The questions that every employer and plan sponsor, every health plan and benefits manager should be asking must reframe the question: How much health, instead of health care, are we buying? How much could we buy with the same money we are spending now, if we purchased services more wisely?
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.
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.
FOR IMMEDIATE RELEASE
Center for Health Value Innovation Vice President Raymond Zastrow, M.D. Earns BizTimes Milwaukee Health Care Heroes Award at Sixth Annual Awards Ceremony
ST. LOUIS, Mo./MILWAUKEE, Wis. – January 05, 2010 – The Center for Health Value Innovation (www.vbhealth.org), the nation’s premier information exchange for value-based design, announced today that Raymond Zastrow, M.D., FAAFP, president, QuadMed, and vice president for evidence of the Center, was recognized by BizTimes Milwaukee for Corporate Achievement in Health Care during its recent sixth annual Health Care Heroes Awards ceremony.
“Dr. Zastrow exemplifies the Center’s commitment to value-based design, and we are extremely gratified that his work is receiving such high-profile recognition,” says Cyndy Nayer, president and CEO of the Center. “As one of the brightest minds working at the frontlines of health care reform, his ongoing efforts to influence decision-makers in Washington D.C. and Wisconsin, as well as his accomplishments at QuadMed, have been nothing short of triumphant.”
Chosen from a field of nominations by an independent panel of health care professionals, Dr. Zastrow is responsible for clinical quality oversight, clinical process re-design, and health care benefit design for Quad/Graphics. QuadMed, a subsidiary of Quad/Graphics to provide affordable, high-quality health care for the company’s employees, has reduced health care costs to approximately $6,800 per employee – 30 percent less than the average similar-sized manufacturer in the Midwest. QuadMed provides on-site, employer-directed primary care and prevention/wellness programs to Quad/Graphic and several other large employers.
“I was very proud to receive this award, which I accepted on behalf of the entire Quad/Graphics / QuadMed organization,” says Dr. Zastrow. “The health care model developed for our employees is based upon staying healthy rather than attempting to fix avoidable problems after the fact. It’s an approach that empowers primary care and that has allowed QuadMed to serve as an example of excellence in on-site care for companies across the nation.” 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
I had a chance yesterday to sit down and talk with Cyndy Nayer (President, CEO, and co-founder) from the Center For Health Value Innovation. For some of you, this is a new buzzword for others it has been around a while. I remember back in the early 2000s when stories of Pitney Bowes kept popping up and then working with a few of our clients (like Marriott) when I was at Express Scripts on what were being called “value-based designs”. [I even had an offer to go to ActiveHealth (now part of Aetna) and work on their Value Based offerings several years ago.]
And, it’s a small world. Several people from my past are involved: (1) Peter Hayes was a client at Express Scripts and (2) Roy Lamphier played soccer with me in high school.
What is the Center For Health Value Innovation?
The center is an “information exchange” for value based design which as she points out is much more than just a prescription benefit and not simply giving people free drugs to make them more compliant. [If only it were that easy!]
What do you mean by Information Exchange?
A place where people can share stories, trends, info, and research. They see their job as getting information out there and providing support around modeling, analysis, and identifying gaps. [And, I know they do a lot of education as you can see Cyndy at many conferences.] She talked about educating the marketplace on an “actionable format” for implementing value-based design.
Can you describe Value Based Design?
Value Based Design is a suite of insurance design, incentives, and disincentives that support prevention and wellness, chronic care management, and care delivery. It is focused on linking stakeholders across the care continuum and developing structures like outcomes-based contracting where all stakeholders benefit from better health outcomes.
She mentioned that in an upcoming edition of the Journal of Benefits and Compensation that there will be a paper that builds on some adherence concepts to discuss the 5 Cs of Value Based Design: [Noting that the first 3 come from some work from Merck.]
Commitment
Concern
Cost
Communication
Community
We talked about the need for communications to be multi-directional and include the patient, the physician, the pharmacy, and other caregivers. We talked about community needing to expand on that to include family, the employer, and other entities. [As we all know, health care is local and value based design is no different.]
We spent a little time here talking about community, and the need for this to happen at a community level. [Much like e-prescribing and other things have found out that localized momentum is important.] One question in my mind is who is the catalyst – the hospitals, the physicians, the local managed care companies, employers, grocery stores, wellness companies, pharmacies.
We talked about the fact that this isn’t the same as Accountable Care Organizations, but like that concept, this has to be developed as part of the fabric of the community not imposed on the community.
Being from Detroit, I asked if this was a model for them to help develop around. That is an area of focus and there has been some work done in the Battle Creek, Michigan area.
Why are employers so interested in Value Based Design?
Originally, employers were interested since it was something new, but the recession forced them to look at this more seriously. But, this is a long-term process and something which they benefit from. Better health lowers absenteeism, and businesses need health communities and healthy workers for growth.
Why don’t companies implement Value Based Design programs?
Companies don’t implement them because they’re not prepared for the amount of work needed to get started and it’s not a cheap fix. [If you want to save money, just drop the benefits…not that anyone really advocates that.] We talked about that lots of people react to the urban legends of just giving out free drugs [which isn't Value Based Design] which would be easy. Companies need to realize there is work to be done to communicate this, design it, and manage the implementation across the community. BUT, once it’s installed, it’s completely sustainable.
Is there a certification (i.e., URAC) for value-based design?
She told me that nothing exists today and that it would be hard to do. Today, there isn’t alignment in the marketplace around incentives and a standard model. They spend a lot of time working with different groups to drive education and training to link health and productivity measurement with value and functional performance.
What’s next for 2010?
In 2010, they will be bringing much more information forward on how to support and extend the work done in the 1st book (Leveraging Health…which Dr. Jan Berger, Silverlink’s Chief Medical Officer co-authored with the Center) and the decision matrix that they recently published. They will continue to serve more as a guide helping interested parties in private, invitation only events to design solutions and then bring those solutions to market.
Wayne Burton, M.D, Longtime Corporate Medical Director of JPMorgan Chase, Joins Center for Health Value Innovation Board of Strategic Advisors.
ST. LOUIS, Mo. – January 19, 2009 – Wayne Burton, M.D., retired corporate medical director at JPMorgan Chase and nationally recognized expert on health and productivity management, has joined the Center for Health Value Innovation’s Board of Strategic Advisors (www.vbhealth.org). As a member of this seven-member advisory board to the Center, the nation’s premier information exchange for value-based design, Dr. Burton will share his wealth of experience and practical strategies for applying value-based designs to benefit both the health of workers and the companies that employ them.
“I’m looking forward to contributing to the Center’s mission to advance analytic tools and educational programs that improve individual health and financial sustainability for organizations,” says Dr. Burton. “I have spent my entire career developing value-based interventions that improve function, reduce disability, increase productivity, ease costs, and strengthen the commitment of workers to their employers. As a member of this distinguished advisory board, I anticipate robust information exchange with Center members.”
At JP Morgan Chase, and previously at Bank One (which was acquired by JP Morgan Chase), Dr. Burton was responsible for managing worksite occupational health services at 20 major locations in the United States and Canada, while managing corporate health initiatives and wellness/disease management programs. Dr. Burton is the author of numerous articles and research that demonstrate the linkages between health risk and medical condition management and improved cost trends at the worksite, such as reduction in short term disability, absenteeism, presenteeism, and total cost burden for the employer.
Dr. Burton is Board Certified in Internal Medicine and is a Fellow of the American College of Occupational and Environmental Medicine, the American College of Physicians, and the Institute of Medicine of Chicago. He is associate clinical professor of Medicine, Feinberg School of Medicine Northwestern University in Chicago, and adjunct professor of Environmental and Occupational Health Sciences, University of Illinois at Chicago.
“Dr. Burton’s unparalleled work in health and productivity management has paved the way for employers to measure, manage, and significantly enhance worker health and improve the return on investment in human capital,” says Cyndy Nayer, president of the Center.
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
