VBID 101 Nancy R. Morris Communication & Member Relations Director 10-15-14.

VBID 101

Nancy R. MorrisCommunication & Member Relations Director

10-15-14

Maine Health Management Coalition | Maine Health Management Coalition-Foundation11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org

Value Based Insurance Design

A form of benefit design that promotes the use of healthcare services that provide more “value” over those services that provide less


63%25%

12%

Preference-sensitivecare

Effective care

Supply-sensitive care

The Dartmouth Institute for Health Policy and Clinical Practice (Wennberg, Weinstein, Fisher, et al.)

Not All Services Are Created Equal


CEO Summit Recommendation

Message from CEO group:

Develop and offer a benefit plan that supports what you want us to do


• Reduce the total cost of care per person per year in Maine to the national average;

• Improve the health of Maine’s population in at least four categories of disease prevalence (including diabetes, mental health, obesity, and tobacco use);

• Improve patient experience scores for targeted practices by 2% from the baseline 2012 survey;

• Increase the number of practices reporting patient experience information from 50% to 66%

Maine’s SIM Goals


MHMC VBID Plan Design



1


Using EMR’s To Aid in Communication

Slow Down and Review Options

Clearing the Path to High ROI Service Use

Stop and Look at the Evidence Before Proceeding

Goal: Reduce Unnecessary Services $265 Billion IOM


Green Services


Yellow Services- SDM


Providing Cost Information Too


Red Services



2


Assuring High Quality Delivery

PCMH’s are the hub. When necessary they refer to:

Quality

High

Costs

Low

Effective & Efficient

Ineffective &

Inefficient

Ineffective & Efficient

Effective &

Inefficient

High Low

Goal: Reduce high prices and inefficiently delivered services $155 Billion IOM



3


Reimbursement is Based on Attaining Outcomes

Providers/ Patients/ Health Plans and Payors share in savings produced by the reduction in preventable admissions and improved health

• ACO’s• Alternative Quality Contracts



4


Making the Patient Part of the Team

Employ incentives and disincentives to produce healthy lifestyle choices and support management of chronic illness at the:

• workplace • the community at large

Goal: Take advantage of missed preventive opportunities $55 Billon IOM



5


Administrative Simplification

•Identify areas of improvement through provider/member complaint logs and patient, provider, health plan, and advocate insights then simplify processes to reduce administration cost burden through process improvement

•Reduce across complexity through standardization across public and private payers through consistency where possible (claim billing, prior-authorization)

•Adjust plan benefits so they encourage the desired behavior in all parties

Goal: Reduce Excessive Administrative Costs $190 Billion IOM


Current Health Plan Rating Display

• Working to standardize VBID benefits

• Working to standardize provider value ratings

• Working to standardize administrative requirements


Potential Future Health Plan Rating Display


Prefers safe providers



Encourages use of shared-decision making tools



Prefers providers with best patient survey results



Does not pay for preventable complications



Why Work Together?

•The data is more robust

•We have data to serve as neutral arbitrator

•Standardization if the foundation of quality improvement

– Operating rules

– Quality measurement

• Together we are more attractive to other organizations

– EMR vendors

– Grantors

– Government payors

• We have any opportunity to attract and maintain more primary care physicians

• We are better prepared for a crisis


Community Effort

• Aetna• Cigna• Anthem• Harvard Pilgrim Health Plan• Maine Community Health

Options• Medical Mutual• Geisinger• MaineCare

Health Plans/Payers

Brokers

Providers/Associates

State & Federal

Others


Community Effort

Health Plans/Payers

Brokers


• Cross Agency• Holden Agency• USI• Aliant• Acadia Benefits

State & Federal

Others


Community Effort

Health Plans/Payers

Brokers


• HealthReach• Maine Optometric Association• MaineHealth• Maine General• OMC Wellness• St. Mary’s• Spurwink• MidCoast Health• InterMed• Maine Osteopathic Association

State & Federal

Others


Community Effort

Health Plans/Payers

Brokers


• Centers for Medicare & Medicaid Innovation

• Maine State Employee Health and Benefits Office

• Maine CDC• Veteran’s

Administration• MEABT• Maine BOI• DHHS

State & Federal

Others


Community Effort

Health Plans/Payers

Brokers


• Lown Institute-MA• IMD Foundation-MA• City of Portland• Maine Quality Counts• Maine Areas on Aging• Health Care Administrative

Solutions, Inc.-MA• Brian Atchison• Milliman MedInsight – Waste

Calculator-WA• Athena• www.TheNNT.com

State & Federal

Others


Community Effort

Health Plans/Payers

Brokers


• Robert Wood Johnson Foundation-NJ

• Oregon State-OR• Internal MHMC staff• Neel Shah, Costs of Care-MA• Integrated Health Association-

CA• Pacific Business Group on

Health-CA• AARP

State & Federal

Others

Continued


How Can You Get Involved

http://www.youtube.com/watch?v=hO8MwBZl-Vc

http://www.youtube.com/watch?v=hO8MwBZl-Vc

Date post:	12-Jan-2016
Category:	Documents
Upload:	leo-stephens
View:	220 times
Download:	0 times

VBID 101 Nancy R. Morris Communication & Member Relations Director 10-15-14.

Documents