VBID 101

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

2. 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

3. Not All Services Are Created Equal Effective care Supply-sensitive care 12% 63% Preference-sensitivecare 25% The Dartmouth Institute for Health Policy and Clinical Practice (Wennberg, Weinstein, Fisher, et al.)

4. CEO Summit Recommendation Message from CEO group: Develop and offer a benefit plan that supports what you want us to do

5. Maine’s SIM Goals • 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%

6. MHMC VBID Plan Design

7. MHMC VBID Plan Design 1

8. Using EMR’s To Aid in Communication Clearing the Path to High ROI Service Use Slow Down and Review Options Stop and Look at the Evidence Before Proceeding Goal: Reduce Unnecessary Services $265 Billion IOM

9. Green Services

10. Yellow Services- SDM

11. Providing Cost Information Too

12. Red Services

13. MHMC VBID Plan Design 2

14. Assuring High Quality Delivery PCMH’s are the hub. When necessary they refer to: High Effective & Inefficient Effective & Efficient Quality Ineffective & Inefficient Ineffective & Efficient Low High Low Costs Goal: Reduce high prices and inefficiently delivered services $155 Billion IOM

15. MHMC VBID Plan Design 3

16. 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

17. MHMC VBID Plan Design 4

18. 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

19. MHMC VBID Plan Design 5

20. 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

21. Current Health Plan Rating Display • Working to standardize VBID benefits • Working to standardize provider value ratings • Working to standardize administrative requirements

22. Potential Future Health Plan Rating Display

23. Potential Future Health Plan Rating Display Prefers safe providers

24. Potential Future Health Plan Rating Display Encourages use of shared-decision making tools

25. Potential Future Health Plan Rating Display Prefers providers with best patient survey results

26. Potential Future Health Plan Rating Display Does not pay for preventable complications

27. 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

28. Community Effort Health Plans/Payers • Aetna • Cigna • Anthem • Harvard Pilgrim Health Plan • Maine Community Health Options • Medical Mutual • Geisinger • MaineCare Brokers Providers/Associates State & Federal Others

29. Community Effort Health Plans/Payers Brokers • Cross Agency • Holden Agency • USI • Aliant • Acadia Benefits Providers/Associates State & Federal Others

30. Community Effort Health Plans/Payers • HealthReach • Maine Optometric Association • MaineHealth • Maine General • OMC Wellness • St. Mary’s • Spurwink • MidCoast Health • InterMed • Maine Osteopathic Association Brokers Providers/Associates State & Federal Others

31. Community Effort Health Plans/Payers • Centers for Medicare & Medicaid Innovation • Maine State Employee Health and Benefits Office • Maine CDC • Veteran’s Administration • MEABT • Maine BOI • DHHS Brokers Providers/Associates State & Federal Others

32. Community Effort • LownInstitute-MA • IMD Foundation-MA • City of Portland • Maine Quality Counts • Maine Areas on Aging • Health Care Administrative Solutions, Inc.-MA • Brian Atchison • MillimanMedInsight – Waste Calculator-WA • Athena • www.TheNNT.com Health Plans/Payers Brokers Providers/Associates State & Federal Others

33. Community Effort Health Plans/Payers • 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 Brokers Providers/Associates State & Federal Others Continued

34. How Can You Get Involved http://www.youtube.com/watch?v=hO8MwBZl-Vc