – Coalition led – Verified responses – Site visits with multiple purchasers discussing strengths and weaknesses – Follow-up to track progress z Provide a data repository of benchmarking data for over 300 health plans nationally z Provide employee decision tools and guidance z Provide community-wide forum for plan improvement eValue8 Users: Coalitions z Alliance for Health (MI) z Buyers Health Care Action Group (MN) z Colorado Business Group on Health z Employers Health Purchasing Corporation of OH z Florida Health Care Coalition z Greater Detroit Area Health Council z Hawaii Business Health Council z HealthCare 21 (TN) z Health Action Council of NE Ohio z Indiana Employers Health Alliance z Memphis Business Group on Health z Michigan Purchasers Health Alliance z MidAtlantic Business Group on Health z Midwest Business Group on Health z New York Business Group on Health z Oregon Coalition of Health Care Purchasers z Pacific Business Group on Health z Puget Sound Health Alliance z South Carolina Health Coalition z Virginia Business Coalition on Health States With Responding Plans eValue8 Users: Employers z 3M z Harry and David z Pitney Bowes z A-Dec, Inc z Portland General Electric z Honeywell z AFL-CIO Employer Purchasers z Public Employees Benefit Board, OR z Intel Corporation Coalition (AEPC) z Resource Training and Solutions z Altria z International Truck and Engine z Robert Bosch Tool Corp. z American Medical Systems z Jewish Federation of Metro Chicago z Rosemount z Andersen Windows z John Crane, Inc. z SAIF Corporation z Argonne National Laboratory z Sanofi-Aventis z Jostens z Barry Wehmiller z Securian Financial z Land O’ Lakes z Bemis z Seneca Saw Mill z Benton County z Landmark Communications z SEIU Local 49 z Bethel School District z Lane County, OR z State of Minnesota z Blount International z Lane Transit District, OR z Starwood Hotels and Resorts z Bristol-Myers Squibb Worldwide z Marriott International z Cargill z Stanford University z Carlson Companies z Maryland Counties: Anne Arundel, z Steelcase z Ceridian Baltimore, Carroll, Harford, z St. Jude z Chesapeake City Public Schools Montgomery, Prince Georges z SUPERVALU z City of Corvalis, OR z Maryland Schools: Anne Arundel z Target z City of Eugene, OR County, Baltimore County, Harford z TCF Financial z City of Springfield, OR County, Montgomery County, Howard z Tektronix, Inc z City of Norfolk, VA County, Prince Georges County z Tennant z City of Virginia Beach, VA z McCormick and Company, Inc z The Auto Club z Comerica Bank z Medtronic z The Bank of New York z Constellation Energy Group z Meijer, Inc z The Northern Trust z Consumers Energy z Merck & Co. z TIAA-CREF z Daimler Chrysler z Minnesota Life z Tiffany & Co. z ELCA z MN Department of Employee Relations z TOC Management Services z EMCOR z New York City Transit Authority z United Metal Trade Association Trust z Eugene School District z Norfolk Southern Corp z University of California z Evraz Oregon Steel Mills z Northwest Airlines z University of Chicago z Exelon-ComEd z Olmsted County z University of MIchigan z General Mills z Oregon Educators Benefit Board z University of Minnesota z General Motors z Oregon School Boards Association z US Bank z First Midwest Bank z Park Nicollet z Virginia Beach Public Schools z Ford Motor Company z Pfizer z Wells Fargo z Harris Trust and Savings Bank z Philip Morris USA z Xcel Energy Contributing Organizations – 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 eValue8 Content z Clinical Sections z Non-Clinical Sections – Chronic Disease – Consumer Engagement Management (Asthma, – Provider Measurement Coronary Artery Disease, – Plan Profile (Accreditation, Diabetes) HDHP) – Behavioral Health – Pharmaceutical Management – Prevention and Health Promotion Provider Measurement z EO: Community Collaboration z EO: Performance measurement and feedback – Physician – Medical group – Hospital z Leapfrog performance z EO: Differentiation and incentives – Lump sum payment – Tiered payment arrangements – Plan design incentives z EO: Health Information Technology z Centers of excellence Health Plan Added Value zeValue8 boils down to the question: zIs the health plan using its resources and information as effectively as possible to improve health and health care? Pay for Performance Content in eValue8 z Broaden the definition to consider Incentives and Rewards – Consumer influences – Providers influences Incentives and Rewards z Consumer influences – Forms of incentives & rewards z Removal of barriers z Active encouragement (HRA, prevention, managing ongoing conditions, acute care options) z Provider steerage z Performance transparency – Target of incentives & rewards (through plan design) z Adherence to prevention guidelines z Effective management of ongoing conditions z Selection of most cost effective providers z Selection of most effective acute treatment alternatives – Support tools z Provider directory& performance reports z Reminders about gaps in care z PHR z Treatment decision support Some 2007 eValue8 Results Value-Based Plan Design Percent of Plans Offering Reduction in Copays/Deductibles for Essential Rx/Tests/Equipment Asthma Depression Diabetes Hypertension Hyperlipidemia Any of these 0 20406080100 Some 2007 eValue8 Results Transparency of Physician Performance Percent of Plans Using All or At Least One of Each Measure Type Complete AQA Set AQA Diabetes AQA Coronary Disease AQA Prevention Patient Experience Episodes of Care NCQA Recognition 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% All At Least One Some 2007 eValue8 Results Transparency of Hospital Performance Percent of Plans Using All or At Least One of Each Measure Type HQA Complete Set HQA Heart Attack HQA Heart Failure HQA Pneumonia HQA Surgical infection Leapfrog AHRQ Patient experience Episodes of care 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% All At Least One Some 2007 eValue8 Results Physician Directory Percent of Plans Using it as a Source of Performance Transparency Any Quality Measure Mortality/Complication Patient Experience ePrescribing EHR 0 20406080100 Some 2007 eValue8 Results Treatment Choice Support Percent of Plans Using Specific Vendors Best Treatments HealthDialog Healthwise NexCura Subimo WebMD 0 20 40 60 80 100 Some 2007 eValue8 Results Support for Self Management: PHR Percent of Plans Making Use of Electronic Data to Prepopulate the PHR Rx Fills Lab Results Visits/Tests Physician Notes (from EMR) Personal History (from