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eValue Aetna NY NJ CT HMO and Aetna NY PPO Evaluation Results Price Transparency
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 A A RI re A rim re M M M o co fts lg Sc S fts S tS Tu B Pi B Tu t C C es es rd B B B B va O O r Ha PP HM 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
"eValue Aetna NY NJ CT HMO and Aetna NY PPO Evaluation Results Price Transparency"