employers, coalitions and health system transformation presentation to florida commission on...
TRANSCRIPT
Employers, Coalitions and Health System Transformation
Presentation to Florida Commission on Healthcare and Hospital Funding
Laurel Pickering, MPHPresident & CEO
Northeast Business Group on Health
August 31, 2015
Agenda
• Why Employers Matter in Transformation• Coalitions and NEBGH• New York’s Health System Transformation• Commission Topics of Interest• Leapfrog: Transparency of hospital quality and
safety
Transforming HealthcareWhy Employers Matter
• Employers pay for healthcare• Employers can improve access to high-value care
solutions • Employers can implement health and wellness initiatives • Employers can use benefit design • Employers can engage employees and create a “culture
of health”• Employers hire numerous vendors to fill gaps in the
system
Supporting Employers as Purchasers: Regional Business Coalitions:
• Groups of employers within a local or regional community collaborate to influence their healthcare delivery systems to achieve greater value
• Coalitions began in the early 1980’s; Now more than 50 local and regional coalitions around the country
• Vary in size, model, and member composition
• Represented in Washington, D.C. by the National Business Coalition on Health (NBCH)
What do coalitions do?
Education
LeverageCommercialPurchasers
Drive ValueAnd
Improvementin the
SystemBusiness
CommunityLeadership
CommunityStakeholderConvenings
Products & Services
Delivery System
Evaluation
Northeast Business Group on Health
• Represents 70 employers based in New York, New Jersey, Connecticut and Massachusetts – many are large national, self-insured employers
• Employer driven and multi-stakeholder: 180 members also include health plans, providers, benefit consultants, suppliers and other stakeholders
• Represents about 12 million covered lives
• Use employer purchasing leverage to drive value in the system
• Mission: Empowering our members to drive excellence in health and achieve the highest value in healthcare delivery and the consumer experience
NEBGH Activities• Education• Vendor Management
– Health plan evaluation (eValue8)– User Groups: Aetna, Anthem, United, Kaiser and PBM
• Multi-Stakeholder Collaboration– Diabetes– Weight Management– Cancer– Readmissions– Integrating Behavioral Health into Primary Care
• Leapfrog• HealthPass• Future: Direct Contracting
“You have to have a collaborative force to push
back on the status quo”
Don Berwick, former Administrator of the Centers for Medicare and Medicaid Services
• One of the nation’s oldest, most successful small business, multi-carrier private exchanges (est. 1999)
• 2-50 employees (expanding to 100)• Public/private partnership; seed money from
City of New York• Over 15 years, insured 14,000+ small businesses
and 175,000+ members• Owned by NEBGH
The Vision• Healthier New Yorkers (population health)• Lower costs• Engaged consumers• Systems, programs, financing, policies that support
and value these goals• Triple Aim
State Health Innovation Plan (SHIP) GoalsIdentify and stimulate the spread of promising innovations in health care delivery and finance that result in optimal health outcomes for all New Yorkers.Population Health Goal of the SHIP: • Improve population health through strengthened capacity and
improved screening and prevention through closer linkages between primary care, public health, and community based supports.
• 2020 Goal: Achieve top quartile performance among states in prevention and public health
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Shift to Payment for Value
• Better practice of medicine and better outcomes drive higher payments
• Coordination of care paid for
• Focal point is the ‘whole person’
• Incorporates population health management
• More services and more complex services drive higher payments
• Time spent coordinating care generally not paid for
• No rewards for better quality and outcomes; ‘re-work’ rewarded
• Focal point is the provider and the procedure
Fee-for-Service Payment for Value
The Source of Funds (SHIP/DSRIP)Strong, expert, coordinated state leadership can create value over the next four years
DSRIP Advanced Primary Care
APD
PHIPs
NY SHIPvalue-basedpurchasing
Prevention Agenda
NY State of Health
Capital Restructuring
SIM Testing Grant ▪ Statewide
leadership▪ Stakeholder
alignment▪ Multi-payer
business design and support
Workforce strategy
Common Scorecard
SHIN-NY
Rate Review
Currently funded
Planned SIM funding
Multi-payer funding
The Acronyms
• ACA – Affordable Care Act • ACO – Accountable Care
Organizations • APC – Advanced Primary Care• APD – All Payer Database • DSRIP – Delivery System Reform
Incentive Payment Program (Medicaid)
• PHIP – Population Health Improvement Program
• SHINY-NY – Statewide Health Information Network for New York Systems
• SHIP – New York State Health Innovation Plan (all payers)
• SIM – State Innovation Model (all payers)
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Why Advanced Primary Care?
Primary care is viewed as the foundation of value-based care and the Triple Aim, focused on:
• Prevention• Care coordination (particularly for chronic conditions)• Management of complex/multiple conditions
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SIM Grant• The Affordable Care Act (ACA) created State
Innovation Model (SIM) grants• To qualify, States must demonstrate commitment to
multi-payer health care payment and delivery reform to:
• Improve health system performance• Increase quality of care• Decrease costs
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New York State SIM Grant
• New York received a $100 million four-year grant
• Two-thirds ($67 million) of the funds will be invested in practice transformation
• The New York SIM grant is focused on transforming and strengthening primary care based on the Advanced Primary Care (APC) approach
• State Goal: 80% of residents with access to primary care under a value-based payment model by 2019
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Multi-Payer Collaboration is key
• Greater impact on health care delivery• Less complexity for primary care practices – particularly smaller practices• More consistency for consumers/patients
“Successful multi-payer alignment can amplify the impact of payment and delivery system reforms by sending consistent incentives to health care providers and aligning performance measurement”
Millbank Memorial Fund/Pacific Business Group on HealthAll Aboard: Engaging Self-Insured Employers in Multi-Payer Reform
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Role of NEBGH with NYS Reform
• How come about?
– No long standing relationship
– NEBGH had a vision and track record of working with self-insured employers and multi-payer projects
• Our Role:
– Engage and gather input from payers (health plans and self-insured employers) and regional collaboratives
– Help move towards multi-payer approaches
– Provide feedback to New York State
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SIM Structure
Workforce Support training the next generation of the healthcare workforce who will function in a system that is better integrated and includes a strong focus on behavioral and population health.
Access to CareElimination of financial, geographic, cultural and operational barriers to access appropriate care in a timely manner.
Health Innovation
Council
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This initiative will create benefits across the system
Consumers Employers Primary Care Providers
• Improved health• Better experience, more
coordination• More sustainable costs
• More sustainable costs• Higher productivity• Less need for vendors to fill
in the gaps
• More focus on the patient• Better practice of medicine• Resources for practice
transformation and ongoing support
• More aligned measures and reporting
Health Plans
• Greater impact from primary care initiatives• Improved health• More sustainable costs
• Resources for practice transformation
Convincing Providers to Share Data
• What’s in it for them?• If data is just based on claims it will be inaccurate.• No one wants inaccurate data to be used for public
reporting or payment• Better ability to manage health of the patient if data
is collectively shared and used
Quality Measures
• How important is for payers to use consistent measures? Critical, but very difficult
• Does NEBGH have an interest in quality measures in Medicaid? Up until now we really haven’t. SIM project changes a lot
• Readmissions…did we agree on a methodology among payers? We focused on resources, not rates initially
Challenges Measuring Quality
• Hospitals easier to measure than physicians• Groups of physicians easier to measure than individual
physicians• Individual physicians is what consumers care most about• If individual physician data is publicly reported, data accuracy
is critical• Not many public sites report individual physician performance• Funding
APCD and Public ReportingReasons why All-Payer Databases are Critical• Benefit to State
– Complete picture of what care costs, how much providers receive from payers for same and similar services, the resources used to treat patients and variations across the state and among providers in the total cost to treat an illness or medical event
• Benefit to Providers– Providers get a complete picture of their population– If insurers provide their own reporting, providers may look different across
insurers. Particularly problematic when tiering
• Benefit to Consumers and Businesses– Performance and cost data available regardless of insurer– Can use information to make better-informed decisions about cost-effective care
• Benefit to Insurers– Comprehensive data to make better-informed decisions about cost –effective
care
Healthcare as a Business Challenge
• Cadillac tax has made healthcare a major business challenge.• Employers at a crossroads: actively manage healthcare to get
reductions in costs (wellness, care management, value-based benefit design, incentives, onsite clinics, work directly with providers, reference-based pricing, etc.) or go to a defined contribution approach and private exchange
• Almost all employers are offering high deductible health plans
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• Purchaser-driven nonprofit publicly reporting on hospital quality and safety
• Founded by purchasers in 2000 in response to 1999 IOM Report To Err is Human
• The right care at the right price, while empowering consumer decisionmaking
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The Leapfrog Hospital Survey
• One-of-a-kind • A free, voluntary survey on measures of hospital performance
important to purchasers• Completed annually by over 1,500 hospitals from across the
country• Measures unavailable elsewhere on the national level• Gold standard in transparency• Used by plans, vendors, and purchasers
What’s in the Leapfrog Hospital Survey
1. How patients fare– Survival Predictors– Infection rates– Maternity measures
2. Resources used in caring for those patients– Readmission rates– Length of stay
3. Management practices that promote safety– NQF-endorsed safe practices
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Breakthrough Legislation in Michigan to Require Hospitals Report to Leapfrog
On June 3rd , the Michigan Legislature passed a law effectively requiring hospitals to fully complete the Leapfrog Hospital Survey in order to be eligible to receive graduate medical education funding. 57 Michigan Hospitals receive this funding, and a good number of them currently decline to report. This is the first time any state has required Leapfrog.
Laurel PickeringPresident & CEO
Northeast Business Group on [email protected] x224