eValue8

A Quality Improvement Process for Healthcare

eValue8 – So what’s up today?

• An estimated 30% waste of healthcare resources costing over $600 Billion per year or an additional $2,000 PEPY

• Avoidable hospital deaths approaching 100,000 at an additional cost of up to $29 Billion

• Doctors provide appropriate care only about half of the time

eValue8 – So, Toyotas are good?

If US Healthcare was an automobile, which one would it be?

• 2006 Lexus

• 1996 Honda

• 1976 Plymouth (for this exercise make believe that this car still exists)

eValue8 – So, why Toyota?

• W. E. Deming, Statistician,

Quality equals Value to the customer

Value Improvement is achieved through:

• Process Evaluation• Defect Prevention • Measurement• Improving suppliers• Universal responsibility for process quality,

Value Improvement leads to:

lower cost and higher customer outcomes.

eValue8 – So, what is it?

eValue8 is:

• A health plan evaluation process

• A measurement system by which all plans can be continually compared with an eye on continuous quality and value improvement

• A vehicle that enables many employers to join as one voice, leverage their collective influence and steer health plans toward these employer’s collectively desired outcomes

eValue8 – So, what is it, really?One monster of a questionnaire that asks:How is the health plan improving quality of care?

• Prevention and Health Promotion?• Consumer Engagement and Support?• Health Information Technology?• Disease Management Initiatives?• Provider Management and Incentives?• Pharmaceutical Management?• Behavioral Care Management• Administration, Operations and Accreditation

eValue8 – So, what about results?

Results are used to:

• rank each plan against the best in class,

• identify strengths and opportunities for continuous improvement, and

• increase the employer’s understanding of the health plan’s value proposition...

beyond network discounts, low premiums

eValue8 – So, what?The cost of poor quality healthcare? We can’t afford it!

$380,000,000 X 30% = $114,000,000Annually!

Employers have been disconnected from the actual purchase process and the care providers

Traditionally health plans were concerned with expanding provider networks and increasing discounts not provider quality

The eValue8 process connects employers to the quality process by holding the plans accountable for provider improvement and their own quality initiatives

eValue8 – So why trust it?

Developed by NBCH

• for a group of 8 flagship companies

• with the help of CDC, CMS, SAMHSA, AHRQ, NCQA, JCAHO, URAC, Leap Frog and a some smart guys at PSU and GWU

• Now used by 15 Health Coalitions and more than 80 large employers

• 130 Health Plans were evaluated in 2006

eValue8 – So how is it working?• There are numerous and significant

success stories across the nation in Minnesota, New York, Tennessee and other states

• Achievement include local and state initiatives in healthcare quality resulting directly form the eValue8 process

• Coalitions have adopted uniform RFIs incorporating the eValue8 tool

eValue8 – So, what do you get?

• A turn-key, validated, comprehensive and leveraged tool to influence health plans to improve the quality of their organizations and their contracted providers

• An enlarged, transparent and uniformly measured value proposition at RFP time

• A blue print to develop and measure impactful health plan performance guarantees

• A loudspeaker to our plans and healthcare providers that employers can shout in together.

eValue8 – So, what’s up in VA?

• eValue8 was used to evaluate nine Health Plans in Virginia in 2006:– Anthem PPO and HMO– Cigna HMO– United HMO– Optima HMO and PPO– Care First– Aetna Mid-Atlantic HMO– Kaiser HMO

eValue8 – So, what’s up in VA?

• The results were discussed with the participating plans this summer (except Anthem declined to meet)

• Sponsoring employers have reviewed the results and have begun identifying strengths (harder) and opportunities to improve (easier) for their plans

• The eValue8 committee and VBCH will coordinate submission of several opportunities to the plans for consideration

• One participating plan has already requested eValue8 results which they will use to plan future activities and priorities and get ready for eValue8 2007

eValue8 – So, hop on board?

Not happy with today’s healthcare situation?

eValue8 is here and may be the best chance your company has to start making a difference

The eValue8 train is on track and rolling towards 2007 when we will evaluate the plans again to see how they have listened and improved

So hop on board today!