Purchaser Learning GroupApril 2015

www.hcgc.org

… catalyzing the spread of healthcare best practices

CO-LEARNING DISCUSSION

www.hcgc.org

What is Price Transparency?• Price = an estimate of a consumer’s complete health care

cost on a health care service that reflects:• Negotiated discounts• Inclusive of all costs to the consumer associated with

a service• Identifies consumers out-of-pocket costs• Includes information that helps define the value of

those services• Enables patients and other care purchasers to

identify, compare and choose providers that offer the desired level of value

SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Best Practice Features• Easy to use• Allow consumers to

understand their share of cost, total cost and spending and utilization to date

• Show quality measures• Side-by-side comparison of

price and quality easily• Help consumers identify

and understand value• Encourage consumer to use

the tool

• Contain info on Rx and ancillary services

• Help consumers avoid unneeded care and find less expensive options

• Easily customized and easily integrated with other platforms and products

• Give employers reports on utilization and savings and involves them in continuous quality improvement activities

SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges

1. Incomplete definitions of medical episodes and small number of episodes and or procedures

2. Ignoring whether providers deliver needed versus unneeded care

3. Creating price estimates from a small number of cases

4. Not accounting for rate increases5. Not using carefully chosen visuals that are easy to

understand and accurately interpret

SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

1. Incomplete definitions of medical episodes and small number of episodes and or procedures

Solution:• Have well constructed episodes of care • Help consumer distinguish between typical services

and those associated with avoidable complications• Show estimate of average price of complications for

long duration episodes• Provide consumers with complimentary quality

information, especially outcomes where available

SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

What challenges and opportunities exist to implement the suggested solutions?

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

2. Ignoring whether providers deliver needed versus unneeded careSolution:• Take steps to education consumers about

needed/recommended care • Create standard episode price based on

recommended care and compare that standard to providers actual price

• Help consumers identify potentially unneeded care

SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

What challenges and opportunities exist to implement the suggested solutions?

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

3. Creating price estimates from a small number of casesSolution:• Don’t show price estimates when sample size is small• Include confidence intervals with the price estimate

that make sense to a consumer• Disclose to consumer which provider’s price

information is blocked due to contractual restrictions

SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

What challenges and opportunities exist to implement the suggested solutions?

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

4. Not accounting for rate increases

Solution:• Ensure published prices are adjusted to reflect most

recent negotiated fees or indicate the year for which the price was calculated

SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

What challenges and opportunities exist to implement the suggested solutions?

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

5. Not using carefully chosen visuals that are easy to understand and accurately interpret

Solution:• Experiment with most effective means of

communicating price info to various audiences

CO-LEARNING DISCUSSION

www.hcgc.org

Price Transparency Tool Challenges and Solutions

What challenges and opportunities exist to implement the suggested solutions?

About HCCI

HCCI is a non-profit, independent, non-partisan research institute dedicated to creating the United States’ most comprehensive source of information on health care activity and promoting research on the drivers of health care costs and utilization. Founded in 2011

•Public mission - improving US health system by creating comprehensive data infrastructure and analytics •Research - We currently hold claims, with allowed amounts, for more than 50 million Americans, from 2007 onward which we make available for academic, non-commercial research•Support from Aetna, Assurant Health, Humana, Kaiser Permanente, UnitedHealthcare. Foundation support/contracts with Robert Wood Johnson, Pew, Commonwealth Fund, John and Laura Arnold Foundation

Current and Future HCCI Data

• Administrative Claims– employer-sponsored insurance– individual insurance; – Medicare Advantage (Part C)

• All 50 states and D.C.• Updated annually • HIPAA-compliant, de-identified• Vermont data for public

reporting purposes– other APCD data

• By end of 2014:– Medicare (2009+) through

Qualified Entity Program • Part A (100%)• Part B (100%)• Part D (~40%)

• In 2015, data from State APCDs

• Other commercial data from additional insurers

• SGR fix – Medicaid and CHIP

20142014 20152015

HCCI currently holds claims data on 50 million people per year (2007 – 2013)

Everything HCCI does is HIPPA and anti-trust compliant and protective of company information

Bill Frist, M.D.!Bill Frist, M.D.!

Hussey PS, Wertheimer S, Mehrotra A.The Association Between Health Care Quality and Cost: A Systematic Review. Annals of Internal Medicine, 2013, 158(1):27-34.

“Unfortunately, the published literature does not provide clear input on [the relationship between quality and cost]. Our systematic review found inconsistent evidence on both the direction and the magnitude of the association between health care costs and quality.”

We do have to keep in mind when publishing cost data that

Cost and Quality do NOT Correlate

CO-LEARNING DISCUSSION

www.hcgc.org

LEAPFROG GROUP: Predicting Patient Survival

Our Strategic Areas of Focus

www.hcgc.org

…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers

PATIENT-CENTEREDMEDICAL NEIGHBORHOOD

COLLABORATIVE LEARNING

QUALITY TRANSPARENCY…improve care coordination between providers & social services

…improve the use of quality data

…improve the application of learning in Greater Columbus

PATIENT ENGAGEMENT…improve engagement between patients andproviders

Advisory Discussion

www.hcgc.org

• Regional Quality Reporting Project• State Innovation Model (SIM) Report

Update • Benefit Consultant Learning Group

Regional Quality Reporting2015 Approach

www.hcgc.org

voluntarily demonstrating their value

hospital-owned practices

private practices federally qualified

health centers

Healthcare professionals

identifying opportunities for

improvement

Purchasers seeing value

from the care they are buying

Patients making better informed choices about

their care

Sharing all-payer quality data from Electronic Medical

Records (EMR)

Cancer Diabetes Heart

Regional Quality Reporting Website

(refreshed every 6 months starting

Q4 2015)

Regional Consumer

Reports InsertQ1 2016

promote regional website

primary audience

Patient-centered medical homes Episode-based payments

Goal 80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years

Year 1 ▪ In 2014 focus on Comprehensive Primary Care Initiative (CPCi)

▪ Payers agree to participate in design for elements where standardization and/or alignment is critical

▪ Multi-payer group begins enrollment strategy for one additional market

Year 3

Year 5

▪ State leads design of five episodes: asthma (acute exacerbation), perinatal, COPD exacerbation, PCI, and joint replacement

▪ Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year

▪ Model rolled out to all major markets▪ 50% of patients are enrolled

▪ 20 episodes defined and launched across payers

▪ Scale achieved state-wide▪ 80% of patients are enrolled

▪ 50+ episodes defined and launched across payers

State’s Role ▪ Shift rapidly to PCMH and episode model in Medicaid fee-for-service▪ Require Medicaid MCO partners to participate and implement▪ Incorporate into contracts of MCOs for state employee benefit program

5-Year Goal for Payment Innovation

1. Perinatal2. Asthma acute exacerbation3. COPD exacerbation4. Joint replacement5. Percutaneous coronary intervention (PCI)

OHIO: Public-Private Healthcare Innovation Plan (SIM grant)

OHIO: Public-Private Healthcare Innovation Plan (SIM grant)

OHIO: Public-Private Healthcare Innovation Plan (SIM grant)

www.hcgc.org

What are your reflections and questions?