vbid 101 nancy r. morris communication & member relations director 10-15-14
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VBID 101
Nancy R. MorrisCommunication & Member Relations Director
10-15-14
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Value Based Insurance Design
A form of benefit design that promotes the use of healthcare services that provide more “value” over those services that provide less
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
63%25%
12%
Preference-sensitivecare
Effective care
Supply-sensitive care
The Dartmouth Institute for Health Policy and Clinical Practice (Wennberg, Weinstein, Fisher, et al.)
Not All Services Are Created Equal
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
CEO Summit Recommendation
Message from CEO group:
Develop and offer a benefit plan that supports what you want us to do
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
• Reduce the total cost of care per person per year in Maine to the national average;
• Improve the health of Maine’s population in at least four categories of disease prevalence (including diabetes, mental health, obesity, and tobacco use);
• Improve patient experience scores for targeted practices by 2% from the baseline 2012 survey;
• Increase the number of practices reporting patient experience information from 50% to 66%
Maine’s SIM Goals
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
MHMC VBID Plan Design
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
MHMC VBID Plan Design
1
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Using EMR’s To Aid in Communication
Slow Down and Review Options
Clearing the Path to High ROI Service Use
Stop and Look at the Evidence Before Proceeding
Goal: Reduce Unnecessary Services $265 Billion IOM
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Green Services
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Yellow Services- SDM
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Providing Cost Information Too
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Red Services
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
MHMC VBID Plan Design
2
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Assuring High Quality Delivery
PCMH’s are the hub. When necessary they refer to:
Quality
High
Costs
Low
Effective & Efficient
Ineffective &
Inefficient
Ineffective & Efficient
Effective &
Inefficient
High Low
Goal: Reduce high prices and inefficiently delivered services $155 Billion IOM
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
MHMC VBID Plan Design
3
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Reimbursement is Based on Attaining Outcomes
Providers/ Patients/ Health Plans and Payors share in savings produced by the reduction in preventable admissions and improved health
• ACO’s• Alternative Quality Contracts
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
MHMC VBID Plan Design
4
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Making the Patient Part of the Team
Employ incentives and disincentives to produce healthy lifestyle choices and support management of chronic illness at the:
• workplace • the community at large
Goal: Take advantage of missed preventive opportunities $55 Billon IOM
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
MHMC VBID Plan Design
5
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Administrative Simplification
•Identify areas of improvement through provider/member complaint logs and patient, provider, health plan, and advocate insights then simplify processes to reduce administration cost burden through process improvement
•Reduce across complexity through standardization across public and private payers through consistency where possible (claim billing, prior-authorization)
•Adjust plan benefits so they encourage the desired behavior in all parties
Goal: Reduce Excessive Administrative Costs $190 Billion IOM
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Current Health Plan Rating Display
• Working to standardize VBID benefits
• Working to standardize provider value ratings
• Working to standardize administrative requirements
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Potential Future Health Plan Rating Display
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Prefers safe providers
Potential Future Health Plan Rating Display
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Encourages use of shared-decision making tools
Potential Future Health Plan Rating Display
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Prefers providers with best patient survey results
Potential Future Health Plan Rating Display
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Does not pay for preventable complications
Potential Future Health Plan Rating Display
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Why Work Together?
•The data is more robust
•We have data to serve as neutral arbitrator
•Standardization if the foundation of quality improvement
– Operating rules
– Quality measurement
• Together we are more attractive to other organizations
– EMR vendors
– Grantors
– Government payors
• We have any opportunity to attract and maintain more primary care physicians
• We are better prepared for a crisis
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Community Effort
• Aetna• Cigna• Anthem• Harvard Pilgrim Health Plan• Maine Community Health
Options• Medical Mutual• Geisinger• MaineCare
Health Plans/Payers
Brokers
Providers/Associates
State & Federal
Others
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Community Effort
Health Plans/Payers
Brokers
Providers/Associates
• Cross Agency• Holden Agency• USI• Aliant• Acadia Benefits
State & Federal
Others
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Community Effort
Health Plans/Payers
Brokers
Providers/Associates
• HealthReach• Maine Optometric Association• MaineHealth• Maine General• OMC Wellness• St. Mary’s• Spurwink• MidCoast Health• InterMed• Maine Osteopathic Association
State & Federal
Others
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Community Effort
Health Plans/Payers
Brokers
Providers/Associates
• Centers for Medicare & Medicaid Innovation
• Maine State Employee Health and Benefits Office
• Maine CDC• Veteran’s
Administration• MEABT• Maine BOI• DHHS
State & Federal
Others
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Community Effort
Health Plans/Payers
Brokers
Providers/Associates
• Lown Institute-MA• IMD Foundation-MA• City of Portland• Maine Quality Counts• Maine Areas on Aging• Health Care Administrative
Solutions, Inc.-MA• Brian Atchison• Milliman MedInsight – Waste
Calculator-WA• Athena• www.TheNNT.com
State & Federal
Others
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
Community Effort
Health Plans/Payers
Brokers
Providers/Associates
• Robert Wood Johnson Foundation-NJ
• Oregon State-OR• Internal MHMC staff• Neel Shah, Costs of Care-MA• Integrated Health Association-
CA• Pacific Business Group on
Health-CA• AARP
State & Federal
Others
Continued
Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org
How Can You Get Involved
http://www.youtube.com/watch?v=hO8MwBZl-Vc
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