VBBD Webinar Dec 2010
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VBBD Webinar Dec 2010

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Leveraging Value Based Benefit Design to Improve Adherence and Lower Costs

Leveraging Value Based Benefit Design to Improve Adherence and Lower Costs

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VBBD Webinar Dec 2010 VBBD Webinar Dec 2010 Presentation Transcript

  • © 2010 SCIOinspire Corp.
    Leveraging Value Based Benefit Design to Improve Adherence and Lower Costs While Improving Member Health
    Part One
    December 8, 2010
    www.scioinspire.com
  • | Presentation Agenda
    • Introduction and Panelists
    • Defining Value Based Benefit Design
    • VBBD Overview
    • Lessons from Early Adopters
    • Interactive Question and Answers Session
  • Webinar, Panelists
    Barbara Christensen is Chief Sales and Marketing Officer for Providence Health Plans, has more than 30 years of experience in the health insurance industry. Prior to joining Providence Health Plan, she was with Kaiser Permanente. Her current duties include management of statewide sales, marketing and product development for Providence Health Plan’s commercial, individual and Medicare programs.
    Marcia Bondi is Director of New Product Implementation at Highmark Blue Cross Blue Shield in Pittsburgh. For the last two years, Marcia has spearheaded the design and implementation of Highmark’s forward-thinking Value-Based design program. In June 2010, Marcia was invited and presented Highmark’s approach to Value-Based design at the prestigious AHIP conference. Prior to joining the Product Development department, Marcia spent 16 years in Highmark’s Underwriting department and oversaw the group renewals and quotes of small, middle and large employers.
    David Hom is an internationally-recognized expert in the field of Value-based Benefits and Employee Wellness. He joined SCIOinspire after more than 25 years with Pitney-Bowes Corporation, where he was responsible for introducing their leading-edge programs in value-based wellness, responsible for reducing medical trend to half of the industry average over a number of years.
    Moderator
    Bart Bracken is a healthcare executive with more than 20 years of experience in the healthcare and disability industries as a consultant and serving in senior leadership positions with large managed care organizations and specialty entrepreneurial companies. His broad experience includes managed care operations, strategic planning, marketing, business development, product development, and program management with both private and public sector programs. He has a Master in Industrial and Labor Relations from Cornell University and a BA, magna cum laude, in Economics from St. Lawrence University
  • Defining Value Based Benefit Design (VBBD)
    “VBBD is using plan designs and incentives to drive member engagement for high value services which can improve adherence leading to improved health status and longer term medical savings. VBBD will also identify low value services and create the right disincentives to use those services which can be adjusted based on the clinical severity.”
    David Hom (President, Care Management Services, SCIOinspire Corp.)
  • US Healthcare Market, Trends and Solutions
    Health Insurer Trends
    Healthcare Reform
    Member & Provider Engagement
    Care and Wellness Management Effectiveness
    Payment Integrity
    Legacy Cost Structures
    OPPORTUNITY TO TRANSFORM
    Solutions
    Data/Analytics
    Driven Transformation Solutions
    Business Process/Cost Optimization
    Payment IntegritySolutions
    Care Analytics and Reporting
    Member Engagement
    Solutions
    • Recover from third parties and other payers
    • Reduce payment errors
    • Recover complex overpayments
    • Improve effectiveness of care programs and ROI
    • Improve Product Design
    • Leverage technology and media
    • Better value-based benefit designs tie incentives with behavior change
    • Data Integration
    • Global Delivery
    • Consulting
  • Health Plan Adoption of Value Based Benefits
    Key Milestones in the Adoption of Value Based Benefits
    2007
    2009
    2008
    2010+
    • Smaller regional plans adopted for their own associates
    • Began to productize for their book of business
    • Regional Health plan adoption for their own associates
    • Creating products for self insured and assessing for fully insured business
    • National health plans began product introductions
    • Products created for specific chronic conditions e.g., Diabetes
    • Trizetto announces software enhancements integrating VBBD features with claims payment
    Four Trends:
    • Linking incentives to activities, outcomes in the future
    • Evaluation Methodologies
    • Aligning to supply side (P4P, Tiered network)
    • Solution based sales
    • Greater supporting research
  • Limited scope of Plan Design
    Technology and Systems
    Health Plan
    Health Plan
    Plan Design Challenges
    Plan designs are focused on copayments rather than on engaging the member throughout the care continuum
    • Plan changes can result in negative ROI
    • Designs need to align with physician incentives
    • Designs should coordinate with care management programs (e.g., Health coaching and Disease Management)
    • Prioritization
    Technology and Systems
    • Plan designs often differ at the member level, posing problems for administrative systems geared to group-level administration
    • Systems updates take time and resources
    • VBBD needs to be integrated into all communications and outreach to the member
    • Need to integrate VBBD compliance goals with providers and other professionals
    VBBD compliance goals require more detailed Clinical and Financial Reporting
  • Marcia Bondi
    Director, New Product Implementation
    Early adopter experience
    Background
    Internal Drivers of VBBD
    Product Packages
    Key Lessons and Conclusions
  • Background
    Highmark has offered Value-Based since 2007
    Pitney-Bowes’ success prompted market entry
    Focused on prescription drug – 8 conditions
    Offered Rewards program since 2007
    Employer funded rewards program focuses on all employees and rewards for engagement
    Packages: health risk assessment, lifestyle improvement, preventive, condition management and online tools
  • Internal Drivers of Value Based Benefit Design
    Value Based Design
    • Cost effective rewards for healthy behavior through benefit design or premium contributions
  • Value-Based Product – Packages
    Lower cost-sharing on high value medical services & prescription drug
    Integrate Condition Management
    Protocol Compliance at member level
    Feature to focus on high-risk
    Broad Population
    Targeted Patients
    Encourage Engagement
    Reward for Outcomes
    Reward for Results
    Worksite screenings
    Informed Decision Making
    Higher cost-sharing on low value services band not using Shared-Decision making
    Risk Assessment
    Complete Wellness Profile and Receive Preventive Care
  • Implementation Lessons
    Key Lessons and Conclusions
    Key Conclusions
    Analyze data to determine what your population needs
    Savings must be built into the price for mass acceptance
    Target the right customers to steer them to the right products
    Communications need to be robust throughout the year supporting various media types and engaging based on health personality
    Take time to design, build your product continuum and implement in phases
    Ensure legacy systems are compatible
    Establish evidence-based guidelines -takes time to define
    Perform segmentation on your population to develop the right messaging
    Ensure portal is friendly and engages, provides tools, is educational and provides benefit summary and status of protocols
  • Barbara Christensen
    Chief Sales and Marketing Officer
    Early adopter experience
    Background and Internal Drivers
    Goals
    Tiered Structure
    Lessons
    Conclusions
  • Drivers
    Internal Driver: The Health Leadership Task Force
    Commissioned by the Portland business community in the summer 2008
    Goal: Develop solutions and actions to keep health care costs and premium increases closer to the CPI
    Sponsors: Major health systems and health plans
    Build on Oregon Health Plan history of collaboration
  • Value-Based Benefit Design Goals
    Create a culture of health
    Support, prevention, and health maintenance
    Reduce financial barriers to the management of chronic care
    Reduce the use of nationally-recognized (Wennberg/Fisher) care that, for a population, is driven by provider-preference or supply rather than medical evidence
    Implement benefit design that encourages the most effective care with more appropriate incentives
    Achieve a 10% reduction in premium relative to a comparable open option plan
    Engage employers and employees in discussing plan design in a new way: drives innovation for early adopters
  • Design Features: Three Tiers
    PREFERENCE/SUPPLY SENSITIVE SERVICES
    THE “USUAL” STUFF
    DESIGNED TO BETTER MANAGE CHRONICS
  • Design Features: Tier 1 - Designed to better manage chronics
    No deductibles & zero or minimal co-pays
    Preventive health & wellness services
    Screening exams
    Routine immunizations
    Nutritional counseling
    Smoking deterrent medications
    Chronic care management (Depression, CHF, CAD, Diabetes, COPD, Asthma)
    Generic Drugs
    Condition-specific labs/imaging/tests
    Primary care office visits
    PREFERENCE/SUPPLY SENSITIVE SERVICES
    THE “USUAL” STUFF
    DESIGNED TO BETTER MANAGE CHRONICS
  • Design Features: Tier 2 - The “usual” stuff
    Medical services subject to the standard deductibles/co-insurance/out-of-pocket maximums
    Inpatient services
    X-ray
    Lab
    Maternity services
    DME
    Outpatient surgery & services
    Home health
    PREFERENCE/SUPPLY SENSITIVE SERVICES
    THE “USUAL” STUFF
    DESIGNED TO BETTER MANAGE CHRONICS
  • Design Features: Tier 3 - Preference/Supply sensitive services
    Preference/Supply sensitive treatments (18.4% all expenses)
    Separate deductible
    Higher co-insurance
    Separate out-of-pocket maximum
    Preference/Supply sensitive treatments
    Upper GI endoscopy X
    Nuclear cardiology
    Spine procedures for pain X
    Knee replacement X
    Knee Arthroscopy X
    Hip replacement X
    Shoulder surgery X
    Hysterectomy
    Emergency room Visits
    Coronary stents and angioplasty
    Coronary artery bypass surgery
    High tech imaging (CT, PET, MRI) X
    PREFERENCE/SUPPLY SENSITIVE SERVICES
    Our Customer: 6000 members
    X = Additional Cost Tier
    $500 co-pay in addition to hospital & outpatient co-pays
    Imaging $100
    THE “USUAL” STUFF
    DESIGNED TO BETTER MANAGE CHRONICS
  • Implementation Lessons
    Preference sensitive is lousy consumer language: customer used “additional cost tier”
    For shelf product we have used “select value” and “value level 1,2,3”
    Allow customer to pick among treatment categories but no exception on how the category is defined by codes. No exception panel if someone really needs the treatment in a category.
    Claims payment depends on correct coding by providers
    Decision tools important so consumer can learn treatment options
    Health Risk Assessment useful in finding chronic care members early
    We anticipate uptick in member appeals
    Employer, member and provider education is key
    Important to keep both tiers 1 and 3 to achieve price point
    Important to keep nationally recognized list in tier 3
  • Key Conclusions
    Decision tools important: provider usage/endorsement best
    Employers philosophically get it but prefer to not deal with noise and individual that needs a treatment category
    Will not be mainstream soon
    Great innovation discussion
  • Interactive Q&A Session
    Please use the messenger on your screen
    to submit your questions
  • © 2010 SCIOinspire Corp.
    Contact Us
    Annie Welsch
    Email: marketing@scioinspire.com
    SCIOinspire Corp.
    220 Farmington Ave, Suite 4
    Farmington, CT 06032
    Phone: 1.412.278.5800
    Fax: 1.412.278.5810
    www.scioinspire.com