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

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Presentation transcript:

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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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.

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | The Cost of Health Care

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | MHMC VBID Plan Design

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | MHMC VBID Plan Design 1 1

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | Green Services

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | Yellow Services- SDM

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | Red Services

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | MHMC VBID Plan Design 2 2

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | |

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | MHMC VBID Plan Design 3 3

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | MHMC VBID Plan Design 4 4

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | MHMC VBID Plan Design 5 5

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | Current Health Plan Rating Display Working to standardize VBID benefits Working to standardize provider value ratings Working to standardize administrative requirements

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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 State & Federal Others

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | 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

Maine Health Management Coalition | Maine Health Management Coalition-Foundation 11 Bowdoin Mill Island, Suite 260 | Topsham, ME | (207) | | How Can You Get Involved Contact: Robin Allen at or extension 244 with suggestions or to join a