American Institute of Minimally Invasive Surgery (AIMIS, 501 C 3) was formed to advance current and future surgeries and procedures that improve patient outcomes while saving money. Initially through our Las Vegas based Centers of Excellence we are able to demonstrate our strategic design to improve women’s health through aligned incentives across multiple stakeholders. AIMIS would like to collaborate with the Center for Health Value Innovation to champion preferential steerage of patients to AIMIS Certified Centers of Excellence with outstanding physicians and hospital systems that demonstrably deliver safer, higher value minimally invasive surgery care.  The Strategic Objective of AIMIS is to achieve safer hysterectomies and to develop, designate and replicate affiliates and centers of excellence dedicated to minimally invasive procedures that safely benefit patients while reducing health care costs.

Runner-Up Recipient of the John J. Mahoney, M.D.

2010 Community Health Value Innovation Award

Anthem Blue Cross and Blue Shield’s Diabetes and Hypertension Self-Management Program, originally piloted in Ohio, will be expanded to other communities. The pilot improved treatment adherence, diabetes and hypertension outcomes, and cost trends.  Anthem BCBS’  Diabetes and Hypertension Patient Self Management Project provides an opportunity for employers to provide a positive health benefit to their employees. It is hypothesized that successful participation in this program will lead to improved patient care and wellness, less absenteeism from employees, and lower overall health care costs which will result in economic benefits to the employer.

STRATEGIC OBJECTIVE

The Diabetes and Hypertension Patient Self Management Project provides an opportunity for employers to provide a positive health benefit to their employees. It is hypothesized that successful participation in this program will lead to improved patient care and wellness, less absenteeism from employees, and lower overall healthcare costs which will result in economic benefits to the employer.

BARRIER OBJECTIVE

Effective January 1, 2008, the City of Cincinnati employees will be offered both the self-management services that encourages employees with diabetes and/or hypertension to seek counseling from Kroger pharmacists in regards to appropriate pharmaceutical management and application of self- management tools.

TACTICAL OBJECTIVE

The program is voluntary, however patients participating in the program will realize the following benefits:

• Diabetes and/or hypertension classes provided by a Kroger Pharmacist – 100% paid by the City • Follow-up visits with your assigned Kroger Pharmacist – 100% paid by the City • A drug copay reduction of $5.00 per prescription for medications related to diabetes, hypertension and cholesterol • A $100 City contribution to the Health Reimbursement Account with enrollment in the Healthy Lifestyles program.

Success of the program will be based on member satisfaction, improved education, medication adherence, monitoring of diabetes and hypertension treatment goals, and health care costs, office visit utilization, blood pressure control, weight, lipid values, and glucose control.

Runner-Up Recipient of the John J. Mahoney, M.D. 2010

Community Health Value Innovation Award

The Mayor’s Fitness Council of Austin, Texas will positively impact Austin residents’ physical activity levels and nutritional intake with the goal to become the nation’s fittest city.  While the MFC is focused on improving health behaviors, those behaviors are the precursor for the long term outcomes measured through data provided by the MFC’s business group partners, including body mass index, blood pressure, cholesterol and other disease management indicators.  The MFC’s work with employers in the value-based benefits design initiative is critical in building local linkages between companies who are and are not making strides toward improving health care, wellness and pharmacy benefits to their employees.

Grand Prize Recipient of the John J. Mahoney, M.D.

2010 Community Health Value Innovation Award

The Michigan Health Information Alliance (MiHIA) mission is to advance its efforts in driving health innovation and improving health, performance, and economic outcomes by advancing a high-quality, patient-centered, cost-effective health care system.

As the primary award recipient, Michigan Health Information Alliance (MiHIA) received our $40,000.00  grant.  MiHIA is an alliance committed to advancing high quality, patient-centered, cost-effective health care. They will use the award to measure engagement and adoption.  The Consumer Engagement project is part of a broader strategic plan approved by the AHRQ within the chartered value exchange.  Measurement and evaluation of consumer engagement levels are key to the value of this project and these, too are prerequisites for the Mahoney award.  They will use the monies and the Center’s oversight to facilitate the use of the patient activation measure as a science-based baseline and measurement of the project’s impact, thereby creating a sustainable model that drives consumers toward a culture of engagement.

Original Application Letter From Thomas Smith, Executive Director:

On behalf of Michigan Health Information Alliance (MiHIA), I am pleased to submit this application for The John J. Mahoney, M.D. Award for Community Health Value Innovation. This opportunity will enable MiHIA to advance its efforts in “driving health innovation and improving health, performance, and economic outcomes.” MiHIA’s Consumer Engagement project’s mission and objectives are uniquely aligned with The Center for Health Value Innovation initiatives.

As stated in the preceding documents, we are a community collaborative that demonstrates the strategic design to improve health through aligned incentives across multiple stakeholders.  We are committed to advancing a high-quality, patient-centered, cost-effective health care system. At its core, health care is local. We believe it is critical for community stakeholders to identify and work together on shared health-related community priorities. We also believe it is critical to use standard performance information to engage providers in improving and facilitating consumer decision-making. Such efforts would ensure public reporting, and promoting effective public and payment policies, and ultimately consumer incentives that reward or foster better provider performance. This will provide a foundation to assess, improve, monitor, and manage health care within and across communities.

We hope for favorable consideration from The Center for Health Value Innovation and look forward to collaborating in order to improve the quality of health through the innovative use of information.

Sincerely,
Thomas Smith

Runner-Up Recipient of the John J. Mahoney, M.D. 2010

Community Health Value Innovation Award

The Wichita Business Coalition on Health Care is made up of employers, physicians, hospitals and health plans representing over 30,000 employees in south central Kansas.  Coalition members are committed to working together to pursue increased value in the health care system.  The mission of the Wichita Business Coalition on Health Care (WBC)  is to engage employers and physicians in a formal process to create alignment that will result in higher value from health care investments for plan sponsors and better health for employees and their dependents.

JOHN J. MAHONEY, M.D. AWARD FOR COMMUNITY HEALTH VALUE INNOVATION

Application by the Wichita Business Coalition on Health Care

Coalition Members

The Wichita Business Coalition on Health Care is made up of employers, physicians, hospitals, and health plans representing over 30,000 employees in south central Kansas (see attached for membership list). Coalition members are committed to working together to pursue increased value in the health care system.

Mission

The mission for this project is to engage employers and physicians in a formal process which will create alignment between the work environments, benefits strategies, and the health care system and will result in higher value from healthcare expenditures for employers, and better health for employees and their dependents.

Health Improvement Desired

The target population will be employees with specific chronic conditions, or at risk for developing chronic conditions. However it is expected that this project will have a “halo” effect in that it will improve care and outcomes across the community. Targeted conditions initially will be diabetes and cardiovascular disease. The desired health improvement for these individuals is a reduction in complications, improved health status, a slowing of progression of the disease, and fewer at‐risk individuals developing the disease.

Experience The sponsoring entity for the overall project is the Wichita Business Coalition on Health Care. The Coalition will be partnering with ProviDRs Care Physician Network throughout this project.

The Business Coalition is a multi‐stakeholder, collaborative organization consisting of membership from all the major stakeholders in the region (employers, physicians, hospitals, health plans, pharmaceutical companies, and benefits consultants/brokers). Coalition members have expressed a strong desire to increasingly move towards more “value‐based” benefit designs. They are working through the Coalition to find ways to bring more resources and support for members regarding value based benefits design and purchasing strategies. In addition the Coalition has also launched an initiative called “Healthy Wichita”, a grant funded project being done in partnership with the Sedgwick County Health Department and the Wichita Health and Wellness Coalition. This project will engage business leadership in supporting physical activity and nutrition as primary prevention of diabetes, and is a call for them to demonstrate “leadership by example” as they publically commit to supporting good health starting with their own companies.

ProviDRs Care Physician Network is a physician owned Preferred Provider Organization with over 4,500 physicians and supervised mid‐level practitioners operating across the entire state of Kansas. As a physician owned network with its affiliation with the Sedgwick County Medical Society, ProviDRs Care has a long history of engaging physicians in initiatives to improve care and care processes.

ProviDRs Care is a member of the Business Coalition, and the leadership of both organizations regularly collaborate on a wide variety of community projects and initiatives.

Strategic Objectives

Improve care for patients and lower costs for employers

Increased communication between physicians and employers

Achieve alignment between the worksite environment, benefits design, and clinical care provided to employees and their dependents

Provide employers with expertise, resources, tools, and practical and actionable information to guide them towards more comprehensive and strategic benefit designs that purposefully support improved health and lower costs.

Barrier Objectives

The relationships in health care are often not aligned around the patient. Employers typically look to health plans and TPA’s to provide health care coverage. Physicians, as the actual providers of care to employees and their dependents, are often left out of critical discussions and decisions made between employers and their insurance partners that can impact their patients. This project aims to overcome this barrier by directly involving physicians with employers to generate systemic solutions to specific health care conditions and issues.

Another barrier this project strives to overcome is the traditional tactical, commodity‐like approach to purchasing health care benefits that many employers take. This project is intended to facilitate a strategic approach to benefits with a process and the tools to help employers develop a more informed and strategic approach to their health care expenditures.

Tactical Objectives

Engage employers and physicians in an ongoing process of dialogue and joint solution generation regarding the connections between employee health status – benefits design – company wellness strategies – and the clinical care provided by physicians in the health system.

Project Description

This project has two core sets of activity. One is to strengthen the knowledge base and the ability of employers to implement value‐based insurance designs, the other is to strengthen working relationship between physicians and employers to create alignment between the work environment, benefits strategies, and the health care system. The project will focus on increasing the value of health care benefits and ultimately will result in better care for employees and their dependents. The project will include the following elements:

• A series of workshops and workgroup sessions engaging specific employers in a practical educational process regarding evidence‐based care, elements of value in health care services, the acquisition and use of data, working with partners and vendors, understanding levers, and practical benefit design issues.

• A formal Working Group (Wichita Employers and Physicians Care Collaborative) consisting of specific employer and physician members.

• Physicians will be invited to apply to participate, and specific criteria will be set to determine the desired composition of the physician membership (specialty, group membership, etc.)
• Employer members will represent organizations committed to participate in the project

• The participating employers will be engaged in a formal process of assessing their data, identifying priority areas of focus, and in a strategic benefits design process.

• The Working Group will provide a forum for employers to meet with physicians and identify principles and objectives for both employers and physicians as it relates to both the benefits structures as well as the clinical care processes.

• The Working Group will be co‐chaired by an employer and a physician
• Each meeting of the Working Group will have a defined agenda with desired outcomes. The Working Group will meet regularly to discuss, problem solve, and identify specific changes, interventions, and recommendations for each element of the health system as it relates to the specific clinical conditions of focus.

• Case studies and real‐life examples will be used to inform the process.

• The Working Group will identify measures and metrics to be used to assess performance and to track improvements in care over time. Measures and metrics will include both process and outcomes.

The collaborative process and Working Group will:

1. Inform employer’s decisions around benefits design and communication with employees, as well as company policy and procedure, total health strategies, worksite wellness and health promotion.
2. Inform physician’s practices with regard to practice guidelines, the consistent application of established standards of care, communication between providers, physician and staff education, and clinical process improvements.

The Working Group will report back to both the Board of the Wichita Business Coalition on Health as well as the Board of ProviDRs Care Physician Network. Employers and physicians will work to ensure broad communication and implementation of the group’s recommendations to other employers and physicians in the community.

Keeping An Eye On The Health Care Prize

Understanding that things had to change if employers were to be able to continue to afford health care, a few forward thinking payers and influencers began to rethink their health care strategies. Two health care pilots began to take hold. One involved refocusing employees on the virtues of health and wellness. The other focused on decreasing the financial barriers to some of the care that would actually put healthier people back to work because they were compliant with their treatments.

These experiments that utilized reductions in co-pays for some populations continued to broaden with the inclusion of incentives for participation in annual or baseline health risk assessments, health fairs, and disease management. So began the development of behavior change through incentives that actively engage consumers to participate in their health and healthcare. The use of these incentives have evolved into the levers of population change that form the core of value-based design initiatives.

Learning Objectives:

Understand the nature of value-based design and the challenges it is designed to resolve.

Be conversant with the 4 Ds of value-based design . . data, design, delivery and dividends.

Know why health promotion is a foundational element of value-based design.

Learn the key skills and competencies that health promotion practitioners bring to successful implementation of value-based design.

Cyndy Nayer and John Riedel, Leveraging Health: A Primer for Health Promotion Practitioners using Value-Based Designs from Michaela Conley, HPCareer.Net on Vimeo.  Learn more about HPCareer.net here!