It’s a bit into the New Year, but I find that these first weeks often are cluttered with tasks from the year before, chaos from holiday celebrations, and a redefining of personal goals.  Eventually, the bright light of early January takes center stage as the days begin to lengthen, and with that brighter light comes renewed energy.

Our November Annual Meeting and Innovation Summit seems far away, yet the success of over 150 people in the room still resonates.  I’m continuing to work with the some of the companies to connect them, define the opportunities to work together, and build showcases of improvement in engagement and accountability for outcomes, the very essence of any value-based design.  I’m waiting for the movies to be clipped to their important messages and the new pages on our website/Facebook/twitter to be created so we can share some of the detail of the summit with all of you.

But standing still is not part of my DNA.  So let’s frame the work of this coming year.

MLK:  A genuine leader is not a searcher for consensus but a molder of consensus.

At the summit, I framed my talk on quotes from Steve Jobs.  Interesting, here, that Jobs and King are in alignment, but perhaps not so surprising, since we were all so influenced by Dr. King.

My role in the Center, as the CEO and one of the founders, has been to assemble leaders, case studies, market evidence, and organizational evidence of improved health outcomes with value-based designs.  But make no mistake:  the accumulation of data points is not my endpoint.  I amass trend data and then create “what if” scenarios that link the art of health promotion to the science of engagement.  I’ve done it my whole life:  I take disparate entities and mold consensus to achieve better outcomes.  Everyday.  In every conversation.

Now there are some who rely on focus groups, surveys, and more.  There is good evidence that these provide information. But my impatience and inability to accept incremental change drives me to rapidly move forward based on the data that is often NOT in the focus group or survey.   In other words, I mold consensus.  I take the vision of “what could be” and compare to the noise of “what is” and ask, “Where is the disconnect that is stalling the improvement?”  Then, I track back to data to see if there is verification of a missed opportunity, I seek evidence and research that show the end-point is valid and achievable, and I prioritize the steps to get there.

Jobs said he didn’t poll the public because he invented what the public didn’t know it wanted—he merged science and creativity into disruptions that changed our lives. King used our emotional ties to our faith to define a disruption that overhauled social systems, forever changing our humanity.  I gain bravery by reading about brave people who carve a different path.  I bring many of those brave people together to solve for improved health.

I don’t equate my efforts with Jobs or King, but I am inspired by them and build my courage from theirs—hence, they are part of my collection of heroes.

This is the ecosystem of the Center for Health Value Innovation as well.  We have created a safe haven for implementing new models for health engagement, an innovation incubator that takes existing and emerging technologies and inserts them into these community models, and an educational resource that informs the general community through our website, summits, webinars and social media.

MLK: Faith is taking the first step even when you don’t see the whole staircase.

It’s imperative that there is a safe haven concept studio such as the Center (CHVI).  People need to know that there are others who have disrupted the status quo and who can share the learnings.  They need to know the first steps to creating the change and avoiding the pitfalls.  They need to know that, once they reset the course, they won’t be left without the map to the next location for supplies—that they can proceed on the course and, when they run into interference, others will help them through.  Vision without action is frustration.  Vision with first steps is the way out of a rut that is holding back progress.  If a company or a person comes to us with vision and faith, we help turn on the lights to the rest of the staircase. Sometimes, we even discover a better way to build the staircase together!

MLK:  All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence.

We are motivated by evidence.  We ask companies who work with us to share their findings and experiences in safe ways, never identifying the company unless the company says it’s ok.  Sometimes companies join our Center to purportedly share learnings, but actually to access leading innovators at big companies.  They quickly find out that they will get little support from us.  The excellence comes because we share with each other.  By creating a data repository of journeys, services that were used, and improvement in outcomes, we quickly can refer or connect organizations.  When the connections are made, the expectation is that a new level of data will come back to the repository.  The excellence in outcomes is sustained by the continual refreshing of the data metrics, which we track over time.

MLK:  Almost always, the creative dedicated minority has made the world better.

We are not a large organization.  Rather, we are a dedicated organization.  We are not solving for better health care—we believe that health care is a tool for better health.  We do not open our doors widely when we are testing a new model, as we’ve learned that others may not revere the confidentiality of a discussion intended to provoke thought.  In order to foster creativity, we respect our differences and leverage them for a better solution.  We understand that all companies are not large brand names and there are no “bad” companies or market segments.  We focus on narrow agendas in order to provide intelligent road maps to the marketplace as a whole.

MLK:  Our lives begin to end the day we become silent about things that matter.

There is no question that is too off-track, too elementary, too argumentative that we won’t ask.  There is no connection of innovation to models that we won’t consider if it’s novel and it’s potential for success has been excellently measured (and has a good chance of succeeding).  The energy in our discussions and presentations is palpable because we believe, en masse, that what we are doing truly matters.   We recognize that some may not move as quickly as we’d hoped, some may even abandon one model for awhile or for another.  But we continue to share among ourselves and with our communities.  We force conversations on their side so we can examine the hidden consequences of our actions.  We are far from silent on the topic that matters and unifies us: health promotion and disease prevention.

That’s who we are at the Center.  Some tell me that we are continually changing our definitions, but we believe we are refining and recommitting to new goals.  Some tell me that we are not growing our membership quickly enough, but we respond that members have to be comfortable with who we are and what we do, and sometimes that takes a bit of learning about us and experiencing our intensity.  Others join our efforts from tweets, posts and seminars in which we present data along with actionable steps for change, a methodology that is rare and based upon some experience and some faith.

Today I find it amazing that one year has passed since I wrote the E Pluribus Unum blog, calling for a commitment to doing better, reaching higher, and securing a stable environment for our children.  You may remember that I was moved by the death of a little girl in Arizona  (Christina) who had gone to meet her Congressional representative and was caught in the shootings that day.  I was overcome with sadness and hoping that others would help me and help them.

It’s amazing what vulnerability can bring.  Today I’m energized with hope and clarity of purpose: I will continue as a change agent for those who truly want to change.  Since last year’s blog, I’ve met new friends at more conferences and private meetings than I ever dreamed possible.  I hear daily from people who are doing nothing less than changing their communities, their companies or their personal lives for the better—and I’m quite sure that’s a commitment that tears at their souls, engages their intelligence, and delivers highs and lows on a daily basis.  I’ve grown more comfortable in admitting that I’m shamelessly working to improve health in America, that I revere the work of Dr. King and Mr. Jobs, that I’m honored to serve with the folks on our Board of Directors in improving the health and economic status of communities.

I’m excited to see who will knock on our door, or phone me on my, well, iPhone, or email me on my (you guessed it) Mac, asking for info or how to join or where we can meet or just chat.

On this day, let us all become disciples of Dr. King, building a better world in whatever way we can.  I hope that we all can stand up and say, “I have a dream…”

Allow me, then, to tie this to my passion for improved health.  To do this, I’m using some quotes from the Founding Fathers as well as some from more modern efforts.

We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness. This line from our Declaration of Independence, penned by Thomas Jefferson, captures the intent of the Founding Fathers (note: I’m choosing to translate “men” as the placeholder for both genders).  People are born with certain rights that must be protected and promoted.  Jefferson also linked the pursuit of happiness to the health of body and mind, writing,  “Happiness is not being pained in body or troubled in mind.”  He wrote, too, of purpose, education, and walking fast—all items that would enhance our life, liberty and the pursuit of happiness.  If one respects Jefferson, one respects health and understands that health grows as we acknowledge its importance in our pursuit of happiness, building wisdom and proficiency in managing our health.

Let us not proclaim infallibility. Benjamin Franklin thoughtfully considered every word and passage in our Constitution.  Writing that he could not proclaim that all evils were addressed in its words, he cautioned humility and the opportunity to let time judge the words—and then he signed the Constitution.  He was quite sure that it was better than any other guarantee of freedoms that existed: it was a game-changer.  He also knew that healthy living was a game-changer (“healthy, wealthy and wise…”), and he wrote of value in words that ring true today: “When the well’s dry, we know the worth of water.”  Today, the wells of both health and wealth are running low, with obesity on the rise, inactivity robbing our children of their future, and wealth stolen from them as we argue over “who pays.”  Our communities are paying, our businesses are paying, our government is paying, and all of those mean that we, individually, are paying.   Yet we behave as though our declining health is worth the lack of attention we personally give to it.  Unhealthy, un-wealthy, and unavoidably unwise? The fallacy of ignoring our personal health is the mounting debt that poor health leaves on all of us. That’s not the test of time Franklin, Jefferson, nor any of the Patriots envisioned. Young men, lean and often hungry and cold, fought for the freedom to pursue better lives, and their wives and sisters kept the spirit alive in every home.   The spirit of America demands we do better, that we are not infallible and can recognize our poor behaviors and change them.

The question isn’t who’s going to let me; the question is who’s going to stop me. Ayn Rand wrote these words.  For those of you too young to know her, she’s not a Founding Father but an insightful author.   Her words ring true on this day of Independence:  Each of us has, within us, something that causes us pride, rouses us in the morning, proclaims devotion to a significant other, perhaps a child, a spouse, or a higher purpose.  We support that flame of purpose by building a machine that can withstand the trials of both success and failure: a healthy body and mind.

I hope that this July 4^th, we each pause for a moment to declare our independence from poor health, poor wealth, and lack of wisdom to acknowledge the implications of both.  In America, we have the opportunity to do better for ourselves:  take a walk.  In America, we have the responsibility to do better for our families:  teach them healthful eating.  In America, we have the spirit to lift our communities to be the healthiest in the world, shining a new level of hope as a beacon for the world.  We have the tools, we have the model, and we have the obligation to those who came before us and those who will come after us to embody the freedoms we passionately defend.  On this July 4^th, I wish America well.

FOR IMMEDIATE RELEASE CONTACT:

March 15, 2011 Carl Graziano

(202) 737-5781

Care Continuum Alliance Releases Value-Based Addendums to Outcomes Guidelines

WASHINGTON, D.C. – The Care Continuum Alliance today released three addendums to its Outcomes Guidelines Report that illustrate how the guidelines’ evidence-based program measures can support a value-based benefits design framework developed by the Center for Health Value Innovation (CHVI).

The addendums build on work started in 2010 to combine the Care Continuum Alliance’s structure for measuring outcomes in population health management with the CHVI’s framework for “Outcomes-Based Contracting.” At the Care Continuum Alliance’s 2010 annual meeting, The Forum 10, the groups presented the concept during a joint educational session.

Each of the addendums released today includes a matrix that provides guidance on data and outcomes measures, incentive “levers” and delivery methods for three value-based design approaches: waste reduction, risk reduction and performance and productivity improvement. The addendums also include case studies keyed to each of the value-based design levels to demonstrate the various approaches in practice.

“Our collaboration with CHVI is a valuable extension of our Outcomes Guidelines work and these new documents show the synergy between our approaches to improving care quality and value,” says Jeanette May, PhD, MPH, Care Continuum Alliance research and quality vice president.

“The Care Continuum Alliance has repeatedly published the evidence of coordinated care management for better outcomes. Linking this with the work of our CHVI has been a joy, as it shows the alignment of incentives for better outcomes through engagement, accountable care and predictable cost trends,” says CHVI President and Co-Founder Cyndy Nayer, MA.

The Care Continuum Alliance last year produced a fifth volume of its landmark Outcomes Guidelines Report, an industry consensus, evidence-based approach to measuring clinical and financial outcomes in wellness and chronic care programs. The guidelines and new addendums are available as free downloads from the Care Continuum Alliance at www.carecontinuum.org.

# # #

About the Care Continuum Alliance

The Care Continuum Alliance represents more than 200 organizations and individuals and aligns all stakeholders in the care continuum toward improving population health. Through advocacy, research and education, the Care Continuum Alliance advances strategies to improve care quality and outcomes and reduce preventable costs for the well and those with and at risk of chronic conditions. Learn more at www.carecontinuum.org

About the Center for Health Value Innovation

The Center for Health Value Innovation (CHVI, 501c3) showcases evidence of improved health quality and economic trend through value-based benefit designs. CHVI has developed the Health Value Accelerator™ so that the market can use the evidence to improve business health outcomes. Evidence and Health Value Accelerator are available at www.vbheath.org

Five years ago, 5 of us came together to consider the establishment of an organization that would be a community of innovators to share evidence of improved health and performance through investments in appropriate healthcare services.  We each had very different competencies and reasons for our shared vision.  Only Jack and I remain quite visible in the Center; 2 have left to pursue their passions, and one remains on our Council of Advisors.  But Jack and I forged a bond that said our goal was clear and our visions/passions aligned:  innovators needed a “safe haven” in which to test ideas, share journeys, bolster courage, teach others.  We identified innovation in the market, and we frankly rarely spoke about Pitney’s example as we wanted to showcase innovation that was built on the needs and cultures of other companies; not every company would be identical to Pitney–not as large, not led by such an engaged CEO as Mike Critelli, but perhaps more innovative in other ways, led by CEOs who understood the value of their workforce as fundamental to their success.  So we catalogued the journeys of others, built comparative data that we showcased at conferences, hailed and called attention to new ideas and innovation.

Others joined the Center, from large and small companies, from each sector of the health value supply chain (health plans, health systems, physician organizations, non-profits, for-profits, consultants, academics, pharmaceutical and device companies, and more).  In each company, there were groups of new thinkers and, more importantly, do-ers, who were willing to share their stories, their challenges and their data to build a new pathway to improved outcomes.  We don’t all agree about everything, but that’s the beauty of our collective wisdom:  it feeds the curiosity without threatening the development of new ideas.  Together we focus on what we all view as important.  It’s the impact, not the inputs, that we have in our visions, the impact of improved health and economic outcomes, the very essence of health value, which Jack put in our title.

Now, Jack has received recognition for the work he has done for 15 years and more that added to the science of health and productivity management.  From our earliest phone conversation, where Jack and I shared our experiences and visions for engaging populations in the successful management of their health, we have traveled a long and sometimes circuitous route together.  We committed to each other, and a very cold Chicago meeting room, that we would see this Center to its founding purpose, to be the safe haven where new ideas could be shared and measured and communicated to and from the business community.  I’ve been lucky to share this road with Jack, and we have developed a strong bond.

That’s what I wanted to share with you about my business partner and friend, Jack Mahoney.  He wants patients to get the right treatment at the right time, as do all of us in the Center.  He’s not afraid to consider engagement opportunities, particularly for at-risk or vulnerable populations.  That’s what we built in the Center, and we will continue to amplify the successes.  We will focus on the impact, solving to equalize the incentives for all of the engaged, accountable stakeholders in the health value chain.  It will always be about the outcomes.

I’m sharing here an excerpt of the PR that the Pharmacy Benefit Management Institute released about the awardees.  And I’m also linking you to the PR and video that we shared at the conference this past week:  click here and listen to Jack’s acceptance so you, too, can get to know my friend Jack,  the architect of value-based benefit design.

SCOTTSDALE, AZ–(Marketwire – February 17, 2011) – The Pharmacy Benefit Management Institute (PBMI) has awarded four 2011 Rx Benefit Innovation Awards to the Center for Health Value Innovation, Cigna Pharmacy Management, CVS Caremark / Arcelor Mittal, and InformedRx, an SXC company. The awards were announced today at PBMI’s 16^th Annual Drug Benefit Conference in Phoenix.

The recipients of this year’s awards were selected based on the project’s overall originality, strength of reported results, and potential to improve patient outcomes. ”Our 2011 award recipients have demonstrated creative thinking by designing solutions to address numerous challenges in prescription drug programs,” says Tim Watson, PharmD, MBA, Executive Director of PBMI. “Their example will inspire other plan sponsors to implement one or more of these approaches in their own populations.”

Center for Health Value Innovation
The Center for Health Value Innovation is being recognized for their pioneering work in the design, implementation and measurement of Value Based Insurance Designs. The center’s co-founder and Chief Medical Officer, Jack Mahoney led the charge behind Value Based Design with a firm resolve to prove that lowering access barriers to health care services could ultimately engage the most at risk populations, thereby improving care and lowering costs. The center’s work to measure and disseminate outcomes associated with these design strategies continues to provide guidance to others who wish to implement these programs in their population.

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.

Among Dr. Mahoney’s comments on the challenges in implementing value-based designs:

People may be used to research conducted by double-blind randomized controlled trials or pure health economic or cost-effectiveness research. But the employer world is more experiential and decisions have to be made very quickly. You also have to live with the rules of the road for dealing with employees; you can’t really put people into randomized double-blind studies in the employer world.

Read the full interview.

ST.  LOUIS, Mo. – June 30, 2009 – The Center for Health Value Innovation, (www.vbhealth.org), the nation’s premier organization dedicated to establishing value and producing evidence for sustainable health and financial improvement, announced today that 11 of its member organizations received awards for the 2009 Best Employers for Healthy Lifestyles from the National Business Group On Health (NBGH; http://www.businessgrouphealth.org/).

NBGH is the nation’s only non-profit, membership organization of large employers devoted exclusively to finding innovative and forward-thinking solutions to their most important healthcare and related benefits issues, and its awards program acknowledges those organizations for their exceptional commitment to a healthy workplace and for helping their employees and families make better choices about their own health and well-being.

Recognizing The Center members which earned this distinction, Cyndy Nayer, president and CEO of The Center says, “Our member companies continue to be acknowledged for their cultures of health and emphasis on prevention and wellness, testimony to the success of value-based benefit design,” says Cyndy Nayer, president and CEO of the Center. “They are pioneers and innovators, demonstrating the power of consumer engagement to drive improved health, better outcomes and lower cost trends.”

These Center members earned the following NBGH 2009 Best Employers for Healthy Lifestyles Winners awards:

PLATINUM:  Recognizing established “Healthy Weight, Healthy Lifestyles” programs with measurable success and documented outcomes.

FPL Group
Hannaford Supermarkets
IBM
Pitney Bowes Inc.
Quest Diagnostics
(Campbell Soup Company is part of this award category.  While not a member of the Board of the Center, it is working with the Center and other companies in the Camden Counties Healthy Employees Consortium for an innovative model of value-based design).

GOLD:  For creating cultural and environmental changes that support employees who are committed to long-term behavior changes.

Chrysler Group LLC
Humana
Mayo Clinic
WellPoint, Inc.

SILVER:  For employers who have launched programs or services to promote living a healthier lifestyle.

sanofi-aventis U.S.

About The Center for Health Value Innovation
Information Exchange for Value-Based Design
Launched in 2007, The Center for Health Value Innovation is a multi-stakeholder not-for-profit (501c3) alliance focused on employers that drives the financial value of health dollars.  www.vbhealth.org.