Can Employers Drive Value Can Employers Drive Value Based Purchasing? Based Purchasing? Andrew Webber, President & CEO National Business Coalition on Health Leonard Davis Institute of Health Economics February 27, 2004
Dec 21, 2015
Can Employers Drive Value Can Employers Drive Value Based Purchasing?Based Purchasing?
Andrew Webber, President & CEO
National Business Coalition on Health
Leonard Davis Institute of Health Economics
February 27, 2004
Presentation OutlinePresentation Outline
NBCH IntroductionImagine – Crossing the Quality
Chasm We Have Met the EnemySome Hopeful Signs
National Business Coalition on National Business Coalition on HealthHealth
National, non-profit, 501 (c)(6), membership organization of employer-based health coalitions- 85 coalition members- 7,000 individual employer members of coalitions- Representing 30 million covered lives
Not to be confused with the National Business Group on Health
National Business Coalition on National Business Coalition on HealthHealth
Vision – Establishment of a value-based health care market in every community
Value-based purchasing fundamentals:
- Publicly report performance information
- Reward health plan/provider performance
- Leading to: an accelerated pace of health
care delivery system reengineering
National Business Coalition on National Business Coalition on Health Health
Mission – To provide superior membership service
- Building the capacity of NBCH members to advance value-based purchasing
- Identification and dissemination of best
practices
Some Major NBCH InitiativesSome Major NBCH Initiatives
Sponsor of the Common RFI/eValue8 Product Leapfrog Partner – 75% of Regional Roll Outs led
by NBCH Members Exploring Bridges to Excellence Initiative Active participant in National Quality Forum and
Disclosure Group
NBCH Summary: A Distribution Network for Best Practices in Value-based Purchasing
An Abundance of OpportunityAn Abundance of Opportunity
44,000 – 98,000 preventable hospital deaths Widespread variation in medical practice and
health outcomes Fragmented delivery system Poor information technology infrastructure Lack of transparency and disclosure Toxic payment system Gap between what we know and do
Volume 348(26) 26 June 2003 pp 2635-2645
The Quality of Health Care Delivered To Adults In the United States
McGlynn, Elizabeth A.: Asch, Steven M.: Adams, John: Jeesey, Joan: Hicks, Jennifer:DeCristofaro, Alison: Kerr, Eve A.
BACKGROUNDWe have little systematic information about the extent to which standard processes involved in healthcare—a key element of quality—are delivered in the United States.METHODSWe telephoned a random sample of adults living in 12 metropolitan areas in the United States and…received written consent to copy their medical records…to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventative care…RESULTSParticipants received 54.9 percent of recommended care. CONCLUSIONSThe deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits are warranted.
The Demand Side Challenge: The Demand Side Challenge:
Misaligned Financial IncentivesMisaligned Financial Incentives Health care is one of the only industries
where a “do over” is a revenue sourceSystem pays for throughput rather than
outcomesConsumer insulated from the cost
consequences of their demand for servicesSupply-side induced demand for servicesProviders not rewarded to improve care
Market-Based Reform: A Path Market-Based Reform: A Path ForwardForward
Performance disclosure Pay for performanceConsumer choice
Desired Outcomes:Health Care System ReengineeringQuality Up and Costs Down
Performance DisclosurePerformance Disclosure
Common set of metrics At plan, provider, physician level Also benefit/risk information at treatment level Publicly reported In ways that the public can understand
Goal: To Embarrass the DeliverySystem into Improvement
Pay for PerformancePay for Performance
Differential payments to plans/providers based on understood and recognized performance metrics
Question: what % of total reimbursement needs to be tied to performance to influence behavior change
Goal: Financial Rewards to High Performers Motivating Improvement by Others
Consumer ChoiceConsumer Choice
Health benefit architecture designed to incentivize/reward employee selection of high performance plan/providers and evidence based medical treatments
Question: What are the copayment thresholds that will influence consumer selection?
Question: What is the ROI?
Goal: Patient Volume Migration To High Performers
““We have met the enemy and We have met the enemy and they is us”they is us”
Pogo Pogo Walt KellyWalt Kelly
Health System Reform Starts at Health System Reform Starts at Home with Home with
Employers/PurchasersEmployers/Purchasers
Taking ownership and responsibilityParticularly for the misaligned
financial incentivesAnd failure to incentivize and reward
quality and efficiency
A Report Card on Employer A Report Card on Employer Performance Performance
Investment in Human Capital, Employee Health & Worker Productivity
1. Provision of health insurance benefits B-2. Provision of worksite health promotion and
prevention programs C3. Investment in disease management programs C-4. Employee education C5. Demonstration of corporate leadership and
trust C-
A Report Card on Employer A Report Card on Employer Performance Performance
Track Record in Value-based Purchasing
Support managed care during backlash C- Reward plan and provider performance
through differential payments D Activate employees/consumers through
innovative benefit architecture D Demand health plan engagement in I/Rs C- Participate in coalitions and group purchasing C
Public Reporting of Public Reporting of PerformancePerformance
NCQA Health Plan Accreditation/HEDISLeapfrog Hospital SurveyState and Community Report Cards NCQA Physician Recognition ProgramCMS Voluntary Hospital Reporting
ProgramMedicare Pay for Reporting Requirement
Pay for PerformancePay for Performance
Bridges to Excellence Integrated HealthCare Association – P4P Project CMS/Premier P4P Demonstration Medicare Drug Bill Payment Demos at Physician
Level IOM and MedPAC Studies of suitable measures
for P4P Health Plan Initiatives
Consumer ChoiceConsumer Choice
General Motors – Plan SelectionBoeing – Hospital SelectionPitney Bowes – Pharmaceutical
SelectionBridges to Excellence – Physician
Selection
Can Employers Drive Value Can Employers Drive Value Based Purchasing?Based Purchasing?
Yes, But – The pace is slow Corporate leadership is lackingBest practice models are neededConsumers, government purchasers, and
health plans must all get on board