ESTERO, FLA. – August 31, 2012 –When cancer patients are given more of a voice in their own care, many choose less intervention rather than more, experts say.  Further, when patients and their clinicians are aligned in evidence-based treatments and care coordination, quality of life is enhanced while of quality of health care is improved.
These findings, part of a presentation at the Center for Health Value Innovation’s recent webinar on “Specialty Solutions for Oncology,” are part of many pieces of evidence that plan designers can use to contain the costs of cancer care, one of the fastest-growing segments of health spending.
“Cancer is a scary disease and people who have it deserve effective, evidence-based care,” said Cyndy Nayer, president of the Center. “Designers of health plans can take advantage of the best modern science has to offer by considering all of those affected by cancer, including the health system, the patient and family, and the care providers, surrounding them with the evidence, quality of life, and best outcomes for their disease, while at the same time keeping their financial health under control.”
“Many patients prefer a less aggressive approach, especially at end of life,” Bruce Feinberg, D.O., chief medical officer, Oncology, for   Cardinal Health Specialty Solutions. “By including the patient in decision-making as a stakeholder and paying attention to evidence-based treatment pathways, care providers and health plans can achieve the best possible results for the patient without posing unfair cost burdens to families.”
Cardinal Health Specialty Solutions’ approach includes such measures as matching treatment to disease through evidence-based and peer-reviewed studies, then working with providers to develop the treatment pathways they will follow.  Pathways offer one of the rare opportunities in which all health care stakeholders can be similarly benefitted.  Providers collaborate with payers to reduce inefficiencies and waste while achieving consensus about uniform standards of care.  Patients then benefit from the lower costs and improved standards,” said Feinberg.
Jack Mahoney, M.D., M.P.H., chief medical officer, Center for Health Value Innovation, presented the full-market implications of specialty solutions for cancer care.  Focusing on employers and health plans as plan sponsors, he cited the evidence of rising use of balancing cost control measures while assuring access to high quality care by plan sponsors and carve-out specialty pharmacy managers as published by PBMI (Pharmacy Benefit Management Institute), an early ally of the Center.
“We are cataloguing cost-control mechanisms in cancer care and other specialty solutions that are quite similar to those we saw for many years in chronic care solutions:  prior authorizations, tiering, cost-sharing, and more,” said Dr. Mahoney.  “And, as we might expect, with more administrative burden or cost-shifting to the patient, we are also seeing potential barriers to treatment adherence.  Therefore, our Center is identifying innovations in specialty solutions that keep administrative burden and costs simpler for these individuals who can significantly benefit from the new treatments.”
One of the earliest supporters of the Center’s focus on outcomes-based contracting has been Laurie Amirpoor, Pharm.D., vice president of clinical pharmacy strategies for WellPoint Inc. and a member of the Center’s Board of Directors.  Dr. Amirpoor encouraged plan designers to design future plans that avoid high out-of-pocket costs for cancer drugs, citing studies that find patients are more likely to abandon such treatments. Instead, she recommended such cost management mechanisms as quantity management, adherence monitoring and following established treatment pathways.
John Poniatowski, Vice President of Clinical Pharmacy for Specialty Pharmacy at Cigna, highlighted the approach used by his company. “Our holistic care model focuses on the patient, not just the drug,” he said, “we make sure care is affordable, outcomes are improved through adherence and superior service is provided. As a health care company, we believe an integrated approach, including all of the patient information on one health technology platform so all caregivers can review treatment plans and more, is fundamental to the better outcomes for everyone.”
“We chose our speakers to reinforce the message of focusing on the outcomes and appropriate, evidence-based care paths to get there,” said Nayer.  “Each of these companies has received kudos from us for their early adoption of outcomes-based contracts.  We have been outspoken not only on value but on the outcomes-based contracts that align the patient, payer, plan sponsor and providers in a treatment path in which all can achieve well-defined goals.  Each of these organizations embraces the science of health care with the humanity of health outcomes.  Each has shared their philosophies and analyses with us as members of our Center.”
Nayer commended the group on their efforts to present various perspectives to the large audience of health plans and employers who gathered for the webinar.  “Together, we are forging new paths in care outcomes that include better health and financial outcomes.  We have become the innovation hub for care coordination and plan design that we hoped to achieve.  Based on the hundreds of health care decision-makers who registered for this first thought-leader event, we’re confident that we’ll be seeing greater innovation in plan design for oncology and other high-cost and debilitating conditions. We will be scheduling more of these summits and webinars for our members and publishing the results so that communities throughout the United States will derive the benefit of thought leaders such as ours.”

About the Center for Health Value Innovation (CHVI)CHVI (501c3) is focused on the relentless pursuit of innovation in health and benefit designs that improve engagement, accelerate accountability and create a predictable health cost trend. CHVI members represent over 60 million lives from all market segments in the health value supply chain, sharing the evidence of improved health and economic outcomes through value-based designs, including the Outcomes-Based Contracting™ platform for accelerating meaningful change. The Center for Health Value Innovation’s goal is to improve the health of people, organizations and communities throughout the U.S.  www.vbhealth.org# # #

 “In past iterations of this survey, we’ve found a number of useful results that have helped employers better understand how to target their health care dollars,” explained Cyndy Nayer, president of the Center.

“In order to get quality results, we want to invite a wide variety of businesses to take the survey, with a promise that their organizations will not be individually identified and that no personal health information is requested,” Nayer continued.

Employers of all sizes, including nonprofit and government agencies, are invited to take the survey today at https://www.surveymonkey.com/s/value-based. Results will be gathered through Sept. 15, 2012. Those who take the survey will get a complimentary PDF copy of the results.

The Center has been unique in its vision for health benefit designs focused on outcomes. In tracking this link and the development of more sophisticated value-based systems over the past five years, the CHVI survey has been instrumental in defining outcomes-based contracting.

Outcomes-based contracting is a growing trend that aligns all stakeholders (health plans, employers, clinicians, consumers, patients) to engage patients in their health, hold providers accountable for health improvement, and create a predictable cost trend for organizations and communities. Previous iterations of this survey have shown the emergence of outcomes-based contracts and their focus on systemic incentives and accountability.

Special areas targeted in this year’s survey include outcomes-based contracts in special situations (for example, cancer care); direct contracting with delivery systems; and telehealth.

The Value-Based Designs and Outcomes-Based Contracting Survey is made possible by the generous support of Cigna and United Healthcare, with promotional help from Employee Benefit News.

MEDIA CONTACT: Pat Washburn, pat@vbhealth.org or (207) 619-2143

About the Center for Health Value Innovation (CHVI)

CHVI (501c3) is focused on the relentless pursuit of innovation in benefit designs that improve engagement, accelerate accountability and create a predictable health cost trend. CHVI members represent over 60 million lives from all market segments in the health value supply chain, sharing the evidence of improved health and economic outcomes through value-based designs, including the Outcomes-Based Contracting™ platform for accelerating meaningful change. The Center for Health Value Innovation’s goal is to improve the health of people, organizations and communities throughout the U.S.  www.vbhealth.org

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Health Value Accelerator INFOGRAPHIC  and analysis of data from the Health Value Accelerator™ is complete.  Information on engagement and participation, from companies large and small, across market sectors (manufacturing to health care to cities-counties-states and more), representing over 750,000 covered lives and $221B in total revenue, the results are in:  better engagement in personal health management and purchasing/service offerings can reduce waste, reduce risk, and result in better outcomes including saved jobs.  CEO Cyndy Nayer, who produced the infographic, notes there is much more data behind these numbers, and the opportunity to get better health engagement is quite obvious to each employer when their personalized priorities are reported back.

In a year of health reform uncertainty, the Center expands our mission of innovation and implementation guidance. For 5 years we have been surveying employers, consultants and health plans to track the trends in value-based designs, adding to the shared intelligence that moves organizations and communities toward better health. This year we are expanding our focus on outcomes-based contracting as bundling and performance reimbursements take hold.

Our survey explores various insurance plan designs and delivery system reimbursements, plus the incentives and disincentives for patients and providers. Your successes, challenges, and experiences will help drive the new wave of innovation for improved health and economic outcomes.

Read the full report

Special thanks to our Media Sponsor

Click here for the Full Report CHVI OBC Systematic Linking of Value-Based Design and Accountable Care

So, the kids can stay on their parents’ plans till they are 26, the individual mandate means a penalty on those who don’t participate (it moved from a commerce clause–you have to buy– to a tax clause–if you don’t get in, you pay a penalty, a lot like not reporting your income and paying your taxes), no one will be denied insurance after 2014, the donut hole for Medicare-covered drugs closes (a savings that seniors have felt this year), state exchanges move forward.  Or, the fight might go into November and beyond with Republicans vowing to cast this law aside.

Some of the pundits are saying the country is weary of this fight.  Others are saying it’s not over.  I say it just took on a new dimension:  the actual issue is jobs, the very essence of the American dream is owning a house (NYT survey June 2011:  Which is more important your job or your house?  Majority answered “House.”).  By closing, even for awhile, the arguments over the ACA, we can rise up to the real problems, of which health care is a prime cause, but jobs and house are the endposts.

This is the sigh, not one of relief, but one of checking off the box that says “ACA” and refocusing on what matters:  the economy, the jobs.  Most folks understand that taxes are paid through jobs, houses are bought with jobs, health care is delivered mostly through jobs (either at the worksite or through the money earned at the worksite).  Most folks don’t want that to change.  Most folks understand that the costs of the insurance have been going up, that U.S. businesses are buckling under the weight, and, when insurance is not in place, the whole community pays in taxes for uninsured coverage in the emergency room.  Health care derails jobs, productivity, sales, activities, and taxes, which pay for police, firemen, new roads and bridges, and so much more.  So, control the health care costs, and we can actually make a dent in this job/house situation by preserving revenues for rebuilding and purchasing, preserving jobs and communities.

Today’s affirmation of the individual mandate is a subtle reminder that we all have an individual responsibility to take care of our assets, including our health.  The door has been opened wider for Americans to manage their health as they manage their wealth:  we can invest in our health checkbook with better eating habits, better activity habits, better stress management habits.  The more we do individually and with our families, the more we will save in health care costs.  As we lower our risk profiles (overweight, sedentary, smoking, no prevention screenings, no immunizations, too much alcohol or pain medication, for example), the less CARE costs us and the more HEALTH we achieve.

I’ve mentioned before a book I wrote years ago–Lifetips:  101 Tips for Personal Health Management (that was the name the publishing house assigned to it, I didn’t get to choose)–that included the concept of health-wealth portfolio, managed by the person/CEO-of-my-health, that leads to better health and wealth and performance.  It’s time we revisit the concept.

In today’s lexicon, 4 years after I wrote the book, the word to use is “Accountability.”  We read about Accountable Care Organizations, but I  posit an innovative thought:  The Family is the Accountable Care Organization.  Every decision we make about what to eat, stepping up our activity, cutting our risky behaviors, getting the right care at the right place at the right time, affects the health and wealth and performance of the family.  Diagnosed with an acute sickness or chronic condition?  That will cost the whole family, could cut down on vacation time, or, worse, on education savings.  Need a new car?  Might have to make do with the clunker because the medication you need has a higher co-pay.

You understand, I don’t need to belabor this discussion.  What we witnessed today is the revival of our spirits as we experienced the revival of the belief in the American system:

“The Framers created a Federal Government of limited powers, and assigned to this Court the duty of enforcing those limits. The Court does so today. But the Court does not express any opinion on the wisdom of the Affordable Care Act. Under the Constitution, that judgment is reserved to the people.” — John Roberts, Chief Justice of the United States Supreme Court (thank you MCOL).

Any doubt we had about partisanship on the Supreme Court has been dissolved.  Justice Roberts used the rule of law to search for solutions that upheld the Congressional will, and only in the case of the state Medicaid mandate was the revision made, still leaving the law intact but one clause modified.  The headline surprised many, but the Supreme Court did was it was supposed to do:  SCOTUS was the Accountable Organization to assure the law of the land was upheld, according to the voted representaties of our government.

Now, the collective sigh must be turned to the jobs and houses.  It starts with each of become our own CEO of our self-defined Accountable Care Organization.  Our consultants in the medical community, our beneficiaries in the neighborhoods where we live, will thank us.

We can do it.  Turn our collective will to the rebuilding of our economy and our communities.  Do the best we can at managing our everyday health and watch the wealth begin to flow again.  Make small changes, track progress and stay the course, recruit others to join.

Accountability is our action, health is our goal.  Choose wisely, my friends.  Now, inhale deeply, and sigh audibly:  it’s time to make America the healthiest nation in the world.

This post also appears on Managed Care Online.

Please note:  We are postponing this summit until early 2013.  

Our promise to you has been to feature the most innovative solutions for current health management issues.  We believe that, with the uncertainty in the legislation until later this year, we will do a better job of fulfilling our mission if we wait for some of the fog to clear.  We trust that you will keep visiting the website for updates, and we will update you on our monthly “topic conversations” that we usually conduct with our Board members.  Because you are valuable to us, we will be opening these topic conversations to our general members and the communities we serve.