Transcript P5117 - Kansas City Collaborative Template

Value-based
Benefit Design
An Employer
Coalition Approach
William L. Bruning
President & CEO, Mid-America
Coalition on Health Care
KC2: A Truly Collaborative Model
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Top 10 Medical, Drug & Productivity Costs
-- per 1000/FTEs -Back/Neck Pain
Depression
Fatigue
Other Chronic Pain
Sleeping Problems
High Cholesterol
Arthritis
Hypertension
Medical
Drug
Absence
Presenteeism
Obesity
Anxiety
$200,000
$400,000
$600,000
Loeppke, R., Taitel, M., Richling, D., Parry, T., Kessler, R.C., Hymel, Pl., and Konicki, D. Health and productivity as a
business strategy J Occup Envrion Med. July 49(7):712-21, 2007
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Value-Based Benefit Design: Restructuring
Health Benefits
 VBBD is a strategy that minimizes or eliminates out-of-pocket
costs for high-value services in defined patient populations
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High-value services are identified through scientific evidence
The more clinically beneficial and cost-effective the therapy is
for a patient group, the lower the out-of-pocket costs
 Lowering out-of-pocket costs for high-value services has been
found to improve access to and use of those services
 More effective use of high-value services may positively impact
the health of the targeted population
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Preventable adverse health consequences reduced
Related high-cost health care services avoided
Chernew ME et al. Health Aff (Millwood). 2008;27:103-112; Fendrick AM et al. Am J Manag Care. 2001;7:861867;Fendrick AM, Chernew ME. Am J Manag Care. 2006;12 (special issue):SP5-SP10.
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Value-Based Benefits: Turning
Theory into Solutions
 Applicable in any company large enough to be focused on
benefits and plan design
 Not just for large employers, with big HR budgets,
sophisticated HR staffs, and a C-Suite that understands the
value of benefits
 Expensive data integrators are not mandatory
 Employers can make better use of their existing data
 Employers can partner more effectively with vendors
 Not just about “giving away benefits and drugs,” it’s about:
 Maximizing the value of your data to understand your
employees’ health risks and stratify your employee population
 Measuring what you’re already doing
 Messaging to employees and C-Suite on the impact of health
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17 Employers, 64,000 KC Employees;
463,000 Lives Firm Wide
Firm
Wide
Small to Mid-Size
Mid-Size to Large
Jumbo
# EEs
375 – 3,000
3,000 – 10,000
10,000+
H&R BLOCK
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VBB is not Just for Large Employers
 Of the 17 participating employers, 4 have fewer than 1,000
employees in KC, and 8 have fewer than 2,000 employees
 The median participating employer has 4,000 employees
firm wide
 The fundamental issue of understanding your data and
workforce risks is key for all employers
 The KC2 Tools are being tested for employers of all sizes
Trademarks on this page are the property of their respective owners
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Methods: Initial Survey and Employer
Interview
Excerpt from Initial Survey:
What Kansas City employers told us
•83% currently use data to assess
employee health risks
•61% believe they face more
challenges with internal data collection
than from outside vendors
•Top perceived barriers to
implementing VBB
•Employee Resistance
•Cost of interventions/utilization
•Biggest influencers in benefit design
•Cost / Trend
•Corporate culture and leadership
Source: KC2 Project Team
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Employers Have Asked For:
“What would make participating in this VBB coalition
meaningful and valuable to you?”
Working through issues of plan design
Examples of how others are getting and
using data to show outcomes
Better understanding of
the local community
ROI template
Best practices & case studies
Peer-to-peer review of
practical applications
Want to hear about absenteeism,
productivity and retention from other
employers
Education
Benchmarking
“Knowing how the private sector
measures their bottom line”
Idea generation
Idea sharing
Idea validation
“Toolkit or framework to evaluate a decision from a direct
cost impact, short term impact and long term impact”
Collaboration and workgroups
to share ideas
What works to get through stages of the data cycle
“A plan design that will lead to the best result”
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Process of Applying Value-Based Benefits
Start Here:
Measure and
evaluate
outcomes
ROI
Establish goals,
design and conduct
worksite interventions
Identify and collect
data
SUSTAINABLE
CHANGE
Integrate
data
that remove barriers to
healthy choices.
Use data to
classify
risks
eg. Chronic disease,
lifestyle, high dollar
claims
© 2007 Mid America Coalition on Health Care
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Methods: Data Map
Source: KC2 Project Team
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Methods: Employer Data Tracker (EDT)
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Demographics
Benefit Design
Health Risk Appraisals
Health Screenings
Disease/Case Management Interventions
On-Site Clinics
Employee Satisfaction
 Claims
– Medical/Pharmacy
– Short- and Long-Term Disability
– Workers’ Compensation
– FML
 Laboratory Tests
 Employee Assistance Program
 Productivity
– Absenteeism
Excerpt from EDT:
Baseline Time Period
From:
To:
00/00/00
00/00/00
Medical Claims
Metric
Value
Total Health Care Costs ($)
Total Number of Claimants (#)
Total Health Care Cost Per Claimant ($)
Total Health Care Cost Per Member Per Month (PMPM) ($)
Actual Annual Administrative Cost ($)
Distribution of Covered Lives by Cost (%)
$0 - $999
$1,000-$9,999
$10,000+
Total Number of Non-Users or "Non-Claimants" (#)
$0.00
0
$0.00
$0.00
$0.00
SD
Comments/Notes
0%
0%
0%
0
Source: KC2 Project Team
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Baseline Data Completeness
Minimum Data S et and A ll Data C ompletenes s (% R eporting )
n=12
92%
B enefit E nrollment
88%
88%
Medic al C laims
71%
86%
D emographic s
65%
80%
Health S c reening
40%
74%
Health R is k Apprais al
55%
64%
S T D C laims
46%
64%
E mployee As s is tanc e P rogram
49%
60%
R x C laims
42%
54%
D is eas e Mgmt P artic ipation
45%
42%
40%
W C C laims
38%
L T D C laims
47%
25%
F ML C laims
Abs enc e
Data Gaps
30%
11%
12%
Minimum D ata S et
A ll Metrics
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KC2 Intervention Model Overview
B
Business Goals
S
Objective B
E
L
Intervention Type
Objective A
I
N
Population Health
Goals
Intervention Type
Objective B
Specific Interventions
A
Objective A
Intervention Type
E
Evaluation
Return
Value ofon
Investment
Investment
Source: KC2 Project Team
Sustainable Change Cycle
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Identifying VBB Interventions
Definition:
Focus:
 Health Management Team
 Employer-specific
 Actionable Data
 Measurable
 Environment or Policy
 Evidence-based
 Insurance Benefit Design
 Optimizes outcomes
 Employee Engagement
 Vendor and Provider Value
Source: KC2 Project Team
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Business Goals and Objectives
 Make Health a Core Business Strategy
Health Management Team (HMT)
Incorporate Key Positions
Foster Health Champions
Create and Communicate Corporate Vision of Health
Actionable Data
Increase Access to Data
Align Data Definitions Across Internal and External Sources
Integrate Sources to Create More Actionable Data
Further Develop Data Capabilities
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Population Health Goals and Objectives
 Improve Health Status by Reducing Cardiometabolic Risks
Environment and Policy
Subsidize Healthy Food Options in Cafeteria and Vending Machines
Implement Smoke-Free Worksite Policy
Require Input of Biometric Data on HRA for Credit
Insurance Benefit Design
Waived Co-Pay for Preventive Screenings or Target Drugs
Covered Benefits for Health Coaching for Target Conditions
Employer FSA Contribution as Incentive for Engagement
Employee Engagement
Increase Participation through Incentives
Increase Employee Satisfaction
Implement Weight Management Intervention
Vendor & Provider Value
Work with Partners to Identify Employees/ Dependents with Targeted Risk Factors
Work with Partners to Develop Communication Plans
Work with Partners to Standardize Measures
Abbreviation: FSA: Flexible Spending Account
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Frame Evaluation and Identify Measures
Inputs
What We Invest
Capital
Outputs
What We Do, Who We Reach
Processes
 Financial
 Enrollment
 Human
 Participation
 Mental
 Frequency of contact
 Physical
 Service utilization
 Organizational
Outcomes
What Results
Short-Term, Mid-Term, Long-Term
 Employee
 Health Behavior  Engagement
 Health Status
 Tenure
 Growth and Performance
 Business
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Presenteeism
Productivity
Overtime
Absenteeism
Replacement
Wages
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Retention
Recruitment
Spend
Trend
ROI
Source: KC2 Project Team
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Evaluation: Establishing the Business Case
Measuring Operations
Measuring Program Effectiveness
Is intervention reaching target population?
Is it being implemented in the ways specified?
Is intervention effective?
What’s the connection?
Engagement  health outcomes
Health outcomes  productivity
Mid-Term
Health
Outcomes
Near-Term
Operational
Results
Long-Term
Measuring Costs
Financial
Outcomes
What’s the cost of doing nothing?*
What’s the cost of intervening?
* Edington, D. Zero Trends: Health as a Serious Economic Strategy. Health Management Research Center, University of Michigan. Ann Arbor, MI. 2009.
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Value of Investment (VOI)*
Corporate Viability
Profitability
Growth
Opportunity
Sustainability
Success Builds Success
Mid-Term
Corporate Culture of Health
Support for Future Initiatives
Health
Outcomes
Near-Term
Operational
Results
VOI
Long-Term
Financial
Outcomes
* Source: American Hospital Association
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Key Questions Shape Evaluation Planning
What does “demonstrating value” mean in your organization?
What do you need to know about your interventions to determine if:
You reached the right people?
Programs were well-implemented?
Healthy stayed healthy, those at-risk lowered their risks?
Health outcomes improved?
Costs were better managed?
What’s important to your senior leadership to engage them in continuing
to make health a core business strategy?
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Sharing a Successful Approach
Under Construction
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Spreading The Word About Value-Based Benefits
 Presentations and Public Relations
 Local and National Association Meetings
 Using the media to tell the story
 Employer Guide, including:
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Tools and Modules used
Employer case studies
Lessons learned
Resources available to employers
 Replication
 National Business Coalition on Health (NBCH)
 Pfizer Inc.
 Online presence
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Questions?
William L. Bruning
Mid-America Coalition on Health
Care
[email protected]
www.machc.org
© 2009 Kansas City Collaborative All rights reserved. PHF01265L