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
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.
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.
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.
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.
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.
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:
- 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.
- 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.