Pay-for-Value in Healthcare & Equity

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Policy Readings Pay-for-Value in Healthcare & Equity

PBL 891 Health Policy S.B. ChatterjeeFall 2014

POLICY READINGS Pay-for-Value in Healthcare & Equity

Agenda

Defining Value in Healthcare

Connecticut Innovation Plan Proposal

Payment, Costs & Delivery Systems

Strategies for Value-based

Alternate Payment Systems

Volume-based to Value-based

Massachusetts P4P & Equity Lessons Learned

1

2

3

4

5

6

7


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Defining Value

In Healthcare

Mayo Clinic

New England Journal of Medicine

(Swensen, S. et al (2010))

Variables For Which The Provider Is At Risk Under Alternative Payment Systems.

Miller H D Health Aff 2009;28:1418-1428


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How Different Payment Systems Solve Different Cost/Quality Problems.



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Transition In Both The Payment And The Delivery Systems.


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First Curve to Second Curve MarketsVolume-Based to Value-Based Markets

Source: HRET - Second Curve of Health Care http://www.hpoe.org/resources/hpoehretaha-guides/1360


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Second Curve Evaluation Metrics:

SummaryValue-Based Strategies

Strategy #1: Aligning Hospitals, Physicians and OtherProviders Across the Continuum of Care

Strategy #2: Utilizing Evidence-Based Practices to

Improve Quality and Patient Safety

Strategy #3: Improving Efficiency through

Productivity and Financial Management

Strategy #4: Developing Integrated InformationSystems


Other Must-Do Health Care Transformation

Strategies (Strategies #5-10)

5. Joining and growing integrated provider networks and care

systems

6. Educating and engaging employees & physicians to create

leaders

7. Strengthening finances to facilitate reinvestment and innovation

8. Partnering with payers

9. Advancing an organization through scenario-based strategic,financial and operational planning

10. Seeking population health improvement through pursuit of the

Triple Aim (improving patient experience of care including

quality and satisfaction, improving the health of populations, and

reducing the per capita cost of health care)

Other Value-Based Strategies



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Strategy #1: Aligning Hospitals, Physicians and Other Providers Across

the Continuum of Care

First-Curve

Me

trics

Second-Curve

Metrics

Percentage of aligned andengaged physicians

Percentage of physician and

other provider contracts with

quality and efficiency incentives

Availability of non-acute

services

Distribution of shared savings /

gains to aligned clinicians

Number of accountable

covered lives

Percentage of clinicians in

leadership

Number of physicians

on staff

Financial profit and

loss from employed

physicians

Hospitalist utilization

Number of contracts

for non-acute services

Strategy #1: Aligning Hospitals, Physicians and Other Providers

Across the Continuum of Care


BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATIONMARCH 2012

MassachusettsSpends More on Health Care than Any Other State

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PER CAPITA PERSONAL HEALTH CARE EXPENDITURES, 2009

NOTE: District of Columbia is not included.

SOURCE: Centers for Medicare & Medicaid Services,Health Expenditures by State of Residence , CMS, 2011.

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

UT AZ GA ID NV TX CO AR CA AL VA SC TN NC OK MS OR KY MI MTNM IN IL KS WA LA HI IA MOWY NE SD OH FL WI MNMD NJ VT WV PA ND NH RI NY DE ME CT AK MA

State

NATIONAL AVERAGE
https://www.cms.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asphttps://www.cms.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asphttps://www.cms.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asp


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BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION

Massachusetts

Total Health Spending Will Double from 2009 to 2020

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ACTUAL AND PROJECTED MASSACHUSETTS TOTAL PERSONAL HEALTH CARE EXPENDITURES, 1991-2020

(BILLIONS OF DOLLARS)

SOURCES: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence , CMS, 2011; Massachusetts Division of Health Care Finance and Policy, Massachusetts Health Care Cost

Trends, Historical (1991-2004) and Projected (2004-2020), November 2009.

$20 $21$23 $24 $25

$27 $28$30 $31

$33$36

$39$42

$45$48

$52$56 $58

$61

$68$72

$77$81

$86$92

$97$103

$109

$116

$123

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

A CTU AL P ROJ EC TED

Year

Source: Alberti, et al. Making Equity a Value in Value-Based Health Care - Acad Med. 2013;88:16191623.

Health equity metrics in Pay-for-Performance

Population diversity unsupported

assumptions for target hospitals

Metrics burdensome adding to regularreporting

Top-down compliance ineffective structural

changes

MassachusettsLessons learned for Health Equity
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttps://www.cms.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asp


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Source: Connecticut Healthcare Innovation Plan

http://www.healthreform.ct.gov/ohri/lib/ohri/sim/plan_documents/ct_ship_2013_12262013_v82.pdf

Connecticut

Two tracks

Pay-for-Performance (P4P) rewards for

quality & care experience

Shared Savings Program (SSP) - share the

savings

Alignment of payers to reward structurestied to common scorecard (of P4P & SSP)

Value-based Payment Proposal

Thank you!

POLICY READINGS

Pay-for-Value in Healthcare & Equity

Documents

Pay-for-Value in Healthcare & Equity