Value Based Purchasing Discussion

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Value Based Purchasing Discussion
Moderator Mike Medel Panel Kathleen
Thomas Victoria Lucente Guy DAndrea
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Discussion

• VBCH VALUE BASED PURCHSING
• A range of activities in which public and private
  purchasers engage to influence the behavior of
  consumers, plans, and providers to achieve
  greater value

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Discussion

• VBCH VALUE BASED PURCHSING
• eValue8 RFI Tool to evaluate health plan
  performance
• HOSPITALpick .Your Consumer Hospital Comparison
  Tool
• SelectQuality Care Professional .internal best
  practices benchmarking
• DocTour Graphic Surgery ...surgery made simple

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eValue82006 ResultsVirginia
Kathleen Thomas Landmark Communiations,
Inc. Victoria Lucente Virginia Beach City Public
Schools
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Review of eValue8 Results-Virginia

• VBCH employers funded evaluation of five health
  plans in Virginia
• Four other health plans were evaluated by the
  Mid-Atlantic Business Coalition VBCH enjoyed
  their data

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Virginia Participating Plans in 2006

• HMOs
• Aetna
• Anthem
• Optima (Sentara)
• CIGNA
• Kaiser
• Optimum Choice (MAMSI)
• CareFirst BCBS
• PPOs
• Anthem
• Optima Paid for VBCH
  Members

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eValue8 is NOT home-grownCollaborators include

• 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

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VBCH is not alone Participating
Coalitions

• Memphis Business Group on Health
• HealthCare 21 (TN)
• Buyers Health Care Action Group (MN)
• Colorado Business Group on Health
• Greater Detroit Area Health Council
• Michigan Purchasers Health Alliance
• Midwest Business Group on Health
• Florida Health Care Coalition
• Indiana Employers Health Alliance
• New York Business Group on Health
• MidAtlantic Business Group on Health
• Pacific Business Group on Health
• Alliance for Health (MI)
• Health Action Council of NE Ohio
• Hawaii Business Health Council
• Virginia Business Group on Health

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2006 Evaluation Areas

• We choose today to discuss one or two
  points.even though there are 10 modules and many
  points in the evaluation of the health plan HMO
  and PPO.
• Profile Collaboration/Accreditation/Disparities
• Consumer Engagement
• Provider Measurement
• Health Information Technology
• Prevention Health Promotion
• Pharmaceutical Management
• Chronic Disease Management
• Asthma Management
• Cardiovascular Disease Management
• Diabetes Management
• Behavioral Health
• PPO Operations
• Consumer-Directed Health Plans

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Chronic Disease Management
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CDM Key Factors

• Strengths - Many
• Key Opportunities - Vicki
• Practitioner reports for all conditions,
  particularly asthma
• Provide member participation in interventions
• HEDIS measure (DRE) - most below the 50th ile
  or 25th ile
• Provide/Monitor results for non-HEDIS measures
• Low member identification for diabetes, CAD,
  asthma (18-56)
• CAD HEDIS (esp. LDL post event)
• Diabetes HEDIS (esp. DRE nephropathy lt25th
  ile, others low except LDL screening)
• Practitioner comparative reports not provided
• Stronger member reminder program
• Poor HEDIS performance but significant
  improvements noted in diabetes care no results
  in the 90th percentile. Most around the 25th.
• Consider HEDIS participation for PPO

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Behavioral Health
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BH Key Factors

• Strengths - Many
• Key Opportunities - Kathy
• At or below 25th ile for all other BH HEDIS
• Member support
• Practitioner support
• Consider practitioner reports for AOD
• HEDIS low AOD depression rates in 25th or 50th
  percentile (OAP membership not included in HEDIS)
• Develop programs for depression management and
  alcohol screening
• Monitor use of recommended screening tools
• Practitioner reporting
• Poor HEDIS performance in HMO (generally at or
  below 25th percentile consider monitoring for
  PPO)

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Discussion

• VBCH key strategies going forward
• To improve the purchasing process of employers
  and employees
• To improve the health system (health plans,
  hospitals and other providers
• To improve the health of the community
  (employees, consumers and public)

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Discussion

• Guy DAndrea

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Discussion

• VBCH VALUE-ADDED SERVICES that support our
  mission and objectives
• The Leapfrog Group
• 93 Hospitals Virginia-wide
• 1,000 hospitals nation-wide
• HowsYourHealth.org
• Hospital Report Cards
• HeartBIZ Risk Identification Reduction
• www.myVBCH.org consumer engagement
• Education (Summit/Roundtable/Series, etc)
• Wellness in the Workplace Awards

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Value Based Purchasing Discussion
Thank You!