Houston Business Coalition on Health

Understanding

John Miller, Executive Director, MidAtlantic Business Group on Health

Agenda Overview

• What is eValue8?

• Examples of measures

• Examples of results

• Questions

What IS eValue8?

• How does it work?

• What are the objectives?

• Who is responsible for content?

• Why is it needed?

eValue8 is a Health Plan Performance Review

(Think of it as similar to an Employee

Performance Review)

A national, standardized health plan evaluation created

by business coalitions and employers like Marriott and

General Motors to measure and evaluate health plan

performance

• How does is work?

• Questions are answered via a protected on-line “portal”

• Answers are reviewed by trained reviewers, and sometimes require

documented examples of Health Plan processes

• Final scores are shared with plans prior to general dissemination

• Scores are then reviewed with the plan and purchasers in an in-

person meeting called a “site visit”

eValue8 Objectives

• Articulate Purchaser expectations

• Facilitate value-based purchasing by supplying the Quality

factor in the value equation

• Provide benchmarks for local and national comparisons -

between plans, and over time

• Identify and promote opportunities for quality improvement

• Drive collaboration between Plans and Purchasers

• Educate employees on plan quality

• What it is NOT: A pricing comparison

eValue8 Content Experts

• 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)

• URAC

• American Board of Internal Medicine (ABIM)

• The Leapfrog Group

• HC13/Bridges to Excellence

• NORC at the University of Chicago

• Pharmacy Quality Alliance (PQA)

• Consumer-Purchaser Disclosure Project

• Catalyst for Payment Reform (CPR)

• AND EMPLOYERS!!

Why eValue8? Without Quality Information – How Can

We Assess Value?

A nationally representative survey of > 1,000 employers finds

that most companies that offer health insurance are unfamiliar

with objective data and ratings of health plan quality. (Dec

2014)

• Only 7% of employers who offer health insurance use objective quality

information; 89% do not use or are unfamiliar with any of the

objective sources tested by the survey.

• 60% of employers offering health insurance say quality ratings are an

important factor when choosing a plan, though most are unfamiliar

with independent sources of quality data.

http://www.rwjf.org/en/library/articles-and-news/2014/12/employers-unfamiliar-with-information-on-the-quality-of-health-p.html

eValue8 – Consistent Employer Priorities

• For more than 15 years, eValue8 has set consistent,

evidence-based, employer-verified priorities for health plan

performance

• Measured the same way across vendors and across

geographic boundaries

• Assesses how health plans:

• Improve and maintain the health of members

• Support health care providers to improve care

• Drive out waste and improve value

• Identifies strengths and opportunities for improvement

eValue8 Measures

eValue8 Modules

• Overall Business Profile

• Physician and Hospital Management and Performance

Measurement

• Helping Members Get and Stay Healthy

• Helping Members Be Good Consumers

• Helping Members Manage Acute or Episodic Conditions

and Advanced Care

• Helping Members Manage Chronic Conditions

• Pharmaceutical Management

Topics in eValue8

CancerAccreditation from a

Third Party (NCQA,

URAC)

Consumer tools (selecting physician, hospitals) -

availability of cost and quality information

Diabetes Care Co-ordinationTreatment decision support - availability of cost

and quality information

Cardiovascular (Heart)

Disease and Cardiac

Care

High Cost, Medically

complex patientsClient support - data analysis and reporting

AsthmaPatient Safety (including

Hospital Safety)

Specialty Pharmaceuticals Management

Pharmaceutical adherence monitoring

COPDPayment

Innovation/ReformOutcomes - Relative Resource Use

Weight

Management/ObesityBariatric Surgery

Clinical Performance Results - HEDIS

(Healthcare Effectiveness Data and

Information Set)

Smoking/Tobacco UseEnd of Life Care (member

and family support)

Consumer Performance Outcomes - CAHPS

[Consumer Assessment of Healthcare

Providers and Systems]

DepressionSpecialty

PharmaceuticalsPlan-Plan Collaboration

Substance Use

(including alcohol,

opioids)

Maternity care (including

C-sections)

An example from the Specialty Rx section

• Adherence: Does the Respondent's pharmaceutical management program have a reminder or alert program for refilling specialty medications?

• What conditions?• Hepatitis C

• Multiple Sclerosis• Rheumatoid Arthritis

• Pulmonary Arterial Hypertension

• Cancer

• Anemia from chronic disease

• HIV

• Other - Please specify

Specialty example continued with Multiple Sclerosis:What drugs?

1: Corticosteroids (e.g., oral pregnisone),2: Interferons(e.g., Betaseron,Avonex,& Rebif),3: Glatiramer (Copaxone),4: Natalizumab (Tysabri),5: Mitoxantrone (Novantrone),6: Compliance (medication refills) is not systematically assessed

Specialty example continued

Who is responsible for monitoring and acting on compliance?

1: Plan personnel2: PBM3: Retail or mail pharmacy4: Other (describe)

Specialty example continued

What members are monitored?

1: All members taking the checked drugs are monitored,2: Only DM participants are monitored

Specialty example continued

How does the program function?

1: Member must activate reminders,2: Member receives mailed reminders,3: Member receives electronic reminder (e.g. email),4: Member receives telephone contact,5: Practitioner is mailed an alert,6: Practitioner is contacted electronically,7: Practitioner is contacted by telephone,8: Telephonic coach is notified,9: Gap in fills are communicated electronically to personal health record which will trigger a member alert,10: Other (describe)

eValue8 Results

eValue8 –Variation across PlansPerformance is measured as percent of points available for each of the modules

eValue8– Variation across one plan in different markets

Source: eValue8 2011

eValue8 – Identifying Best Practices

Actual Plan responses (e.g., adherence rates, percent of members identified as obese and

participating in programs)

Source: eValue8 2011

Impact of Measurement

72.2%70.9%

55.9%

49.3%

18.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

20122011201020092008

BCBS HMO: Provider Management 2008-2012

23.0%

44.0%

32.9%

82.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Primary languagecollected on Enrollment

Form

Primary languagecollected when member

calls Plan

Percent of Plans Collecting Information

eValue8 2009 eValue8 2012

Survey Question: Did eValue8 provide information that

you aren't getting anywhere else?

Examples of Purchasers and Plans that Use eValue8

❑Public/State Purchasers• State of TN

• WA State Health Care Authority, King and Pierce Counties, City of Seattle

• Schools

❑ Large and Small Private Purchasers

• Citi

• Pitney Bowes

• East Penn Manufacturing

• Health & WelfareTrusts

• Law Firms

❑Multi-state/National

Carriers

• Aetna

• Cigna

• UHC

• Kaiser

• Anthem

❑Select regional plans and

Blues Plans

How eValue8 results/data have been used

• Drive collaboration among plans in community in areas of interest

(depression, substance use, data submission for reporting)

• Basis for discussion on performance improvement in key areas

• To assess value of contract/Accountability tool

• As quality score in RFP

• Endorsement of health plans in market/selection of Plan partners

• On-Line Plan Chooser Tool for employees

What eValue8 Means to Leaders Across the Country

✓ Transparency. “The plans that participate in eValue8 open themselves up to truly rigorous scrutiny; we

see how they work, where they’re doing well, what the opportunities are for improvement. It lets us know

they’re committed to being open and collaborative partners.” ‐‐ Emma Hoo, Director of Value‐Based

Purchasing, Pacific Business Group on Health

✓ Quality. “The eValue8 survey includes dozens of unique elements focusing on things like how doctors

are paid, gaps in care, price transparency and community collaboration. If a plan does well on the

eValue8 survey, we generally view that as a good indication that our employees are getting great care

and great service.” ‐‐ Patrice Jennings‐Dixon, Senior Benefits Consultant, Pepco Inc.

✓ Value. “We actually incorporated eValue8 and eValue8 results into our RFI and procurement process.

Plans cannot do well on an eValue8 survey unless they are putting a heavy emphasis on value‐based

benefit design and we believe that comes back to us in the form of better care and lower premiums.

eValue8 lets us know that our health plan partners are doing everything they can to make the

most out of every health care dollar.” ‐‐ Kerry Schaefer, Manager, Compensation & Benefits, King

County, Washington

✓ Results. “eValue8 addresses a well thought out set of operating principles for patients receiving

behavioral health care, and the process encourages health plans, delivery systems and local

communities of purchasers to work together. Reducing fragmentation at all levels and improving results

for people who suffer from chronic conditions, which can be remedied when identified and

systematically addressed – results in healthier people who lead fuller lives.“-- Michael Quirk, PhD,

behavioral health services, Group Health Cooperative

How Much Does It Cost and How Do Coalitions Finance?

Cost (Current Model) How Coalitions Finance

(Current Models)

Cost is usually

less than $7000

per plan product

• Price is per coalition

• Includes results for other plans

through other coalitions

▪ Out of dues – no additional fee to

Purchasers

▪ Ask Plans to Pay (100%, 50%, etc)

▪ Cost shared Plan, Purchasers and

Coalition

▪ Pharmaceutical Manufacturer

Sponsorship

Summary

❑ eValue8 is a cost-effective way for employers to fulfill their fiduciary responsibilities of plan selection and performance evaluation.

❑ eValue8 measures Disease Management programs and other consumer engagement efforts – In the future, these types of activities will be important and meaningful for consumers

❑What gets measured gets improved -eValue8 is a “ready made” evidence-based measurement tool

Questions?

Discussion?