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VBID 101 Nancy R. Morris Communication & Member Relations Director 10-15-14.

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Presentation on theme: "VBID 101 Nancy R. Morris Communication & Member Relations Director 10-15-14."— Presentation transcript:

1 VBID 101 Nancy R. Morris Communication & Member Relations Director 10-15-14

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 A form of benefit design that promotes the use of healthcare services that provide more “value” over those services that provide less

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.)

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 CEO group: Develop and offer a benefit plan that supports what you want us to do

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 Reduce the total cost of care per person per year in Maine to the national average; Improve the health of Maine’s population in at least four categories of disease prevalence (including diabetes, mental health, obesity, and tobacco use); Improve patient experience scores for targeted practices by 2% from the baseline 2012 survey; Increase the number of practices reporting patient experience information from 50% to 66% Maine’s SIM Goals

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 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 Providing Cost Information Too

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 Red Services

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 MHMC VBID Plan Design 2 2

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 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

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 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 Employ incentives and disincentives to produce healthy lifestyle choices and support management of chronic illness at the: workplace the community at large 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 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 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

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 Prefers safe providers

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 Encourages use of shared-decision making tools

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 Prefers providers with best patient survey results

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 Does not pay for preventable complications

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 The data is more robust 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

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 Aetna Cigna Anthem Harvard Pilgrim Health Plan Maine Community Health Options Medical Mutual Geisinger MaineCare Health Plans/Payers Brokers Providers/Associates State & Federal Others

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 Community Effort Health Plans/Payers Brokers Providers/Associates Cross Agency Holden Agency USI Aliant Acadia Benefits State & Federal Others

30 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

31 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

32 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

33 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

34 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

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