Presentation is loading. Please wait.

Presentation is loading. Please wait.

Maine’s Value-Based Insurance Design -101 Nancy R. Morris Communication & Member Relations Director 3-18-15.

Published byAlexia Lucas Modified over 8 years ago

Similar presentations

Presentation on theme: "Maine’s Value-Based Insurance Design -101 Nancy R. Morris Communication & Member Relations Director 3-18-15."— Presentation transcript:

1 Maine’s Value-Based Insurance Design -101 Nancy R. Morris Communication & Member Relations Director 3-18-15

2 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Value Based Insurance Design Value-based insurance design (VBID) aims to increase health care quality and decrease costs by using financial incentives to promote high quality, cost efficient health care services and consumer choice.

3 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org 63% 25% 12% Preference- sensitive care Effective care Supply-sensitive care The Dartmouth Institute for Health Policy and Clinical Practice (Wennberg, Weinstein, Fisher, et al.) Not All Services Are Created Equal

4 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org CEO Summit Recommendation Message from clinicians to employers Develop and offer a benefit plan that supports evidence- based care and allows us to move to outcomes based performance

5 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org The Cost of Health Care

6 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org MHMC VBID Plan Design

7 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org MHMC VBID Plan Design 1 1

8 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Using EMR’s To Aid in Communication Slow Down and Review Options Clearing the Path to High ROI Service Use Stop and Look at the Evidence Before Proceeding Goal: Reduce Unnecessary Services $265 Billion IOM

9 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Green Services

10 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Yellow Services- SDM

11 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Red Services

12 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org MHMC VBID Plan Design 2 2

13 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Assuring High Quality Delivery PCMH’s are the hub. When necessary they refer to: Quality High Costs Low Effective & Efficient Ineffective & Inefficient Ineffective & Efficient Effective & Inefficient High Low Goal: Reduce high prices and inefficiently delivered services $155 Billion IOM

14 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org

15 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org MHMC VBID Plan Design 3 3

16 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Reimbursement is Based on Attaining Outcomes The entry point for all non-emergency care should be the PCMH Providers/ Patients/ Health Plans and Payors share in savings produced by the reduction in preventable admissions and improved health ACO’s Alternative Quality Contracts

17 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org MHMC VBID Plan Design 4 4

18 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Making the Patient Part of the Team Employ incentives and disincentives to produce healthy lifestyle choices and support management of chronic illness at the: Point of service Community level – Prevention and Wellness Trust Goal: Take advantage of missed preventive opportunities $55 Billon IOM

19 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org MHMC VBID Plan Design 5 5

20 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Administrative Simplification Identify areas of improvement through provider/member complaint logs and patient, provider, health plan, and advocate insights then simplify processes to reduce administration cost burden through process improvement Reduce across complexity through standardization across public and private payers through consistency where possible (claim billing, prior authorization) Adjust plan benefits so they encourage the desired behavior in all parties Goal: Reduce Excessive Administrative Costs $190 Billion IOM

21 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Current Health Plan Rating Display Working to standardize VBID benefits Working to standardize provider value ratings Working to standardize administrative requirements

22 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Why Work Together? The data is more robust Change is quicker and more coordinated We have data to serve as neutral arbitrator Standardization if the foundation of quality improvement –Operating rules –Quality measurement Together we are more attractive to other organizations –EMR vendors –Grantors –Government payors We have any opportunity to attract and maintain more primary care physicians We are better prepared for a crisis

23 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Community Effort Aetna Cigna Anthem Harvard Pilgrim Health Plan Maine Community Health Options Medical Mutual Geisinger MaineCare Health Plans/Payers Brokers Providers/Associates State & Federal Others

24 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Community Effort Health Plans/Payers Brokers Providers/Associates Cross Agency Holden Agency USI Aliant Acadia Benefits State & Federal Others

25 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Community Effort Health Plans/Payers Brokers Providers/Associates HealthReach Maine Optometric Association MaineHealth Maine General OMC Wellness St. Mary’s Spurwink MidCoast Health InterMed Maine Osteopathic Association State & Federal Others

26 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Community Effort Health Plans/Payers Brokers Providers/Associates Centers for Medicare & Medicaid Innovation Maine State Employee Health and Benefits Office Maine CDC Veteran’s Administration MEABT Maine BOI DHHS State & Federal Others

27 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Community Effort Health Plans/Payers Brokers Providers/Associates Lown Institute-MA IMD Foundation-MA City of Portland Maine Quality Counts Maine Areas on Aging Health Care Administrative Solutions, Inc.-MA Brian Atchison Milliman MedInsight – Waste Calculator-WA Athena www.TheNNT.com State & Federal Others

28 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org Community Effort Health Plans/Payers Brokers Providers/Associates Robert Wood Johnson Foundation-NJ Oregon State-OR Internal MHMC staff Neel Shah, Costs of Care- MA Integrated Health Association-CA Pacific Business Group on Health-CA AARP State & Federal Others Continued

29 Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME 04086 | (207) 899-1971 | www.mehmc.org | www.getbettermaine.org How Can You Get Involved http://www.youtube.com/watch?v=hO8MwBZl-Vc Contact: Robin Allen at rallen@mehmc.org or 207 844-8106 extension 244 with suggestions or to join a subcommitteerallen@mehmc.org

Download ppt "Maine’s Value-Based Insurance Design -101 Nancy R. Morris Communication & Member Relations Director 3-18-15."

Similar presentations

New America Forum April 12, 2010 New America Forum: A First Look at Implementing Health Reform The Delivery System Challenge State Implementation Issues.

New America Forum April 12, 2010 New America Forum: A First Look at Implementing Health Reform The Delivery System Challenge State Implementation Issues.
THE COMMONWEALTH FUND 1 Innovations in Primary Care: Whats In the Affordable Care Act? Melinda Abrams, MS The Commonwealth Fund www.commonwealthfund.org.

THE COMMONWEALTH FUND 1 Innovations in Primary Care: Whats In the Affordable Care Act? Melinda Abrams, MS The Commonwealth Fund
CBIA Health Connections an example of a successful exchange for 15+ years January 8, 2010.

CBIA Health Connections an example of a successful exchange for 15+ years January 8, 2010.
Mary D. Naylor, Ph.D., R.N. Marian S. Ware Professor in Gerontology University of Pennsylvania School of Nursing.

Mary D. Naylor, Ph.D., R.N. Marian S. Ware Professor in Gerontology University of Pennsylvania School of Nursing.
A Private Foundation Working Toward a High Performance Health System Gauging the Safety Net Medical Home Initiative's Impact on Primary Care Melinda Abrams,

A Private Foundation Working Toward a High Performance Health System Gauging the Safety Net Medical Home Initiative's Impact on Primary Care Melinda Abrams,
Update on Recent Health Reform Activities in Minnesota.

Update on Recent Health Reform Activities in Minnesota.
Quality Improvement: Lessons for Workers Compensation Quality of Care Linda Rudolph, MD, MPH Medi-Cal Managed Care Division CA Department of Health Services.

Quality Improvement: Lessons for Workers Compensation Quality of Care Linda Rudolph, MD, MPH Medi-Cal Managed Care Division CA Department of Health Services.
Alternatives to Cost Shifting: Managing Cost through Improving Plan Value A Presentation to Task Force on Employee Wellness And Consolidation of Agency.

Alternatives to Cost Shifting: Managing Cost through Improving Plan Value A Presentation to Task Force on Employee Wellness And Consolidation of Agency.
What is an Accountable Care Organization?

What is an Accountable Care Organization?
MEDICAL HOME 1/2009 Mary Goldman, D.O., President of MAOFP.

MEDICAL HOME 1/2009 Mary Goldman, D.O., President of MAOFP.
The Rhode Island Chronic Care Sustainability Initiative: Building a Patient-Centered Medical Home Pilot in Rhode Island.

The Rhode Island Chronic Care Sustainability Initiative: Building a Patient-Centered Medical Home Pilot in Rhode Island.
Advocating for Better Benefits In Oregon Wendy Bjornson, MPH OHSU Smoking Cessation Center.

Advocating for Better Benefits In Oregon Wendy Bjornson, MPH OHSU Smoking Cessation Center.
Aging Services in the 21 st Century, the Local Perspective Ken Genewick, Director Randy Hoak, Commissioner.

Aging Services in the 21 st Century, the Local Perspective Ken Genewick, Director Randy Hoak, Commissioner.
Shared Decision-making’s Place in Health Care Reform Peter V. Lee Executive Director National Health Care Policy, PBGH Co-Chair, Consumer-Purchaser Disclosure.

Shared Decision-making’s Place in Health Care Reform Peter V. Lee Executive Director National Health Care Policy, PBGH Co-Chair, Consumer-Purchaser Disclosure.
Marie Maes-Voreis RN MA Director, Health Care Homes.

Marie Maes-Voreis RN MA Director, Health Care Homes.
A Patient-Centered Approach with P.R.I.D.E.

A Patient-Centered Approach with P.R.I.D.E.
A Presentation of the Colorado Health Institute 303 E. 17 th Avenue, Suite 930 Denver, Colorado 80203 (Twitter)

A Presentation of the Colorado Health Institute 303 E. 17 th Avenue, Suite 930 Denver, Colorado (Twitter)
Nancy B. O’Connor Regional Administrator, CMS June 2, 2011

Nancy B. O’Connor Regional Administrator, CMS June 2, 2011
1 Quality of Health Care in the U.S.: How Good Is It & What Have We Learned About How to Improve It? Stephanie Teleki, Ph.D. Cheryl Damberg, Ph.D. Robert.

1 Quality of Health Care in the U.S.: How Good Is It & What Have We Learned About How to Improve It? Stephanie Teleki, Ph.D. Cheryl Damberg, Ph.D. Robert.
Aligning Incentives: Anthem’s Accountable Care Model  Anthem Quality In-sights ®  Patient Centered Primary Care John Syer RVP Provider Engagement and.

Aligning Incentives: Anthem’s Accountable Care Model  Anthem Quality In-sights ®  Patient Centered Primary Care John Syer RVP Provider Engagement and.

Similar presentations

Ads by Google