innovative strategies in transparency november 2006 nancy nankivil bennett director of strategic...
TRANSCRIPT
Innovative Strategies in Transparency
November 2006
Nancy Nankivil BennettDirector of Strategic Health Policy
WI Department of Employee Trust [email protected]
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.”
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
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
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.”
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
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
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)
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
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
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)
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
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
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
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.