VBBD Webinar Dec 2010


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Leveraging Value Based Benefit Design to Improve Adherence and Lower Costs

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VBBD Webinar Dec 2010

  1. 1. © 2010 SCIOinspire Corp.<br />Leveraging Value Based Benefit Design to Improve Adherence and Lower Costs While Improving Member Health<br />Part One<br />December 8, 2010<br />www.scioinspire.com<br />
  2. 2. | Presentation Agenda<br /><ul><li>Introduction and Panelists
  3. 3. Defining Value Based Benefit Design
  4. 4. VBBD Overview
  5. 5. Lessons from Early Adopters
  6. 6. Interactive Question and Answers Session</li></li></ul><li>Webinar, Panelists<br />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.<br />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.<br />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.<br />Moderator<br />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<br />
  7. 7. Defining Value Based Benefit Design (VBBD)<br />“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.”<br /> David Hom (President, Care Management Services, SCIOinspire Corp.)<br />
  8. 8. US Healthcare Market, Trends and Solutions<br />Health Insurer Trends<br />Healthcare Reform<br />Member & Provider Engagement<br />Care and Wellness Management Effectiveness<br />Payment Integrity<br />Legacy Cost Structures<br />OPPORTUNITY TO TRANSFORM<br />Solutions<br />Data/Analytics<br />Driven Transformation Solutions<br />Business Process/Cost Optimization<br />Payment IntegritySolutions<br />Care Analytics and Reporting<br />Member Engagement<br />Solutions<br /><ul><li>Recover from third parties and other payers
  9. 9. Reduce payment errors
  10. 10. Recover complex overpayments
  11. 11. Improve effectiveness of care programs and ROI
  12. 12. Improve Product Design
  13. 13. Leverage technology and media
  14. 14. Better value-based benefit designs tie incentives with behavior change
  15. 15. Data Integration
  16. 16. Global Delivery
  17. 17. Consulting</li></li></ul><li>Health Plan Adoption of Value Based Benefits<br />Key Milestones in the Adoption of Value Based Benefits<br />2007<br />2009<br />2008<br />2010+<br /><ul><li>Smaller regional plans adopted for their own associates
  18. 18. Began to productize for their book of business
  19. 19. Regional Health plan adoption for their own associates
  20. 20. Creating products for self insured and assessing for fully insured business
  21. 21. National health plans began product introductions
  22. 22. Products created for specific chronic conditions e.g., Diabetes
  23. 23. Trizetto announces software enhancements integrating VBBD features with claims payment</li></ul>Four Trends:<br /><ul><li>Linking incentives to activities, outcomes in the future
  24. 24. Evaluation Methodologies
  25. 25. Aligning to supply side (P4P, Tiered network)
  26. 26. Solution based sales
  27. 27. Greater supporting research</li></li></ul><li>Limited scope of Plan Design<br />Technology and Systems<br />Health Plan<br />Health Plan<br />Plan Design Challenges<br />Plan designs are focused on copayments rather than on engaging the member throughout the care continuum<br /><ul><li>Plan changes can result in negative ROI
  28. 28. Designs need to align with physician incentives
  29. 29. Designs should coordinate with care management programs (e.g., Health coaching and Disease Management)
  30. 30. Prioritization </li></ul>Technology and Systems<br /><ul><li>Plan designs often differ at the member level, posing problems for administrative systems geared to group-level administration
  31. 31. Systems updates take time and resources
  32. 32. VBBD needs to be integrated into all communications and outreach to the member
  33. 33. Need to integrate VBBD compliance goals with providers and other professionals</li></ul>VBBD compliance goals require more detailed Clinical and Financial Reporting<br />
  34. 34. Marcia Bondi<br />Director, New Product Implementation<br />Early adopter experience<br />Background<br />Internal Drivers of VBBD<br />Product Packages<br />Key Lessons and Conclusions<br />
  35. 35. Background<br />Highmark has offered Value-Based since 2007<br />Pitney-Bowes’ success prompted market entry<br />Focused on prescription drug – 8 conditions<br />Offered Rewards program since 2007<br />Employer funded rewards program focuses on all employees and rewards for engagement<br />Packages: health risk assessment, lifestyle improvement, preventive, condition management and online tools<br />
  36. 36. Internal Drivers of Value Based Benefit Design<br />Value Based Design<br /><ul><li>Cost effective rewards for healthy behavior through benefit design or premium contributions</li></li></ul><li>Value-Based Product – Packages<br />Lower cost-sharing on high value medical services & prescription drug<br />Integrate Condition Management<br />Protocol Compliance at member level<br />Feature to focus on high-risk<br />Broad Population<br />Targeted Patients<br />Encourage Engagement<br />Reward for Outcomes<br />Reward for Results<br />Worksite screenings<br />Informed Decision Making<br />Higher cost-sharing on low value services band not using Shared-Decision making<br />Risk Assessment<br />Complete Wellness Profile and Receive Preventive Care<br />
  37. 37. Implementation Lessons<br />Key Lessons and Conclusions<br />Key Conclusions<br />Analyze data to determine what your population needs<br />Savings must be built into the price for mass acceptance<br />Target the right customers to steer them to the right products <br />Communications need to be robust throughout the year supporting various media types and engaging based on health personality <br />Take time to design, build your product continuum and implement in phases<br />Ensure legacy systems are compatible<br />Establish evidence-based guidelines -takes time to define<br />Perform segmentation on your population to develop the right messaging<br />Ensure portal is friendly and engages, provides tools, is educational and provides benefit summary and status of protocols<br />
  38. 38. Barbara Christensen <br />Chief Sales and Marketing Officer<br />Early adopter experience<br />Background and Internal Drivers<br />Goals<br />Tiered Structure<br />Lessons<br />Conclusions<br />
  39. 39. Drivers<br />Internal Driver: The Health Leadership Task Force<br />Commissioned by the Portland business community in the summer 2008<br />Goal: Develop solutions and actions to keep health care costs and premium increases closer to the CPI<br />Sponsors: Major health systems and health plans<br />Build on Oregon Health Plan history of collaboration<br />
  40. 40. Value-Based Benefit Design Goals<br />Create a culture of health<br />Support, prevention, and health maintenance<br />Reduce financial barriers to the management of chronic care<br />Reduce the use of nationally-recognized (Wennberg/Fisher) care that, for a population, is driven by provider-preference or supply rather than medical evidence<br />Implement benefit design that encourages the most effective care with more appropriate incentives<br />Achieve a 10% reduction in premium relative to a comparable open option plan<br />Engage employers and employees in discussing plan design in a new way: drives innovation for early adopters<br />
  42. 42. Design Features: Tier 1 - Designed to better manage chronics<br />No deductibles & zero or minimal co-pays<br />Preventive health & wellness services<br />Screening exams<br />Routine immunizations<br />Nutritional counseling<br />Smoking deterrent medications<br />Chronic care management (Depression, CHF, CAD, Diabetes, COPD, Asthma)<br />Generic Drugs<br />Condition-specific labs/imaging/tests<br />Primary care office visits<br />PREFERENCE/SUPPLY SENSITIVE SERVICES<br />THE “USUAL” STUFF<br />DESIGNED TO BETTER MANAGE CHRONICS<br />
  43. 43. Design Features: Tier 2 - The “usual” stuff<br />Medical services subject to the standard deductibles/co-insurance/out-of-pocket maximums<br />Inpatient services<br />X-ray<br />Lab<br />Maternity services<br />DME<br />Outpatient surgery & services<br />Home health<br />PREFERENCE/SUPPLY SENSITIVE SERVICES<br />THE “USUAL” STUFF<br />DESIGNED TO BETTER MANAGE CHRONICS<br />
  44. 44. Design Features: Tier 3 - Preference/Supply sensitive services<br />Preference/Supply sensitive treatments (18.4% all expenses)<br />Separate deductible<br />Higher co-insurance<br />Separate out-of-pocket maximum<br />Preference/Supply sensitive treatments <br />Upper GI endoscopy X<br />Nuclear cardiology<br />Spine procedures for pain X<br />Knee replacement X<br />Knee Arthroscopy X<br />Hip replacement X<br />Shoulder surgery X<br />Hysterectomy<br />Emergency room Visits<br />Coronary stents and angioplasty<br />Coronary artery bypass surgery<br />High tech imaging (CT, PET, MRI) X<br />PREFERENCE/SUPPLY SENSITIVE SERVICES<br />Our Customer: 6000 members<br />X = Additional Cost Tier<br />$500 co-pay in addition to hospital & outpatient co-pays<br />Imaging $100<br />THE “USUAL” STUFF<br />DESIGNED TO BETTER MANAGE CHRONICS<br />
  45. 45. Implementation Lessons<br />Preference sensitive is lousy consumer language: customer used “additional cost tier”<br />For shelf product we have used “select value” and “value level 1,2,3”<br />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.<br />Claims payment depends on correct coding by providers<br />Decision tools important so consumer can learn treatment options<br />Health Risk Assessment useful in finding chronic care members early<br />We anticipate uptick in member appeals<br />Employer, member and provider education is key<br />Important to keep both tiers 1 and 3 to achieve price point<br />Important to keep nationally recognized list in tier 3<br />
  46. 46. Key Conclusions<br />Decision tools important: provider usage/endorsement best<br />Employers philosophically get it but prefer to not deal with noise and individual that needs a treatment category<br />Will not be mainstream soon<br />Great innovation discussion<br />
  47. 47. Interactive Q&A Session<br />Please use the messenger on your screen <br />to submit your questions<br />
  48. 48. © 2010 SCIOinspire Corp.<br />Contact Us<br />Annie Welsch<br />Email: marketing@scioinspire.com<br />SCIOinspire Corp. <br />220 Farmington Ave, Suite 4<br />Farmington, CT 06032<br />Phone: 1.412.278.5800<br />Fax: 1.412.278.5810<br />www.scioinspire.com<br />