Keeping An Eye On The Health Care Prize

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.

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.

Cyndy Nayer and John Riedel, Leveraging Health: A Primer for Health Promotion Practitioners using Value-Based Designs from Michaela Conley, HPCareer.Net on Vimeo.  Learn more about HPCareer.net here!

The Value of Dividends in Health: A Call to Align Stakeholders
Cyndy Nayer, MA
Center for Health Value Innovation, St. Louis, Missouri

ABSTRACT
Objective: The purpose of this paper is to describe the philosophy and utility of value-based designs (VBDs), with an eye toward defining a pathway for a shift to VBDs acros US businesses involved in the health care discussion.

You can read more by clicking here.   Clinical Therapeutics Value of Dividends-Nayer Drug Ben

The Value of Health in Health Reform

by Cyndy Nayer

Health care reform is the topic of every conversation, it seems, and many of these conversations are quite impassioned.

You can read more by clicking here.  Trends Nayer-Health in Healthcare Reform

Be sure to visit the AJPB website to access the full text to all the articles / issues  published online at www.ajpblive.com.

February 2, 2010 was our third birthday, and what a celebration was had!  We’ll be updating this post and adding more, but here are a few highlights for you:

JOHN J. MAHONEY MD AWARD for community health innovation was announced.  Polishing Jack’s star is hardly necessary, yet we created this award to expand the concepts and innovations in value-based benefit design that has made Jack the icon that he is.  For those who don’t know, Jack is a co-founder of the Center, serves as our Chief Medical Officer, and still spends a great deal of his time at Pitney Bowes and the Florida Business Health Coalition.  Pitney is where Jack created the first value-based benefit design–but what most don’t know is that it was focused on behavioral health  Rosenheck, Yale Pitney Bowes study EAP A surprise to Jack, this award is an innovator’s dream:  a Pay-it-Forward award.  Initial funding came through an educational grant from Johnson and Johnson Health Care Services, then the Center matched the funds.  Now, multi-stakeholder collaboratives within a community can apply for the $40,000 award and the Center will provide oversight, training, and suggest innovative technology that will fuel value-based benefit designs.  BUT THERE IS MORE:  The community that wins the award must contribute $40,000 into the award “pot” so that the next community that applies will get the same oversight, etc., as the first–that’s the cool Pay-It-Forward concept, and it’s just how Jack works!  He shares openly on his learnings, his experiences, and his challenges.  For more on the award, Mahoney Award App FINAL Dr. Cathy Baase of Dow, medical director for Dow, a member of our Board and an expert in community health improvement, will chair the judging committee–all applications must be received electronically at the Center no later than May 31, 2010.

Michael Taylor MD (Chairman of our Board) and Wayne Burton MD (new Strategic Advisor and Master of Ceremonies for the Award announcement) were nothing short of stellar at the Board Meeting.  You know Dr. Burton as the former Medical Director of JPMorgan Chase (and, before that, BankOne) and the research guru of Health and Productivity Management.  Mike, of course, is the Medical Director for Health Promotion for Caterpillar.  Over 80 people attended our Celebration and we inducted new members into the Fellows of the Center as well (more to follow later). Other luminaries included not only our Board of Directors, but also Mike Critelli (former CEO of Pitney Bowes and now the Chair of Dossia and the Dossia Foundation), Tom Parry (President of the Integrated Benefits Institute), Ron Loeppke MD (Chair of IBI, head of ACOEM’s HPM subgroup, and, now the President of US Preventive Medicine), Andy Webber (President of the National Business Coalition on Health), Tracey Moorhead and Jeanette May of DMAA: the Care Continuum Alliance (Tracey is President and Jeanette is VP of Research), Judy Cahill (Executive Director of AMCP), Sally Greenberg (Executive Director of National Consumer League) and Dr. Joycelyn Elders, former US Surgeon General and now a mainstay in our board meetings–she provides the inspiration close to the hard work we are all doing together.

Finally, at the Annual Meeting we launched the brand new survey that we commissioned from Buck Consultants (Michael Jacobs, National Practice Leader for Buck, is now on our Board of Directors).  Our goal was to survey experienced companies for their view of value-based benefit designs.  Key learnings:  87% use the VBD approach for prevention and wellness, 60% for chronic care management, and 26% for guidance in care delivery.  Most important learnings:  engage the employees faster AND make sure to engage the physicians/pharmacists/clinicians sooner.  CHVI-BUCK VBD 2009 FINAL- Report

We’ll be posting more here, but, as I head off to the IBI-NBCH meeting in San Antonio, I was determined to get the highlights up so you could all share!  Stay tuned, there is SO much more that we’re doing.

Be well,

Cyndy

Read the PR release jointly issued by the Center and Center for VBID here.  Release re MI Testimony October 22

Read Cyndy’s testimony here  C Nayer Testimony before Michigan House Committee

Read Mark’s testimony here Fendrick Testimony to Michigan 10.22