value based design
DESCRIPTION
TRANSCRIPT
Cyndy Nayer
Co-founder and CEO: Center for Health
Value Innovation
John Riedel
President: Riedel and Associates
Consultants, Inc.
Leveraging
Health:
A Primer for Health
Promotion
Practitioners Using
Value-Based Designs
2010 Board of Directors
Jan-Feb 2010©VBHEALTH.ORG
Buck Consultants
Caterpillar [Michael Taylor MD] Johns Hopkins HealthCare
City of Cincinnati Journal Communications
City of Springfield Or Jack Mahoney ~ Pitney Bowes
Detroit Regional Chamber of Commerce Cyndy Nayer
Genesis Health System Partners in Care
Goodyear/Whirlpool Plumbers and Pipefitters Local 525 H/W Fund
Group Health Cooperative Premera BC/Vivacity
Bob Holben ~Gulfstream Quad/Graphics; QuadMed
Peter Hayes ~Hannaford Quest Diagnostics
Health Alliance Med Plans State of Colorado
HEB Univ of Colorado Health Sciences
Horizon BCBS NJ WellPoint
Humana Whirlpool
IBM Yum!
IHP/Battle Creek
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©VBHEALTH.ORG 3
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
4
Fundamentals of Value-Based DesignValue-based design is an ENGAGEMENT TOOL
for the CONSUMER AND PLAN SPONSOR AND PROVIDER
April-May 2010©VBHEALTH.ORG 5
• Direct
• Indirect
DATA
• Insurance
• Incentives
DESIGN• HIT
• Services
• Communication
DELIVERY
• Health/Productivity
• Performance
• Quality
• Cost Trend Reduction
DIVIDENDS
April 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
Evolution of the Health Value
Continuum© 2007
Jan-Feb 2010©VBHEALTH.ORG 6
Value-Based Template
IncentivesPlan Design
Resources
Data
Jan-
Feb
201
0
©VBHEALTH.ORG 7
Prevention
and
Wellness
Chronic
Care Mgt Care
Delivery
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©VBHEALTH.ORG
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 9
VBD Are Economically Sustainable…
April-May 2010©VBHEALTH.ORG 10
79% said no changes
were made in 2009-
2010 due to
economic downturn
…VBD Are Economically Sustainable
April-May 2010©VBHEALTH.ORG 11
56% said no
changes due to the
economic downturn
were anticipated for
the next plan year
Communication is Key to Behavior
Change and Better Utilization
April-May 2010©VBHEALTH.ORG 12
69% of companies
communicate at least
quarterly
Most use a variety of
media to reach and retain
“stickiness”
Challenges to the VBD Benefit
Deployment are VariedEmployee Engagement is Key to Success
April-May 2010©VBHEALTH.ORG 13
What Could They Have Done
Better?Better Employee Communication and Communication with the
Physicians/Pharmacists/Clinicians for Aligned Messaging
April-May 2010©VBHEALTH.ORG 14
Center Launches the
Decision Matrix for
VBBD
Objective: Streamline the decision
process for levers and designs
Showcase examples of Levers for all 3
domains
Use levers in prevention and wellness
Use levers for chronic care
management
Use levers for guidance to
appropriate care delivery
April-May 2010©VBHEALTH.ORG
Fundamentals of Value-Based DesignValue-based design is an ENGAGEMENT TOOL
for the CONSUMER AND PLAN SPONSOR AND PROVIDER
April-May 2010©VBHEALTH.ORG 16
• Direct
• Indirect
DATA
• Insurance
• Incentives
DESIGN• HIT
• Services
• Communication
DELIVERY
• Health/Productivity
• Performance
• Quality
• Cost Trend Reduction
DIVIDENDS
April 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
Leveraging Health Matrix
Jan-Feb 2010©VBHEALTH.ORG 17
Decision Matrix Follows the Health
Value Continuum examples of levers
Solve for: Waste
Reduction
Future 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©VBHEALTH.ORG 18
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 19
Value-Based Design Can Drive
Productivity Outcomes thru Levers Reduction in Total Risks
At the Person level [SMALL Er]
W/3 risks costs $5952
W/1 risk costs $4480
Difference = $1494/year
At the Population level [Mid-Large ER]
100 people moved from 3 risks to 1 risk= $298,700 savings
Comparison Opportunity:
Waste Reduction: Behavioral Health and EAP education/screening
Chronic Care: Dx drives intensive screening/coaching; copays are reduced when enrolled in behavioral health coaching
Care Delivery: Increased reimbursement to care mgt teams for chronic care; reduction in copay for care by these teams
April-May 2010©VBHEALTH.ORG 20
What Is the Value of 100+ Levers?
Individual Health Management: up to 50% trend reduction
1:1 to 1:1.5+ Dividend
$1mm in dividend including productivity losses
Condition Management: up to 50% trend reduction
21% decrease in sick days/unscheduled absence
Overall adherence improved in medications/treatment compliance
Provider Selection (Care Delivery): up to 35% trend reduction
Improved compliance with evidence-based guidelines
Suites
Up to 50% reduction in trend sustained for 4 years and more
April-May
2010©VBHEALTH.ORG 21
Value of Health is Driven by
Sustainable Behavior Change Quality Improvement effort to develop predictability,
alignment in care, and transparency for choice
Risk management focus to reduce inefficiencies and
variability in care and outcomes
Challenge in plan design v incentives leads to innovative use
of levers
Alignment of incentives between delivery system and
consumer decisions reduces friction
Communication that is visible, public and promotional
VBD = PCPCC = Outcomes that drive sustainable behavior
change and predictable reduced trend
Jan-Feb 2010©VBHEALTH.ORG 22
Nayer, Mahoney. Journal of Compensation and Benefits Mar 09
Behavioral Change is the Key to
Sustainable Value
Jan-Feb 2010©VBHEALTH.ORG 24
Obesity Example for Individual Health Competency
Sponsor Goal Lever Action HPP Role Metrics Report to Sponsor
Transfer Reduced Receive nutritional Provide nutritional counseling, P in modules, % participation
responsibility insurance cost counseling, participate provide coaching, changes in % completing
for personal for participation in coaching, complete design online module, eating patterns, interventions,
health or for achievements an online educational provide reminders for updated status % change in
management module, update updating the PHR, of PHR, eating behavior,
to individuals information in the PHR provide technical assistance. change In % change in weight
weight, BMI, % change in BMI
risks related to
obesity.
Jan-Feb 2010©VBHEALTH.ORG 25
Obesity Example for Condition Management
Sponsor Goal Lever Action HPP Role Metrics Report to Sponsor
Increase adherence Reduce cost ofTx Enroll in disease mgmt. Provide education about Improvement % change in weight
to chronic care when individual obtain lab values as obesity, perform ongoing in testing result, % change in BMI
management participates in required, adhere to lifestyle coaching related exams, and lab % change in chol.
approved program recommended care obesity, provide coordination results; % change in HbA1C
activities among care providers improvement
when necessary in indicators
(BMI, cholesterol,
level, HbA1C)
Jan-Feb 2010©VBHEALTH.ORG 26
Obesity Example for Care Delivery
Sponsor Goal Lever Action HPP Role Metrics Report to Sponsor
Use of appropriate Reduce cost of Use of PCP network defined Education about condition Degree of % in-network care
provider based upon primary physician by plan sponsor, adherence or lifestyle, provide referrals adherence to PCP utilization
evidence and care and selected to Tx protocols that are to appropriate providers, recommended patterns,
efficiency specialist care evidence-based coach on care mgmt. and providers; % change in diet
communicating with your improved % change in weight
physician about obesity- testing results % change in chol.
related issues exams, and lab fractions,
results; % reduction in ER use
improved
disease indicators
and health status
indicators (BMI,
cholesterol level,
HbA1C)
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©VBHEALTH.ORG 27
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