Wisconsin–the state best identified with cheese, high taxes, the Green Bay Packers and beer–is also known for health care, creating diverse collaborative health care systems and well-established prevention programs. But it is also plagued by high costs and expenses.  Despite Wisconsin’s health care woes–it ranked as the 16th state with the highest health spending per capita in 2004 (the most recent year for which comparative state-level data are available), it is a state primed for reform, a path it has been pursuing throughout the past decade. Employers, health plans and county governments all share in the journey towards cost-effective, high-quality, accessible health care.

This report, Wisconsin: Levers Drive Value-Based Innovation Across the State, makes a business case for value-based design as illustrated by Wisconsin companies Quad/Graphics [QuadMed], Humana, Journal Communications and Chippewa County. The four organizations are a representative sample of how innovation is providing resolution and relief in Wisconsin and how the state culture has contributed to the success of their solutions. The report is built on the Health Value Continuum, a development pathway for value-based design that shows the route to quality health improvement and behavior change. The Health Value Continuum was developed by the Center for Health Value Innovation to detail the experiences and path of early innovators in value-based benefit design. The four organizations highlighted in this paper (QuadMed, Humana, Journal Communications and Chippewa County, WI) have each reached different points along the Continuum as they move toward optimal health.

“We think Wisconsin is a truly unique learning laboratory,” says Cyndy Nayer, president and chief executive officer of the Center for Health Value Innovation.  “Wisconsin has demonstrated a willingness to innovate, share, and do more. We want to learn about and share the experience of these Wisconsin companies by cataloguing the levers–or incentives–currently in place, the metrics used to measure outcomes, and how statewide efforts can be replicated in the marketplace. These companies are all members of the Center, and our mission is to provide evidence of improved health value so that other companies can improve the value of their health care spend.”

For the complete report in PDF format, please click here.

Our mission is to share the innovations that drive the value of every dollar invested in health.

Our goal is to identify and link innovators and innovation that broaden the boundaries of health value.

Our work is focused on defining value, creating relevance to shareholders and stakeholders, and improving the health and economic viability of communities.

Operating Principles:

We will define value as the improvement in health and economic status at the consumer, organization, and community level.

We will encourage innovation and innovators who improve health through alignment of quality and outcomes across the health value chain.

We will share findings of success and opportunity with the communities we serve.

We will attract best practices and align incentives to drive the value of health across stakeholders.

We will respect confidentiality and proprietary process when promoting new ideas, innovations, and innovators, including the work of our Center and its members.

We will honor boundary-less thinking in our safe, virtual concept studio so that we can, together, improve health outcomes across America.

Membership in the Center for Health Value Innovation is earned through a willingness to share ideas, concepts, trends, and experiences so that innovation is fostered and health value is increased.  Your membership is a valuable asset to your business.  At all levels of membership, you can:

ACCESS collaborative connections to innovators in value-based health design: Learn what they do, what they have learned, and how to make value-based design changes at your worksite

PARTICIPATE in semi-annual webinars

LINK to experts in value-based health strategies that provide additional information and resources to improve your company’s financial sustainability

ACQUIRE tools for qualifying your organizations’ readiness for introducing value-based health innovations – whether you are new to the concept or a veteran innovator.

LEARN the latest news about value-based health innovations in your area and across the country via the Center for Health Value Innovation’s web site and email news bulletins.

E-mail us at info@vbhealth.org

• Our goal is to identify and link innovators and innovation that broaden the boundaries of health value.
• Our work is focused on defining value, creating relevance to shareholders and stakeholders, and improving the health and economic viability of communities.

We are a collaborative community of stakeholders, led by employers of all sizes and sectors, who are improving health status while reducing total cost trends using value-based designs. We learn and share as a community of thought leaders, as a knowledge resource, and as innovators for new trends.

Our latest finding: There are more than 100 levers that influence consumer and patient behaviors in value-based design according to our interviews and surveys. How they are used and the results they bring are part of our shared journey. The 15 macro-levers are published in our book, Leveraging Health – Improve Health Status And Bend The Trend On Financial Inflation With Value-Based Designs, which you can order through our website by clicking on the book icon.

It’s important to note that value-based designs (VBD) are much more than waived or reduced co-pays for chronic care, particularly medications.  A value-based design uses evidence-based clinical impact merged with financial impact (health + economics) to guide the behaviors of populations in managing their health.  VBD can influence choice of care provider, appropriate and persistent treatment, and early risk/prevention/wellness.  All of these have been documented to show a meaningful impact in health status, productivity (safety, disability, unscheduled absences, and more), quality and financial cost trend.

The John J. Mahoney, M.D. Award for Community Health Value Innovation

AWARD OVERVIEW:

The Center for Health Value Innovation (www.vbhealth.org), the nation’s premier information exchange for value-based design, announces the first John J. Mahoney, M.D. Award for Community Health Value Innovation. The initial $40,000 grant will be awarded to the community that demonstrates the strategic design to improve health through aligned incentives across multiple stakeholders. Additionally, The Center will amplify the award by providing one year’s worth of oversight, education, and measurement of improvement.

Community may be defined as geographic (multiple stakeholders in one community), dispersed (global company with multiple locations that can influence multiple locales), or organizational (business coalition, health system, and more).  The award recipient will be chosen for the ability to measure and report outcomes as well as the depth and breadth of lives that can be improved by improving the health and economic status of the community.

John “Jack” Mahoney, M.D. is a founder and Chief Medical Officer of the Center. Dr. Mahoney has served Pitney Bowes as Global Health Strategy director, medical director, and a key team leader for the Company’s innovative health care programs.  He currently serves as chief consultant for Strategic Health Initiatives for Pitney Bowes and continues to be active in shaping the Company’s value-based benefit designs. Jack has devoted countless hours to counseling other companies, communities, and stakeholders, driving health innovation and improving health, performance, and economic outcomes.

REQUIREMENTS OF AWARD APPLICANTS

The community must:

Provide names of companies involved, with key contact for the award, address, phone, email contacts, senior level executive sign-off, and an overview of how /when the initiative was formed.

This multi-stakeholder collaborative must be supported in writing by a senior level executive at each company.  Multi-stakeholder means that there must be representation from employers as well as several other organizations that, together, are focused on improving health quality in their community or region or multi-site company.  These other organizations could be provider/clinician groups, hospitals/health system, health plans, consultants, manufacturers of treatments/devices, health resource companies, or others who are connected in the health value supply chain.

Clearly state your mission.  What kinds of health improvement are you focused on achieving?  What has been your experience in this?  (You may be a new collaborative and just beginning, or you may be an established coalition/collaborative who strives to achieve more).  Please tell us, in 250 words or less:

- Strategic objectives:  what you hope to achieve

- Barrier objectives: what you hope to overcome

- Tactical objectives: process to overcome the barriers and measures that will show success

Requirements for submission include:

- Focus on behavior change across all the stakeholders in the collaborative; will you need help in communication/technology/other best practices from the Center?

- Project manager for each company, or a dedicated person at the collaborative level

- A total of at least 5000 covered lives across the collaborative with corresponding health risk data, claims and eligibility that you can analyze based upon our direction.  You will be providing us with periodic reports.

- Agreement among the members of the collaborative to the metrics that will show outcomes/success.

THE AWARD RECIPIENT WILL RECEIVE THE FOLLOWING FROM THE CENTER

-   Up to 20 hours of design oversight and analysis over 18 months from inception of the work (we will need a benchmark data overview in order to provide guidance and design)

-   A Health and Productivity Snapshot (through our allied companies) for up to six companies

-   Three half-day sessions of training over the 12 months of the implementation (including priorities and alignment, measuring value, and purchasing based upon outcomes for improved health)

-   A press release, case study summary, and a webinar/seminar for community learning

-   A potential submission to a peer-reviewed journal

SeeChange Health – The New Value-Based Health Insurer Aligns Benefits with Preventive Care and Chronic Condition Management

San Francisco, CA–March 22, 2010 – SeeChange Health today launched the first new value-based health insurance company in California, offering personalized, value-based health plans that provide incentives to encourage individuals to play an active role in their health management and improve their quality of life. As the first value-based health insurance company to launch in the United States, SeeChange Health brings affordable, next-generation insurance designs to the employer group market. The plan will be available initially in Fresno, California, but the company plans to expand their offering to Los Angeles, San Diego, Bakersfield, Monterey, Sacramento and San Francisco in the coming months.

Value-based health care encourages individuals to access preventive care, which will identify looming health problems before they become serious – and expensive. Participants who complete a health questionnaire along with age and gender specific preventive examinations, including cancer screenings and basic lab tests, are rewarded with enhanced benefits such as reduced coinsurance and deductibles along with cash rewards.

Unlike typical health insurance companies, SeeChange Health designed its benefit plans to encourage individuals to see their doctor. SeeChange Health covers preventive examinations, including cancer screenings and associated lab tests, at 100 percent.

“We are thrilled to partner with a health plan that rewards its members for building and maintaining a relationship with their doctor,” said Dr. Daniel Bluestone, Chief Medical Officer of Santé Community Physicians. “SeeChange Health promotes healthy behaviors, which will ultimately reduce chronic illnesses and help people live fuller, healthier lives.”

In addition to providing enhanced benefits for completing preventive examinations and related screenings, SeeChange rewards its members with financial incentives for completing health actions necessary for proactively managing chronic conditions, such as diabetes, asthma and coronary artery disease.

“When SeeChange approached us with its groundbreaking solution, we eagerly embraced the only health plan to completely align its benefits with preventive care and chronic condition management,” said Cyndy Nayer, President of the Center for Health Value Innovation, the nation’s premier information exchange for value-based design.

“The reaction and feedback we are receiving from employers is overwhelmingly positive,” said Chuck Trogdon, CEO of Renberg, Trogdon, & Cavale Insurance Services. “Employers are clamoring for affordable health plans with benefits designed to support individual efforts for staying healthy. This approach drives down health plan costs and promotes a healthier workforce.”

Why the initial focus on California? One out of seven residents are uninsured and the number is growing. In the coming months, SeeChange will expand their health insurance offerings throughout California and into twenty-four states where they are licensed to sell value-based health insurance.

“While the nation debates the merits of a national health care plan, the elephant in the room is who is going to pay for it,” said Martin Watson, CEO of SeeChange Health. “With our new plan, we are effectively showing that you can lower health care costs and improve the quality of care while you’re doing it.”

About SeeChange Health

SeeChange Health provides fully-insured, value-based health insurance to employer groups. The company combines value-based benefit designs, data analytics and an interactive personal health record to consistently improve the health profile of individuals. Preventive health actions are assigned and tracked at an individual level. Individuals with disease states such as pre-diabetes, diabetes, asthma and heart disease receive specific health actions based on their medical condition. SeeChange Health is headquartered in San Francisco and is focused on reducing health care costs through proactive health management and early detection of health conditions.

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PRSeeChangeLaunchMarch22-2010

As the country approaches the end of a year of promised reform that would deliver more health care, bend the trend on costs, and get more uninsured people into the system, weariness and wariness have taken root. The focus has moved from “bending the trend” to insurance reform, but the plan sponsors—most often employers of many sizes and sectors—have a job to do, and they need health and productive employees to do it.

Value-Based Designs Deliver Dividends—But Overcoming Non-Adherence Is Key
Adherence indicators may well be part of the “holy grail” for beneconomic outcomes. Using a suite of levers, defined as insurance design, incentives and disincentives, the benefits and compensation decision-maker has the power to influence behavior change for desired results. But the arbitrary implementation of iconic models of value-based designs, using these levers to  remove cost and access barriers for certain populations, is not without consequences.  Value-based designs do work, influencing patient and consumer behaviors in  prevention/wellness, chronic care management, and choice of care delivery.

Read more.  Nayer, Mahoney J Comp Ben Behavior Change and VBBD JCBv26#1 copyright

“Reprinted from Journal of Compensation and Benefits. Copyright © 2010 Thomson Reuters/West.

For more information about this publication please visit www.west.thomson.com

Read more of the primer by clicking here.

AHP HPP primer 3.2010

Read more here  HPM-VBD Seminar

FOR IMMEDIATE RELEASE

TriZetto Joins Center for Health Value Innovation, Signals Role of Healthcare Information Technology in Accelerating Adoption of Value-Based Solutions

ST. LOUIS, Mo./NEWPORT BEACH, Calif. – March 01, 2010 – The Center for Health Value Innovation (www.vbhealth.org), the nation’s premier information exchange for value-based design, today announced that The TriZetto Group, Inc. (www.trizetto.com) has joined its growing membership of healthcare industry innovators.  This collaboration is expected to accelerate the development of new value-based strategies, which many industry analysts and leaders believe are vital to healthcare reform.

“TriZetto will share its knowledge to demonstrate how technology can be used to promote the adoption of value-based designs, and our value-based solutions will incorporate the ideas and principles of the Center,” said Jeff Rideout, M.D., chief medical officer and senior vice president of cost and quality at TriZetto. “As a leader in healthcare payer technology, TriZetto recognizes the potential of value-based designs for healthcare reform and will assist the Center in evaluating value-based strategies, developing critical analytics and leveraging technology to refine programs and measure outcomes.”

The introduction of “levers” of value-based design incentives is now recognized as one of the most effective approaches to encourage individuals to adopt healthier lifestyles and effectively manage chronic conditions by adhering to recognized healthcare guidelines. In its recently released book, Leveraging Health (2009), authors from the Center articulate the role of value-based solutions to enhance workplace health and productivity and promote financial sustainability for organizations.

Gail Knopf, vice president of enterprise strategy at TriZetto, added, “This collaboration presents both TriZetto and the Center with significant opportunities to leverage the latest innovations and best practices to help unlock the potential of value-based designs.  Together, we plan to develop value-based strategies that improve member health, successfully address healthcare economic inflation and drive Integrated Healthcare Management (IHM) and its subset, Systematic Health Management (SHM).”

TriZetto’s industry vision, IHM is the systematic application of processes, shared information and aligned incentives to optimize the coordination of benefits and care for the healthcare consumer. TriZetto’s IHM vision encompasses three areas for payers: administrative costs, supply-driven costs and demand-driven costs. TriZetto has become well recognized for its administrative solutions that increase efficiency for payers and their employer customers and members. TriZetto’s new SHM process focuses on the supply and demand drivers to address clinical cost and quality challenges that primarily manifest themselves in unwarranted variations in care, which create significant waste.

Cyndy Nayer, president and CEO of the Center, said, “With the recent introduction of its Value-Based Benefits Solution, TriZetto demonstrates a serious commitment to developing technology to administer value-based benefits on an individual level and integrate the process in real-time with claims processing. We are grateful to TriZetto for sharing its talent, expertise and technical experience, and look forward to working closely with its leadership.”

About The Center for Health Value Innovation
Information Exchange for Value-Based Design
The Center for Health Value Innovation has grown into the nation’s premier organization dedicated to sharing the evidence of improved health and economic outcomes through value-based designs for sustainable health and financial improvement.
www.vbhealth.org

About TriZetto
Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry. With its technology touching half of the U.S. insured population, TriZetto is Powering Integrated Healthcare Management®, the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The company’s offerings include enterprise and component software, hosting, outsourcing services and consulting that help payers implement and optimize their operations and minimize the risk of bringing to market new products that drive competitive differentiation.

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TriZetto Joins Center for Health Value Innovation, Signals Role of Healthcare Information Technology in Accelerating Adoption of Value-Based Solutions | Business Wire

Wellness, Hard to Define, Reduces Trend up to 4%
Cyndy Nayer,1 Jan Berger, M.D.,2 and Jack Mahoney, M.D.3
Abstract
The purpose of this qualitative study was to identify a common language for ‘‘wellness’’ and a correlating health cost trend reduction through incentive-driven prevention and wellness.

Read more here – Wellness – Population Health 2009