Leveraging Health: Linking HPM to VBD
-
Upload
detroit-regional-chamber -
Category
Health & Medicine
-
view
858 -
download
0
description
Transcript of Leveraging Health: Linking HPM to VBD
Cyndy NayerCo-founder and CEO
Leveraging Health:
Linking HPM to
VBD
©VBHEALTH.ORG
Disclosure
Nayer is on the speakers’ bureau for Merck
Nayer consults for Merck, Novo Nordisk, GSK, and several emerging health plans
April-May 2010
©VBHEALTH.ORG
New Board of Directors
Jan-Feb 2010
Buck ConsultantsCaterpillar [Michael Taylor MD] Johns Hopkins HealthCareCity of Cincinnati Journal CommunicationsCity of Springfield Or Greg JuddDetroit Regional Chamber of Commerce Jack Mahoney ~ Pitney BowesGenesis Health System Cyndy Nayer Goodyear/Whirlpool Partners in CareGroup Health Cooperative Plumbers and Pipefitters Local 525 H/W Fund
Bob Holben ~Gulfstream Premera BC/VivacityPeter Hayes ~Hannaford Quad/Graphics; QuadMedHealth Alliance Med Plans Quest DiagnosticsHEB State of ColoradoHorizon BCBS NJ Univ of Colorado Health SciencesHumana WellPointIBM WhirlpoolIHP/Battle Creek Yum!
©VBHEALTH.ORG
Our Mission
Our mission is to drive the value of every dollar invested in health Our goal is to identify and link innovators and innovation
that broaden the boundaries of health value
Our work is focused on defining value, creating relevance to shareholders and stakeholders, and improving the health and economic viability of communities.
Jan-Feb 2010 4
Center publishes the first book on levers of VBD; white papers, evidence
Jan-Feb 2010©VBHEALTH.ORG
Also publishes evidence on sectors, innovation, outcomes www.vbhealth.org
5
©VBHEALTH.ORG
Just released
Jan-Feb 2010 6
©VBHEALTH.ORG
Peer-Reviewed Calls to Action:Outcomes-Based Contracting
Jan-Feb 2010 7
The Value of Health is Our Economic SurvivabilityOur agenda must be: How much health is that dollar delivering? VBD is an ENGAGEMENT TOOL that engages the EMPLOYEE
(consumer) and the EMPLOYER (plan sponsor) and the PROVIDER
VBD focuses on OUTCOMES VBD has remarkably changed and matured
Data Design Delivery DIVIDENDS VBD is driven by data that drives the suite of performance
tuners: LEVERS VBD can be tracked along the Health Value Continuum© VBD is sustainable and applicable at the small-large employer
AND at the community level VBD builds the Health-Wealth-Performance Portfolio©
Nov 09©VBHEALTH.ORG 8
©VBHEALTH.ORG
What Changed?
Distress x Vision x First Steps > Resistance
April-May 2010 9
©VBHEALTH.ORG
Evolution of the Health Value Continuum© 2007
Jan-Feb 2010 10
©VBHEALTH.ORG 11
September 6, 2009
April-May 2010
Pew Benchmarks States’ Financial Positions v CA
http://www.pewcenteronthestates.org/report_detail.aspx?id=56044 accessed 11.15.09
Changes based on budget gap, unemployment and foreclosures
The Economy Affects Health Behaviors 26% have had problems paying
medical/health bills
6 out of 10 have skipped recommended treatment, exams, etc.
1 out 5 workers is uninsured
Pressure at public level is increased
NOV 09©VBHEALTH.ORG 13
Compliance, Adherence and Persistence Is at Risk
©VBHEALTH.ORG
What Changed?HPM defined VALUE andVALUE-BASED DESIGNS accelerated momentum
April-May 2010 14
©VBHEALTH.ORG
Center contracts with Buck consultants to verify our work
Objective: Understand the experience of companies with value-based designs in place for 2 or more years
Over 100 companies responded Represent over 1 million employees Jumbo to small, public/private, non-profit
and governments-as-employers
Levers cover all 3 domains 87% Use levers in prevention and wellness 60% Use levers for chronic care
management 26% Use levers for guidance to
appropriate care delivery
54% use levers for Depression management
NOTE: some numbers may not add up to 100: this could be due to rounding errors or because companies were allowed to choose more than one response
April-May 2010
What We Now Know… No VBD succeeds without a primary focus on prevention
and wellness
All successful adoptions and accelerations of VBD are linked to the level/timing of communications And no one succeeds when only communicating 1 time per year
Acceleration occurs when aligned incentives drive outcomes This includes patient-centered coordinated care This includes use of community-based assets This includes communication no less than quarterly to keep
stickiness of behavior change across all stakeholders
Sustainable and measurable value occurs across silos, into the community (when providers achieve improvement in health and financial outcomes) and into families
April-May 2010©VBHEALTH.ORG 16
©VBHEALTH.ORG
If Value Is Built on Outcomes, then Purchasing Must Be Built on Outcomes for Alignment
Outcomes can be measured by determinants Clinical Financial Operational (Process) Community
Outcomes-Based Contracting must align incentives between or across the signers of the contract Health Plan/Plan Sponsor Manufacturer/Service Organization
April-May 2010 17
©VBHEALTH.ORG 18
VBD Are Economically Sustainable…
April-May 2010
79% said no changes were made in 2009-2010 due to economic downturn
©VBHEALTH.ORG 19
…VBD Are Economically Sustainable
April-May 2010
56% said no changes due to the economic downturn were anticipated for the next plan year
©VBHEALTH.ORG 20
What Could They Have Done Better?Better Employee Communication and Communication with the Physicians/Pharmacists/Clinicians for Aligned Messaging
April-May 2010
©VBHEALTH.ORG
Where are we now?Levers Accelerate Adoption, Integration, Efficiency and Outcomes
April-May 201021
Fundamentals of Value-Based DesignValue-based design is an ENGAGEMENT TOOL
for the CONSUMER AND PLAN SPONSOR AND PROVIDER
April-May 2010©VBHEALTH.ORG 22April 2008
Uses Data to invest in incentives…
…and services that change behaviors
for improved health, quality, performance and financial trend
VBD is focused on OUTCOMES
©VBHEALTH.ORG
Decision Matrix Follows the Health Value Continuum examples of leversSolve for: Waste
ReductionFuture Risk Reduction
Individual Health Competency
Underuse/ Overuse/ Misuse
Compression of Morbidity
Decision Support for Health-Wealth- Performance
Prevention and Wellness
Remove barriers to primary care
Incentive for early risk reduction
Incentive for use of PHR
Chronic Care Management
Remove barriers to chronic care
Incentive for adherence
Incentive for counseling
Care Delivery
Guide to efficient care site
Incentive for care coordination
Disincentive for ER use
Jan-Feb 2010 23
©VBHEALTH.ORG 24
Application Value-Based Design: Modeled Savings with Applied Data
April-May 2010
Target Productivity Savings Levels
$ Productivity Gains
Added Workdays
% Increase in Human Capital Growth FTEs
1% $ 118,469 212 0.06% 0.8
Adherence will drive value through productivity gains, reduced financial trend
Modeled with IBI
©VBHEALTH.ORG 25
Value-Based Design Is Sustainable When It’s Mapped to Productivity Example: Back Pain
20% loss in productivity in high risk group Waster Reduction Lever:
mandatory fitness/rehab Chronic Care Lever:
EAP/Behavioral health coach Care Delivery Lever: Physical
Therapy
Example: Smoking 9% loss in productivity in high risk
group Waste Reduction Lever:
mandatory cessation classes Chronic Care Lever: reduction in
Tx copays Care Delivery Lever: Weekly
IVR/ phone calls with counselor
April-May 2010
©VBHEALTH.ORG
Data, Design, Delivery, DividendsUpdate on Our Work
April-May 201026
Behavioral Change Has Emerged as the Key to Improving Health Status
Mercer 2009 Recession and Reform Survey
80 percent will increase employee communication/ education aimed at reducing cost or improving health
45 percent will implement programs to improve treatment and medication compliance
29 percent will introduce contribution-based incentives
21 percent will implement consumer-directed health plans
©VBHEALTH.ORG
Alignment: If Value Is Built on Outcomes, then Purchasing Must Be Built on Outcomes
Outcomes can be measured by determinants Health (clinical) Wealth (financial) Performance (operational)
Outcomes-Based Contracting must align incentives between or across the signers of the contract
Jan-Feb 2010 29
©VBHEALTH.ORG
Alignment: If Value Is Built on Outcomes, then Purchasing Must Be Built on Outcomes
Outcomes can be measured by determinants Health (clinical) Wealth (financial) Performance (operational)
Outcomes-Based Contracting must align incentives between or across the signers of the contract
Jan-Feb 2010 30
Innovator DNA
Innovators embrace a mission for change. Make mistakes Take risks Display courage Transform ideas into powerful impact Provide to the general community in order to
change the ecosystem
HBR Vol 87 #12, Dec 2009