20150415 plg slides
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Purchaser Learning GroupApril 2015
www.hcgc.org
… catalyzing the spread of healthcare best practices
CO-LEARNING DISCUSSION
www.hcgc.org
What is Price Transparency?• Price = an estimate of a consumer’s complete health care
cost on a health care service that reflects:• Negotiated discounts• Inclusive of all costs to the consumer associated with
a service• Identifies consumers out-of-pocket costs• Includes information that helps define the value of
those services• Enables patients and other care purchasers to
identify, compare and choose providers that offer the desired level of value
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Best Practice Features• Easy to use• Allow consumers to
understand their share of cost, total cost and spending and utilization to date
• Show quality measures• Side-by-side comparison of
price and quality easily• Help consumers identify
and understand value• Encourage consumer to use
the tool
• Contain info on Rx and ancillary services
• Help consumers avoid unneeded care and find less expensive options
• Easily customized and easily integrated with other platforms and products
• Give employers reports on utilization and savings and involves them in continuous quality improvement activities
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges
1. Incomplete definitions of medical episodes and small number of episodes and or procedures
2. Ignoring whether providers deliver needed versus unneeded care
3. Creating price estimates from a small number of cases
4. Not accounting for rate increases5. Not using carefully chosen visuals that are easy to
understand and accurately interpret
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
1. Incomplete definitions of medical episodes and small number of episodes and or procedures
Solution:• Have well constructed episodes of care • Help consumer distinguish between typical services
and those associated with avoidable complications• Show estimate of average price of complications for
long duration episodes• Provide consumers with complimentary quality
information, especially outcomes where available
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
What challenges and opportunities exist to implement the suggested solutions?
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
2. Ignoring whether providers deliver needed versus unneeded careSolution:• Take steps to education consumers about
needed/recommended care • Create standard episode price based on
recommended care and compare that standard to providers actual price
• Help consumers identify potentially unneeded care
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
What challenges and opportunities exist to implement the suggested solutions?
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
3. Creating price estimates from a small number of casesSolution:• Don’t show price estimates when sample size is small• Include confidence intervals with the price estimate
that make sense to a consumer• Disclose to consumer which provider’s price
information is blocked due to contractual restrictions
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
What challenges and opportunities exist to implement the suggested solutions?
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
4. Not accounting for rate increases
Solution:• Ensure published prices are adjusted to reflect most
recent negotiated fees or indicate the year for which the price was calculated
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
What challenges and opportunities exist to implement the suggested solutions?
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
5. Not using carefully chosen visuals that are easy to understand and accurately interpret
Solution:• Experiment with most effective means of
communicating price info to various audiences
CO-LEARNING DISCUSSION
www.hcgc.org
Price Transparency Tool Challenges and Solutions
What challenges and opportunities exist to implement the suggested solutions?
About HCCI
HCCI is a non-profit, independent, non-partisan research institute dedicated to creating the United States’ most comprehensive source of information on health care activity and promoting research on the drivers of health care costs and utilization. Founded in 2011
•Public mission - improving US health system by creating comprehensive data infrastructure and analytics •Research - We currently hold claims, with allowed amounts, for more than 50 million Americans, from 2007 onward which we make available for academic, non-commercial research•Support from Aetna, Assurant Health, Humana, Kaiser Permanente, UnitedHealthcare. Foundation support/contracts with Robert Wood Johnson, Pew, Commonwealth Fund, John and Laura Arnold Foundation
Current and Future HCCI Data
• Administrative Claims– employer-sponsored insurance– individual insurance; – Medicare Advantage (Part C)
• All 50 states and D.C.• Updated annually • HIPAA-compliant, de-identified• Vermont data for public
reporting purposes– other APCD data
• By end of 2014:– Medicare (2009+) through
Qualified Entity Program • Part A (100%)• Part B (100%)• Part D (~40%)
• In 2015, data from State APCDs
• Other commercial data from additional insurers
• SGR fix – Medicaid and CHIP
20142014 20152015
HCCI currently holds claims data on 50 million people per year (2007 – 2013)
Everything HCCI does is HIPPA and anti-trust compliant and protective of company information
Bill Frist, M.D.!Bill Frist, M.D.!
Hussey PS, Wertheimer S, Mehrotra A.The Association Between Health Care Quality and Cost: A Systematic Review. Annals of Internal Medicine, 2013, 158(1):27-34.
“Unfortunately, the published literature does not provide clear input on [the relationship between quality and cost]. Our systematic review found inconsistent evidence on both the direction and the magnitude of the association between health care costs and quality.”
We do have to keep in mind when publishing cost data that
Cost and Quality do NOT Correlate
CO-LEARNING DISCUSSION
www.hcgc.org
LEAPFROG GROUP: Predicting Patient Survival
Our Strategic Areas of Focus
www.hcgc.org
…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers
PATIENT-CENTEREDMEDICAL NEIGHBORHOOD
COLLABORATIVE LEARNING
QUALITY TRANSPARENCY…improve care coordination between providers & social services
…improve the use of quality data
…improve the application of learning in Greater Columbus
PATIENT ENGAGEMENT…improve engagement between patients andproviders
Advisory Discussion
www.hcgc.org
• Regional Quality Reporting Project• State Innovation Model (SIM) Report
Update • Benefit Consultant Learning Group
Regional Quality Reporting2015 Approach
www.hcgc.org
voluntarily demonstrating their value
hospital-owned practices
private practices federally qualified
health centers
Healthcare professionals
identifying opportunities for
improvement
Purchasers seeing value
from the care they are buying
Patients making better informed choices about
their care
Sharing all-payer quality data from Electronic Medical
Records (EMR)
Cancer Diabetes Heart
Regional Quality Reporting Website
(refreshed every 6 months starting
Q4 2015)
Regional Consumer
Reports InsertQ1 2016
promote regional website
primary audience
Patient-centered medical homes Episode-based payments
Goal 80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years
Year 1 ▪ In 2014 focus on Comprehensive Primary Care Initiative (CPCi)
▪ Payers agree to participate in design for elements where standardization and/or alignment is critical
▪ Multi-payer group begins enrollment strategy for one additional market
Year 3
Year 5
▪ State leads design of five episodes: asthma (acute exacerbation), perinatal, COPD exacerbation, PCI, and joint replacement
▪ Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year
▪ Model rolled out to all major markets▪ 50% of patients are enrolled
▪ 20 episodes defined and launched across payers
▪ Scale achieved state-wide▪ 80% of patients are enrolled
▪ 50+ episodes defined and launched across payers
State’s Role ▪ Shift rapidly to PCMH and episode model in Medicaid fee-for-service▪ Require Medicaid MCO partners to participate and implement▪ Incorporate into contracts of MCOs for state employee benefit program
5-Year Goal for Payment Innovation
1. Perinatal2. Asthma acute exacerbation3. COPD exacerbation4. Joint replacement5. Percutaneous coronary intervention (PCI)
OHIO: Public-Private Healthcare Innovation Plan (SIM grant)
OHIO: Public-Private Healthcare Innovation Plan (SIM grant)
OHIO: Public-Private Healthcare Innovation Plan (SIM grant)
www.hcgc.org
What are your reflections and questions?