minnesota value based purchasing susan mcdonald health care purchasing coordinator minnesota...
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MinnesotaValue Based Purchasing
Susan McDonaldHealth Care Purchasing Coordinator Minnesota Department of Human ServicesDirector Governor’s Health Cabinet
P.O. Box 64998St. Paul, MN 55164-0998
Background:Governor’s Health Cabinet
State government working as a team:
5 agencies regulating or purchasing health care
Purchases health care for 800,000 Minnesotans, 20% of population
Engaged in array of private-public alliances and partnerships to create a value driven health care market.
Mission Statement:Take on the state’s health care costs issues by using its buying power to make substantive changes to Minnesota’s health care market.
Minnesota Model to Value Driven Health Care
Value vs. Volume Volume = Number of office visits, procedures,
hospital admissions x price
Value = Access + Service + Outcome
Price / Time
Transparency of price and quality Electronic information exchange Improving health status of Minnesotans
Engage consumers- Engage consumers- Engage consumers
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Minnesota Advantage Plan
Tiered health benefits plan for state employees Clinic systems placed into 1 of 4 cost level
Based on risk adjusted costs and collective bargaining
Risk adjustment -- apples to apples comparisons If a higher cost level provider is selected, the user
pays more at the point of service Higher copays, deductible, coinsurance
Quality information provided via links to MN Community Measurement website
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Advantage’s key featuresInformation and incentives:
Employees and families to choose high quality, high value providers
Providers to deliver greater value, or lose market share
Use health care wisely and protect/improve health
Saved $30M+ in first year!
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Administration Self-funded program Multiple health plan administrators are used to:
Negotiate provider contracts and manage network Perform core functions such as claims adjudication
Monthly Cost Premium is the same for all provider groups and
administrators When members elect a more expensive cost level,
they pay greater cost sharing each time they receive services
Advantage – How it Works
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Recognition Received
“Innovations” Award by the Council of State Government - 2004
Premium Trends 2006 – 0% - Lost $20M to premium holiday 2007 – 9.9% 2008 – 6.7% - Lost $16M to HRA 2009 – 3.5% 2010 – 0% 2011 – 6.7% - Lost $8M to HRA
Partnering with the Private Sector
“Smart Buy” Alliance Minnesota Smart Buy Alliance was created
to: Define the reason for the gap between cost
and quality Focus purchaser efforts to common market signal No more cost shifting between buyers; rather use buying
power to effect change across entire market
Use common principles and goals in buying health care Require or reward “best in class” certification Adopt uniform measures of quality and results Require the latest information technology Empower consumers with easy access to information
Minnesota’s Health Care Environment
One of the lowest # of uninsured in nation – 7.2%
Healthiest state in nation 4 of last 5 years Most state-wide tools in marketplace Most use of health savings accounts – 9.2% Most purchase of LTC insurance – 10% (over 50 years) More integrated systems (hospitals & clinics) More primary care physicians / citizen More employer sponsored insurance Not for profit HMO’s Collaborative history
Tools Needed to Get Us Where
We Are Today [minnesotahealthinfo.org]
ICSI Institute for Clinical Systems Improvement – private sector developed standards and practice guidelines
Measurement and reporting of quality and price information
Reporting
Measurement of health plan performance
Common standards of payment
Peer grouping of providers + centers of excellence
As market driver
Convenience and employer clinics, alternate care, navigators
MN Community Measurement
Adverse Event
eValue8
QCare / P4P
Tiered plans
Health Savings Accounts
Disruptive providers
Connecting the Consumer to the Tools!
Electronic Information Exchange Minnesota HIT Goals
E-prescribing for all providers, plans, pharmacies by 2011
Uniform administrative transaction required by 2009 Interoperable electronic health records by 2015 Governor Pawlenty initiative to provide personal health
portfolios for all state employees by 2009, all Minnesotans by 2011
Minnesota HIT Environment
Minnesota Health Information Exchange Vision is to link providers to exchange clinical
information in a secure and efficient way Includes private partners and DHS as an
investor Launched in fall 2008 with Rx history Discussions with technology partners to
connect the consumer and physician
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The Minnesota e-Health Initiative
A public-private collaboration established in 2004
Legislatively chartered
Coordinates and recommends statewide policy on e-health
Develops and acts on statewide e-health priorities
Reflects the health community’s strong commitment to act in a coordinated, systematic and focused way
“Vision: … accelerate the adoption and effective use of Health Information Technology to improve healthcare quality, increase patient safety, reduce healthcare costs, and enable individuals and communities to make the best possible health decisions.”
Source: e-Health Initiative Report to the MN Legislature, January 2004
The Value Equation Value = Access + Service + Outcome
Price / Time
Health IT Interoperability Clinical exchange –MnHIE Patient control/owned health information- life long
personal health records
The Tipping Point:Giving consumers the information necessary for creating a health life!
Connecting:Family Health HistoryFamily Health Management and SupportMedical Providers FitnessHealth Monitoring DevicesFinancial ManagementSocial NetworkingSearch for InformationHealth BenefitsHealth Assessment Biometric ScreeningDisease ManagementAnd much more….
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