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Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds [email protected]

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Page 1: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

Innovative Strategies in Transparency

November 2006

Nancy Nankivil BennettDirector of Strategic Health Policy

WI Department of Employee Trust [email protected]

Page 2: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

Presentation Objectives

To convey activities and results from the Wisconsin Transparency push

To stimulate thinking and action on Transparency Innovation

To disprove playwright, Jean Kerr’s words:“If you can keep your head about you when all about you are losing theirs, it’s possible you just haven’t grasped the situation.”

Page 3: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

ETF as a Significant Healthcare Purchaser

ETF Statistics More than 250,000 insured lives in group

health program; over 526,000 members in WI Retirement System

9th largest public pension fund in United States; 23rd largest in world

Total assets currently valued at $77 billion

Annual health care expenditures of $800 million

Secretary is non-partisan & appointed by Board

ETF Mission Develop and deliver quality benefits and services to our customers while safeguarding the integrity of the Trust

Page 4: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

ETF Value-based Purchasing Principles

“Getting best healthcare for best price” Leverage group purchasing power to implement

common quality & patient safety standards Gain transparency (disclosure) of comparative

information at health plan/provider level Reward superior value through Pay for

Performance contracting with Plans/Providers Engage consumers to make more informed

decisions regarding their health care

Page 5: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

What is Being Said About Transparency?

“Transparency in health care means public reporting. The most important way to improve the state of our health is in aligning our quality and cost containment agendas. We need to identify quality providers and drive market share to them.”

“Purchasers of health care need to have this kind of data so they can make apple to apple comparison on price and quality with respect to all providers in our health care marketplace. Then we will have real transparency and real competition in our health care system.”

“Informed consumers, given adequate cost, safety and quality information, and a financial stake in their purchasing decisions, will prove to be an effective driver of quality improvement and cost containment if our health care system.”

Page 6: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

ETF’s Push toward Redefining Value

Began in 2002 with Group Insurance Board Charge focused on value-based purchasing tenets

In 2003 became active in National and State Initiatives like Leapfrog, WI CheckPoint, WI Collaborative, WI Healthcare Purchasers for Quality & IFEBP

2004 Plan Year implemented Tiered Premium Contribution, Rx Partnership and Consumer Engagement Strategy

2005 Plan Year implemented Quality Composite System 2006 public-private collaboration passed legislation

supporting WI Health Information Organization 2007 retaining “Medical Director” role in agency

Page 7: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

Health Plan Tiering Methodology

Health Plan data analyzed by utilization areas (inpatient, outpatient, Rx, etc) and based on Uniform Benefits

Data risk adjusted for age/sex differences, geographical cost variances, high-cost claims & Rx utilization

Premium contribution levels established through “Break-points” (three tiers)

Plans received premium incentive based on Quality Composite System ranking

Page 8: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

Quality Composite System

Health plans compared on overall HEDIS and CAHPS (HCAHPS in future) performance

Specific weight given in 5 areas:• Disease Management (Diabetes, Asthma)• Preventive Care/Wellness (cancer screenings,

tobacco cessation)• Technology/Automation (CPOE, diabetic

registry, eHealth)• Patient Safety (NQF Safety Measures)• Customer Service (billing, grievances)

Page 9: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

Pharmacy Carve-out Program

Centralized administration of three level co-payment benefit structure based on formulary adherence--drive market share to rebated Rx

State-wide P&T committee determines formulary through evidence-based decisions “Quality trumps Cost”--Secretary Stanchfield

All (100%) savings achieved through program passed back to purchaser

All PBM records open for purchaser audit , including retail and manufacturer contracts

Page 10: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

It’s Your Choice BookletIt’s Your Benefit Newsletter

Comparative reporting on cost, quality and patient safety across plans using HEDIS & CAHPS/QCS results

Comparative reporting on specific plan features supporting improved patient care/outcomes

Use of Quality designation for plan hospitals; co-pay differential for quality-future consideration

Promotion of web-based resources for ambulatory quality and safety information at system level only

Page 11: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

Transparency PushReturn on Investment

2005 plan year premium increase at 4.9%; 2006 plan year premium increase at 9.8%; 2007 plan year premium increase at 7.4%

Medicare premiums declined in plan years 2005 & 2006 and again in 2007

Enrollment shifts continue to occur based on cost, quality, and patient safety information

Continued legislative support in budget for value-based purchasing initiatives ($300k in 2005-07; BadgerRx Gold, addition of MD, WHIO)

Page 12: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

WI Health Information OrganizationA Statewide Data Warehouse

Non-profit consortium (501C3) of health care payers, purchasers and providers formed in 2005

State appointed to BOD in 2006 with passing of “Transparency Bill”

Finalizing Vendor Selection Process; January 2007 anticipated contract start date

Initial data-medical and pharmacy claims, physician identifiers and patient demographics; clinical quality data will be merged in 2008

Episode of Care reporting for Cost Efficiency reporting

Page 13: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

Other Wisconsin Transparency Initiatives

WI Collaborative for Health Care Quality WI Hospital Assoc Checkpoint/Pricepoint

• both at wisconsinhealthreports.com Governor’s eHealth Board

• ehealthboard.dhfs.wisconsin.gov Pharmacy Society of WI

• new initiative to be piloted in 07• Pharmacy-based Pay for Quality program

Alignment is key issue for these initiatives

Page 14: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

State Role in Health Care Transparency

Support voluntary, market-based health care solutions/initiatives vs legislated/mandated

Convene and participate in public/private Collaboration around value-based purchasing

Push for efforts that achieve continued transparency of health care information

Lead by example with well defined, credible Benefit Plan Designs that strategically integrate Pay for Quality programs

Use “Bully Pulpit”, especially to align emerging initiatives for effective Public Policy purposes

Page 15: Innovative Strategies in Transparency November 2006 Nancy Nankivil Bennett Director of Strategic Health Policy WI Department of Employee Trust Funds nancy.nankivilbennett@etf.state.wi.us

Conclusion

Conveyed activities and results from the Wisconsin Transparency push

Stimulated thinking and action on Transparency Innovation

Disproved playwright, Jean Kerr’s words:“If you can keep your head about you when all about you are losing theirs, it’s possible you just

Thank you for your attention and interest.