Bending the Cost Curve & Building Value-Based Benefit Design: The Latest from the Maine Health Management Coalition

Transcription

1 Lunch & Learn Webinar Series Bending the Cost Curve & Building Value-Based Benefit Design: The Latest from the Maine Health Management Coalition August 4, PM 1PM Audio is available through your computer speakers or by phone. To access audio by phone, please call: , Access Code: #

2 Working to Improve the Health of Everyone in Maine

3 Leading the Movement for Patient-Centered Care

4 Join Us! Become a Maine Quality Counts Member mainequalitycounts.org/join Networking events Webinars with national experts Discounted registration for QC 2016

5 QC Annual Meeting & Dinner September 17 th Maple Hill Farm Inn Hallowell, Maine Hear updates on QC's work. Learn about Franklin County's successful longterm public health intervention, with a presentation by JAMA study co-authors. Network with fellow QC Members.

6 Innovate, Improve Care & Receive Incentives: Join the Million Hearts Cardiovascular Disease Risk Reduction Model August 18 th 12:00-1:00 PM Hear details on this exciting new initiative directly from Dr. Darshak Sanghavi, Director of the Preventive and Population Health Care Models Group at the Center for Population Health at the Centers for Medicare and Medicaid Services (CMS). Visit for more details and to register.

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8 Important Webinar Notes You are in listen-only mode. Type your questions and comments into the chat box on the lower left-hand side of the screen. If you experience audio difficulties while using computer speakers for audio: - Audio echo: you may be logged into the webinar room twice close one of your ReadyTalk windows. - Audio delay: use the pause button (located in the upper left-hand corner of the ReadyTalk window) to allow buffering time.

9 After Today s Webinar You ll receive links to the slides and recording of today s session this afternoon All QC Lunch & Learn webinars are archived on our website:

10 Today s Presenters Robin Allen is the value-based insurance design manager at the Maine Health Management Coalition. She is currently leading three workgroups to develop a health plan model that promotes utilization of high-value services through quality providers, encourages better health and wellness for Maine people, and reduces waste and overuse of services that increase cost. Robin s health insurance background includes work experience with private and public payers. Lisa Nolan is the Cost of Care Manager at the Maine Health Management Coalition, where she supports multi-stakeholder efforts to identify strategies for reducing health care costs. Previously, Lisa worked as a consultant focusing on health and workforce policy. She has also worked at the Maine Department of Labor and held several posts in the Federal government.

11 Bending the Cost Curve & Value-Based Insurance Design: The Latest from the Maine Health Management Coalition August 4, 2015 Lisa Nolan, Cost of Care Manager Robin Allen, VBID Manager 1

12 About Maine Health Management Coalition MULTI-STAKEHOLDER MEMBERS Mission: The Maine Health Management Coalition is a purchaser-led partnership among multiple stakeholders working collaboratively to improve health and to maximize the value of health care services for the employees and dependents of MHMC members and all the residents of Maine. Vision: The State of Maine leads the country in population health status, patient care experience, and low per capita health care expenditures contributing to a favorable business climate for economic growth and job development.

13 State Innovation Model In February 2013 the State of Maine received one of six State Innovation Model (SIM) awards from the Centers for Medicare & Medicaid Innovation (CMMI). The award has four primary objectives aimed at achieving the Triple Aim: Reduce cost of care in Maine; Improve the health of Maine s population; Improve patient experience Increase number of practices reporting on patient experience SIM partners include the Coalition, Maine Quality Counts, and HealthInfoNet The Coalition s SIM work includes providing data analytics to support system transformation; continued support of multi-stakeholder processes for public reporting of healthcare quality; and convening of multi-stakeholder workgroups around healthcare costs, value-based insurance design, payment reform, and measurement alignment 3

14 SIM Cost of Care Activities Healthcare Cost Workgroup Healthcare Databook Executive summits on healthcare costs 4

15 Healthcare Cost Workgroup Objective: identify actionable strategies to reduce costs while maintaining quality; tools for stakeholders to reduce costs Reconvenes 2012 group that explored cost drivers & potential interventions Meets monthly; participants at each meeting; open to all Balanced, multi-stakeholder forum; participants have included: BIW, Bates, Maine Municipal Association, UMaine System, Maine Education Association Benefits Trust, State Employee Health Commission, Catholic Charities, Norway Savings, MaineCare, Consumers for Affordable Health Care Central Maine Medical, MaineHealth, Eastern Maine, Mercy, MaineGeneral, Mayo, Franklin Memorial, St. Mary s, St. Joseph, InterMed, Redington Fairview, Martin s Point, Sacopee Valley Health Center, Mid Coast, Maine Primary Care Association, Spurwink, Sweetser, Tri-County Mental Health, Maine Medical Association, Maine Hospital Association Aetna, Anthem, Cigna, Harvard Pilgrim, Maine Community Health Options, Maine Association of Health Plans

16 Savings Opportunities Identified Participants reviewed range of possible savings opportunities, including those identified by 2012 cost workgroup Group voted to focus initial attention on: Price Delivery system infrastructure Consumer engagement 6

17 Voluntary Growth Cap Voluntary initiative Under voluntary cap, parties to risk-based contracts agree to voluntary limit annual riskadjusted per member per month growth to no more than an agreed-upon cap Specific growth rates under voluntary cap continue to be established through contract negotiations Over time, voluntary caps should improve affordability 7

18 Voluntary Growth Cap Recommendation Workgroup reviewed several indices, focused on general and medical CPI Compromise: set voluntary cap at CPI-All Urban: medical care in Year 1; by Year 5, voluntary cap trends down to CPI-All Urban: less food & energy plus 25% of difference between 2 indices Safety valve available to modify caps if significant unanticipated events are likely to result in unexpected or unreasonable windfalls or losses Multi-stakeholder contributions essential to effort: Subcommittee on Multi-stakeholder Strategies tasked with developing strategies that various sectors can employ to help keep cost growth within voluntary cap 8

19 Voluntary Growth Cap CPI U.S. city average U.S. Bureau of Labor Statistics Moody s Analytics Forecast All items less food and energy 2.5% 2.3% 2.3% 1.7% 1.0% 1.7% 2.1% 1.8% 1.7% 1.9% 2.4% 2.9% 3.0% 2.7% 2.4% Medical Care 4.0% 4.4% 3.7% 3.2% 3.4% 3.0% 3.7% 2.5% 2.4% 2.7% 3.4% 3.7% 4.0% 4.1% 4.0% Voluntary Growth Cap 3.4% 3.6% 3.6% 3.3% 2.8% U.S. Bureau of Labor Statistics, and Moody s Analytics, U.S. Macro Baseline (July 2015). 9

20 Infrastructure How can the workgroup support and advance ongoing and future efforts aimed at appropriately aligning health resources? Health resources defined broadly; includes buildings, equipment, personnel Exploring two initiatives: Principles and criteria to evaluate and potentially support proposed realignment efforts Inventory of state health resources 10

21 Criteria for Reviewing Infrastructure Realignment Proposals Support from a multi-stakeholder group could contribute to constructive community dialogue around realignment proposals Developing a process under which entities contemplating resource realignment could solicit support, based on criteria that assess the realignment s impact on: Quality Population health Cost Access to care Aligning resources with need Cost effectiveness 11

22 Upcoming Areas of Workgroup Focus Finalize infrastructure recommendations Review recommendations from Subcommittee on Multi-stakeholder Strategies Begin discussions of consumer engagement 12

23 Healthcare Databook Healthcare Databook presents information on: demographics and health status of Maine population Utilization and delivery of healthcare in the state Quality and cost of care Includes county-level data, as well as state and national information Relevant and easy-to-use information in one-stop format Available at under SIM/SIM downloads tabs 13

24 Databook: A Look Inside 14

25 Databook: A Look Inside 15

26 Executive Summits Bring together business executives and providers to discuss healthcare costs, utilization, and innovations, as well as potential levers for influencing cost Venue for leaders to share ideas, concerns, strategies Summits convened in October 2014 in Augusta and July 2015 in Bangor area; next summit scheduled for fall

27 Value-Based Insurance Design Value-based insurance design (VBID) aims to increase health care quality and decrease costs by using financial incentives to promote high quality, cost efficient health care services and consumer choice. 17

28 Why Value-Based Insurance Design? CEO Summit: Clinicians and large employers in Maine discussed the need to lower health care costs while improving quality SIM opportunity to explore VBID as a solution for attaining Triple Aim goals are aligned with this request 18

29 IOM Cost of Health Care Institute of Medicine 19

30 VBID Model

31 VBID Strategy Three workgroups developing components of the plan Clinical: benefits, shared decision making process, EHR development Wellness: patient/consumer engagement in health and wellness activities Administrative Simplification: streamline administration-tasks not directly related to patient care Closely aligned with other SIM initiatives under MHMC 21

32 Clinical Workgroup: Benefit Design 1 Reviewed over 100 services based on PPACA recommendations for preventive care and screenings Established set of preference-sensitive options to apply SDM process Early prostate cancer treatment Knee/hip replacement Spinal stenosis Stable coronary angina Early breast cancer treatment Herniated disc surgery Colon cancer screening Standard set of exclusions under the VBID plan in development 22

33 Benefit Design Next Steps Establish work plan to develop EHR for color coding based on evidence and to promote SDM Secure SDM training for clinicians/staff Define supply-sensitive services for red category and determine appropriate cost sharing and SDM Partner with others (purchaser, EHR vendor, provider, payer) to pilot VBID plan 23

34 Wellness Workgroup: Patient Engagement 2 Define expectations for employees, employers, providers and payers to engage/activate patients Consider social determinants of health for community resource support Increase healthcare literacy 24

35 Wellness Next Steps Recommending activities to motivate people to engage in healthy choices and follow through with clinical recommendations Identifying evidence based incentives (i.e. health coaching, premium reductions, cash/gifts) Exploring how community resources can be linked to VBID for patient support 25

36 Administrative Simplification Workgroup 3 Payers & providers shared top issues Approximately 20 issues identified for health plans and Medicaid Prioritized top issues: #1 = Provider Credentialing and Enrollment 26

37 Administrative Simplification Applied LEAN process improvement to map inefficiencies and streamline process through standardization 2 areas that can be addressed immediately Provider enrollment application Concise payer requirements and contact information accessible through a single site 27

38 Administrative Simplification Provider enrollment application Standardized format being used by payers in MA 4 health plans in Maine will accept; 2 considering Single source for provider enrollment guides Summary of each payer s required forms, documents, provider credentials and contact information All payers will participate 28

39 Administrative Simplification Next Steps Develop a website to house the provider enrollment application and enrollment guides Create enrollment guide summaries with active links to payer s websites Review issues list and tackle next priority for improvements 29

40 Workgroup Efforts in Print VBID Graphic published in medical text book MPBN publication Lead story for Mainebiz coming in August 30

41 Questions? If you have questions, or would like more information, please contact: Lisa Nolan at about the Healthcare Cost Workgroup and other cost of care activities Robin Allen at about VBID workgroups and activities Thank You!!

42 SAVE THE DATE 2015 Annual Symposium

43 This image cannot currently be displayed. MHMC and SIM This work is made possible with funding from the Maine State Innovation Model Initiative 33

44 QC Lunch & Learn Webinar Series Delivering Health Care & Health Series August 11, 12:00PM 1:00PM Community Health Workers: A Key Resource for Improving Care and Patient Experience for At-Risk Patients August 18, 12:00PM 1:00PM Special QC-Maine & New England QIN-QIO Webinar: Innovate, Improve Care & Receive Payment Rewards: Join the CMS Million Hearts Cardiovascular Disease Risk Reduction Model September 1, 12:00PM 1:00PM Telehealth in Maine: Resources, Recommendations, and Reimbursement Find more information and register: