Leveraging Health: Linking HPM to VBD

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Presented by Cyndy Nayer at the Detroit Regional Chamber 2010 Health Care Forum

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Leveraging Health: Linking HPM to VBD

  1. 1. Cyndy Nayer<br />Co-founder and CEO<br />Leveraging Health: <br />Linking HPM to VBD<br />
  2. 2. Disclosure<br />Nayer is on the speakers’ bureau for Merck<br />Nayer consults for Merck, Novo Nordisk, GSK, and several emerging health plans<br />April-May 2010<br />©VBHEALTH.ORG<br />
  3. 3. New Board of Directors<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />
  4. 4. Our Mission<br />Our mission is to drive the value of every dollar invested in health<br />Our goal is to identify and link innovators and innovation that broaden the boundaries of health value<br />Our work is focused on defining value, creating relevance to shareholders and stakeholders, and improving the health and economic viability of communities.<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />4<br />
  5. 5. Center publishes the first book on levers of VBD; white papers, evidence<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />Also publishes evidence on sectors, innovation, outcomes www.vbhealth.org<br />5<br />
  6. 6. Just released<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />6<br />
  7. 7. Peer-Reviewed Calls to Action:Outcomes-Based Contracting<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />7<br />
  8. 8. The Value of Health is Our Economic SurvivabilityOur agenda must be: How much health is that dollar delivering?<br />VBD is an ENGAGEMENT TOOL that engages the EMPLOYEE (consumer) and the EMPLOYER (plan sponsor) and the PROVIDER<br />VBD focuses on OUTCOMES<br />VBD has remarkably changed and matured<br />Data Design Delivery DIVIDENDS<br />VBD is driven by data that drives the suite of performance tuners: LEVERS<br />VBD can be tracked along the Health Value Continuum©<br />VBD is sustainable and applicable at the small-large employer AND at the community level<br />VBD builds the Health-Wealth-Performance Portfolio©<br />Nov 09<br />©VBHEALTH.ORG<br />8<br />
  9. 9. What Changed?<br />Distress x Vision x First Steps > Resistance<br />April-May 2010<br />©VBHEALTH.ORG<br />9<br />
  10. 10. Evolution of the Health Value Continuum© 2007<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />10<br />
  11. 11. September 6, 2009<br />April-May 2010<br />©VBHEALTH.ORG<br />11<br />
  12. 12. Pew Benchmarks States’ Financial Positions v CA<br />http://www.pewcenteronthestates.org/report_detail.aspx?id=56044 accessed 11.15.09<br />Changes based on budget gap, unemployment and foreclosures<br />
  13. 13. The Economy Affects Health Behaviors<br />26% have had problems paying medical/health bills<br />6 out of 10 have skipped recommended treatment, exams, etc.<br />1 out 5 workers is uninsured<br />Pressure at public level is increased<br />NOV 09<br />©VBHEALTH.ORG<br />13<br />Compliance, Adherence and Persistence Is at Risk<br />
  14. 14. What Changed?HPM defined VALUE andVALUE-BASED DESIGNS accelerated momentum <br />April-May 2010<br />©VBHEALTH.ORG<br />14<br />
  15. 15. Objective: Understand the experience of companies with value-based designs in place for 2 or more years<br />Over 100 companies responded<br />Represent over 1 million employees<br />Jumbo to small, public/private, non-profit and governments-as-employers<br />Levers cover all 3 domains<br />87% Use levers in prevention and wellness<br />60% Use levers for chronic care management<br />26% Use levers for guidance to appropriate care delivery<br />54% use levers for Depression management<br />NOTE: some numbers may not add up to 100: this could be due to rounding errors or because companies were allowed to choose more than one response<br />Center contracts with Buck consultants to verify our work<br />April-May 2010<br />©VBHEALTH.ORG<br />
  16. 16. What We Now Know…<br />No VBD succeeds without a primary focus on prevention and wellness<br />All successful adoptions and accelerations of VBD are linked to the level/timing of communications<br />And no one succeeds when only communicating 1 time per year<br />Acceleration occurs when aligned incentives drive outcomes<br />This includes patient-centered coordinated care<br />This includes use of community-based assets<br />This includes communication no less than quarterly to keep stickiness of behavior change across all stakeholders<br />Sustainable and measurable value occurs across silos, into the community (when providers achieve improvement in health and financial outcomes) and into families<br />April-May 2010<br />©VBHEALTH.ORG<br />16<br />
  17. 17. If Value Is Built on Outcomes, then Purchasing Must Be Built on Outcomes for Alignment<br />Outcomes can be measured by determinants<br />Clinical<br />Financial<br />Operational (Process)<br />Community<br />Outcomes-Based Contracting must align incentives between or across the signers of the contract<br />Health Plan/Plan Sponsor<br />Manufacturer/Service Organization<br />April-May 2010<br />©VBHEALTH.ORG<br />17<br />
  18. 18. VBD Are Economically Sustainable…<br />April-May 2010<br />©VBHEALTH.ORG<br />18<br />79% said no changes were made in 2009-2010 due to economic downturn<br />
  19. 19. …VBD Are Economically Sustainable<br />April-May 2010<br />©VBHEALTH.ORG<br />19<br />56% said no changes due to the economic downturn were anticipated for the next plan year<br />
  20. 20. What Could They Have Done Better?Better Employee Communication and Communication with the Physicians/Pharmacists/Clinicians for Aligned Messaging<br />April-May 2010<br />©VBHEALTH.ORG<br />20<br />
  21. 21. Where are we now?<br />Levers Accelerate Adoption, Integration, Efficiency and Outcomes<br />April-May 2010<br />©VBHEALTH.ORG<br />21<br />
  22. 22. Fundamentals of Value-Based DesignValue-based design is an ENGAGEMENT TOOL for the CONSUMER AND PLAN SPONSOR AND PROVIDER<br />April-May 2010<br />©VBHEALTH.ORG<br />22<br />VBD is focused on OUTCOMES<br />April 2008<br />
  23. 23. Decision Matrix Follows the Health Value Continuum examples of levers<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />23<br />
  24. 24. Application Value-Based Design: Modeled Savings with Applied Data<br />April-May 2010<br />©VBHEALTH.ORG<br />24<br />Adherence will drive value through productivity gains, <br />reduced financial trend <br />Modeled with IBI<br />
  25. 25. Value-Based Design Is Sustainable When It’s Mapped to Productivity<br />Example: Back Pain<br />20% loss in productivity in high risk group<br />Waster Reduction Lever: mandatory fitness/rehab<br />Chronic Care Lever: EAP/Behavioral health coach<br />Care Delivery Lever: Physical Therapy<br />Example: Smoking <br />9% loss in productivity in high risk group<br />Waste Reduction Lever: mandatory cessation classes<br />Chronic Care Lever: reduction in Txcopays<br />Care Delivery Lever: Weekly IVR/ phone calls with counselor<br />April-May 2010<br />©VBHEALTH.ORG<br />25<br />
  26. 26. Data, Design, Delivery, Dividends<br />Update on Our Work<br />April-May 2010<br />©VBHEALTH.ORG<br />26<br />
  27. 27. Behavioral Change Has Emerged as the Key to Improving Health Status <br />
  28. 28. Mercer 2009 Recession and Reform Survey<br />80 percent will increase employee communication/ education aimed at reducing cost or improving health<br />45 percent will implement programs to improve treatment and medication compliance<br />29 percent will introduce contribution-based incentives<br />21 percent will implement consumer-directed health plans<br />
  29. 29. Alignment: If Value Is Built on Outcomes, then Purchasing Must Be Built on Outcomes<br />Outcomes can be measured by determinants<br />Health (clinical)<br />Wealth (financial)<br />Performance (operational)<br />Outcomes-Based Contracting must align incentives between or across the signers of the contract<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />29<br />
  30. 30. Alignment: If Value Is Built on Outcomes, then Purchasing Must Be Built on Outcomes<br />Outcomes can be measured by determinants<br />Health (clinical)<br />Wealth (financial)<br />Performance (operational)<br />Outcomes-Based Contracting must align incentives between or across the signers of the contract<br />Jan-Feb 2010<br />©VBHEALTH.ORG<br />30<br />
  31. 31. Innovator DNA<br />Innovators embrace a mission for change.<br />Make mistakes<br />Take risks<br />Display courage<br />Transform ideas into powerful impact<br />Provide to the general community in order to change the ecosystem<br />HBR Vol 87 #12, Dec 2009<br />
  32. 32. Jack Mahoney MDCyndy Nayer<br />www.vbhealth.org<br />info@vbhealth.org<br />April-May 2010<br />©VBHEALTH.ORG<br />32<br />

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