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eValue Aetna NY NJ CT HMO and Aetna NY PPO Evaluation Results Price Transparency

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					eValue8 2010
RI Insurer Evaluation Results
What is eValue8 and what are the project
objectives?
 eValue8 is a national standardized Request for Information
 established by the National Business Coalition on Health
 which is distributed to health plans with the intention of:
    Implementing Standardized Performance Expectations
    that are evidenced-based and defendable in the Board
    Room and are consistent nationally.
    Differentiating Plan Performance and Stimulate
    Improvement, Particularly In Health Status and Cost
    Encourage Health Plans to Evaluate and improve the
    Delivery Systems that Comprise their Networks
    Promote Consumer Engagement and Informed Decision
    Making
    Provide a Community-Based Forum for Communication
    Between Purchasers and Plans
    Reinforce Topics of Emphasis That Spawn Inter-Plan
    Collaboration To Accelerate Improvement
    Reduce Redundancy by Consolidating Purchaser Requests
Participating Coalitions in 2010
In addition to RI, there are numerous coalitions
throughout the United States currently using the
eValue8 tool as a method of monitoring and improving
health plan performance including:
   Buyers Health Care Action Group (MN)
   Colorado Business Group on Health
   Florida Health Care Coalition
   HealthCare 21 (TN)
   Health Action Council of OH
   Memphis Business Group on Health
   Mid-Atlantic Business Group on Health
   Midwest Business Group on Health
   New York Business Group on Health
   Oregon Coalition of Health Care Purchasers
   Pacific Business Group on Health
   Puget Sound Health Alliance
   South Carolina Business Coalition on Health
   Wichita Business Coalition on Health Care
eValue8 Collaborators
The following organizations contribute to the
development of eValue8:
   Centers for Disease Control (CDC)
   Centers for Medicare and Medicaid Services (CMS)
   Substance Abuse and Mental Health Services
   Administration (SAMHSA)
   Agency for Healthcare Research and Quality (AHRQ)
   National Committee on Quality Assurance (NCQA)
   Joint Commission for the Accreditation of Health Care
   Organizations (JCAHO)
   URAC
   American Board of Internal Medicine (ABIM)
   eHealthInitiative (eHI)
   The Leapfrog Group
   Pennsylvania State University
   George Washington University
Participating RI Plans in 2010
  Participating Health Plans
    BCBS RI PPO
    Tufts RI PPO

    United declined to participate in
    the RI marketplace, but did
    participate in other markets.
 2010 Evaluation Areas
Plan Profile
Provider Measurement

    Consumer Engagement

Pharmaceutical Management
Prevention & Health Promotion
Chronic Disease Management
Behavioral Health
Primary Components of Evaluation Areas
  Plan Profile
    Efficiency, Accreditation and Compliance Reviews
  Provider Measurement
    Hospital/PCP/Specialist Performance Measurement and Feedback
    to Provider
  Consumer Engagment
    Decision Support Tools including Practitioner Information and
    Price Transparency
  Pharmaceutical Management
    Promoting Adherence, Managing Utilization
  Prevention and Health Promotion
    Tobacco Use and Obesity Programs and Cancer Screening
  Chronic Disease Management
    Performance Measurement (Diabetes, Coronary Artery Disease)
    Chronic Disease Member Identification and Support
  Behavioral Health
    Member AND Practitioner Support
      Plan Profile
                                  2010 eValue8 Results
              Profile: Accreditation, VBBD, Waste, Disparities

     100.0
      90.0
      80.0                                                     23                                             23
      70.0                                                     3                                              3
                                                  12
      60.0                                         2           20                           14                20
                                                   7                           9             2
      50.0          9               19                                         0             7
                    0                                                         11
      40.0          11              3
                                    1
      30.0
                                                  47           45                           41                45
      20.0          31              32                                        36
      10.0
       0.0
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Accreditation & Performance Reporting            Plan Design   HIT       Provider Contracting, Disparities, Admin
BCBS RI Key Opportunities
 Report physician performance and introduce
 performance information into directory with enhanced
 functionality
 Offer Cost transparency/calculator tools
 Consider constructing value-based formulary for Rx
 Consider more proactive identification, engagement
 and tracking of tobacco users and obese members
 Improve Prenatal and Postpartem care
 Leverage knowledge of Rx fill gaps to help drive
 prescription adherence
 Provide physicians with actionable gaps in care support
 and comparative reports.
 Consider introducing 24/7 crisis response capability
 and implementing a depression management program
Tufts RI Key Opportunities
 Expand all programming in RI
 Consider expanding contractual conditions for
 hospital acquired conditions (some are included, but
 could go further)
 Consider expanding “centers of excellence”
 programming
 Extend functionality of cost estimation tools, link to
 provider directories and interactive treatment
 support
 Leverage knowledge of Rx fill gaps to drive
 prescription adherence
 Consider more proactive identification, engagement
 and tracking of tobacco users and obese members
 Implement 24/7 Crisis Management with Warm
 Clinical Transfer and consider implementing a
 formal depression management program
Discussion Themes of eValue8 2010
Site Visits

1.   ADDRESSING ‘WASTE’ AND THE
     MEDICAL COST TREND
2.   INFLUENCING MEMBER BEHAVIOR
3.   AGGRESSIVELY CLOSING
     ‘GAPS IN CARE’
 Priority Theme for Discussion
‘WASTE’ AND THE MEDICAL COST TREND

   Price Transparency –Is your plan willing to supply this
   type of data and participate in a collaborative,
   measurement effort that may involve enabling legislation?
   Addressing Variation – What is your health plan
   doing to measure/identify plan-specific variation in
   treatment patterns? What specific interventions do you
   have in place to address the variation?
   Medical Cost Trend – What are your health plan’s top
   1-2 strategies to address the cost trend in this market?
   Are there specific ways that purchasers can support your
   efforts?
   Payment Reform - What are you doing to collaborate
   with purchasers and with other payors to initiate changes
   in provider payment that will better align payment with
   value rather than volume?
 Priority Theme for Discussion
INFLUENCING MEMBER BEHAVIOR

   Coordinating with Purchasers – How can the health
   plan more effectively work with purchasers to coordinate
   strategies to educate members about available benefits,
   programs, and tools for informed decision and self-
   management?
   Price transparency –What are the opportunities and
   barriers in the use of cost calculators that link member-
   specific benefits to provider-specific prices/costs in this
   market? What does the plan have underway to improve
   price transparency for consumers?
   Value-based Benefit Design – What do you need
   from purchasers to do a better job of designing and
   administering value-based benefits?
   Predictive Modeling – Is there a way to use predictive
   modeling that links together different data sources (e.g.,
   trend, workers comp, HRA, etc.) to identify who is likely to
   need services and/or intervention?
 Priority Theme for Discussion
AGGRESSIVELY CLOSING ‘GAPS IN CARE’

   Is the health plan fully leveraging its
   information and programs to improve the
   health status of its members?
   Involving Members – How effectively and how
   broadly does the health plan ‘push’ information out
   to members to educate and coach them, and remind
   them (screenings/tests, use of medication)?
   Coordinating with Providers – Specifically, how is
   the plan linking its disease management programs to
   provider practices and coordinating efforts with
   providers to maximize the effect?
   Collaborating with Purchasers – How can
   purchasers and plans integrate employer data with
   plan data (from the HRA or ‘carved out’ programs
   like pharmacy or behavioral health) to more
   effectively identify gaps in care?
How well do New England
insurers “close the gap?”
Gap for What Condition: Preventive, Chronic
                           GAPS IN CARE
                    by Disease Category Reported


100
 90
                                                                       36
 80
 70
 60                                                                    12
 50                                                                     8
                                  13
 40       7         7
                                  6             2            2
          8         8                           7            7         28
 30                               6
          7         6                           8            8
 20                               15
         12        12                           14          13
 10                                                                    14
          6         6             7
          2         3             3             7            7          3
  0                                             0            0
      BCBS MA   BCBS MA     Harvard        Tufts MA     Tufts RI   Perfect
        HMO       PPO      Pilgrim MA        HMO         PPO       Score
                               HMO

  Asthma/COPD   Diabetes    CAD        Cancer   Other Prevention   Other Chronic
      Type of Gap: Screening, Rx, Other
                          GAPS IN CARE
                             by Type of Gap


100
                                                                        13
90
80
70
                                                                        49
60
50                                 7
40                                 13           3
                                                5             2
                                                              5
30
         7          7
         14        14                                                   38
20                                 30           29            29
10       14        12
  0
      BCBS MA   BCBS MA    Harvard         Tufts MA       Tufts RI   Perfect
        HMO       PPO     Pilgrim MA         HMO           PPO       Score
                             HMO

                 Screening/tests        Pharmaceuticals     Other
      Recipient of Gap Reminder
                          GAPS IN CARE
                             by Person Notified


100                                                                 10


80

                                                                    51
60

                                 3
40       3          3
                                               3          3
         16        16            29
                                               17         16        39
20
         18        17                          13         13
                                 12
  0
      BCBS MA   BCBS MA      Harvard       Tufts MA   Tufts RI   Perfect
        HMO       PPO       Pilgrim MA       HMO       PPO       Score
                               HMO

                   Member      Physician     Coach/case mgr
eValue8 2011 – Next Steps
RIBGH intends to support eValue8 in
2011 as well
  RIBGH members will receive access to
  summary results for participating RI
  insurers in 2011 (since BCBSRI will be in
  Year 2, their results will be available going
  forward)
  Companies who specifically support
  eValue8 within RIBGH will have access to
  substantial detailed report results
Goals
  Improving quality and cost throughout the
  RI marketplace

				
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posted:12/25/2010
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Description: eValue Aetna NY NJ CT HMO and Aetna NY PPO Evaluation Results Price Transparency