NBCH’s 2009 eValue8™ Results Stress Importance of Focusing on Keeping People Well, Not Just Treating the Sick

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Health care purchasers and coalitions are doing their part to reform the health care system at the point of care

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Perhaps more than most, employers understand that the U.S. needs an efficient health care system focused on illness prevention, care coordination, chronic disease management, and incentive alignment to reward higher quality and improve patient outcomes

Today, the National Business Coalition on Health (NBCH), a non-profit organization of employer-based health coalitions, released the 2009 findings for the eValue8(™) RFI (Request For Information) tool used by its member coalitions and purchasers to compare the quality and efficiency of America’s health plans. The findings indicate that health care purchasers and business health coalitions are seeking to reform the health care system from the ground up working with health plans on improving the various dimensions of care delivery. While national health care reform efforts continue, coalitions and their employer members are also doing their part to improve the system at the point of care.

“Perhaps more than most, employers understand that the U.S. needs an efficient health care system focused on illness prevention, care coordination, chronic disease management, and incentive alignment to reward higher quality and improve patient outcomes,” said Andrew Webber, president and CEO, NBCH. “eValue8 helps employers and health plans to form a partnership dedicated to doing more than respond when patients get sick. To keep employees out of the health care delivery system, employers are making significant investments in health and wellness programs.”

eValue8 is the nation's leading standardized RFI tool used by employers and coalitions to gather health care data from 73 HMO and PPO health plans. More than 96 million Americans, or about two-thirds of those insured by employers, are members of health plans that respond to eValue8.

2009 eValue8 Findings
– Payment reform: eValue8 asks plans what they are doing to alter the toxic fee for service payment incentives by shifting payments to relate more to outcomes and adherence to clinical guidelines. Plans that report using clinical results as a factor in determining financial rewards for physicians was 57%. Regional plans are more likely to do this compared to national plans (62% versus 53%). For hospital rewards, regional plans are more likely to offer financial rewards based on clinical results (50% versus 33%). Use of patient experience is less common than clinical results for hospitals (as with physicians) and this is more commonly used as a factor by regional plans to determine financial rewards.

– Coordination of care: Plans are making progress on leveraging information and technology to improve the health status of their members. eValue8 determines whether plans track the absence of age and disease-specific services needs like cancer screening for age- and gender-appropriate members and blood-sugar tests for members with diabetes. eValue8 indicates that 77% of the plans reported providing gap reminders for breast cancer screening, but only 54% for cervical cancer. Over 90% of plans report providing reminders to members and their physicians for gaps in care for diabetes and heart problems.

Coordination with physician offices is also important to coordinate care and plans have much to do in this realm, especially in areas like tobacco cessation and obesity. Very few plans coordinate with physicians to identify and treat members in need of intervention and services for prevention and chronic conditions and coordination for behavior health services is even lower. There is a drop-off of physician coordination comparing diabetes to depression and a more significant drop off comparing depression to alcohol dependence.

– Plan design: eValue8 examines four distinct areas of consumer choice to align consumer incentives with desired behavior: choice of wellness/prevention behaviors (e.g. controlling weight and completing cancer screenings), adhering to chronic condition maintenance guidelines, choice of more cost-effective acute care treatment alternatives and choice of better performing doctors and hospitals. Incentives for preventive services are very common and almost all plans offer products that waive copays for preventive services like breast cancer screening and annual physicals.

Adjusting copays and deductibles for services to chronic patients can be much more complex, especially if combined with the goal of lower out-of-pocket liability available only to targeted plan members or contingent on adherence to clinical guidelines. In spite of this, over 60% of the plans report the ability to administer such plans.

“Value based purchasing is important to our business-health coalitions and their member employers because it is an approach to contracting that promotes high quality care at the best price,” said Cristie Upshaw Travis, CEO of the Memphis Business Group on Health and NBCH’s board chair. “eValue8 allows us to measure how successful health plans have been in a variety of measures and to determine what’s working as well as areas for improvement.”

By working together, employers, health plans and coalitions are transforming the delivery system away for one that focuses almost exclusively on acute care illness to one that promotes health, prevents illness, coordinates care delivery, and manages the care of those with chronic disease and acute conditions efficiently and effectively.

A publicly-available report on the findings will be available later this year. George Washington University’s Center for Integrated Behavioral Health Policy analyzed the data.

About the National Business Coalition on Health and eValue8
NBCH is a national, non-profit, membership organization of more than 60 business and health coalitions, representing over 7,000 employers and 25 million employees and their dependents across the United States. NBCH and its members are dedicated to value based purchasing of health care services through the collective action of public and private purchasers. eValue8™ is a product of the National Business Coalition on Health and is the nation's leading evidence-based request for information (RFI) tool used by coalitions and major employers to assess and manage the quality of their health care vendors. For additional information visit: http://www.nbch.org.

Join us for the 2010 IBI/NBCH Health & Productivity Forum, February 8-10, 2010 in San Antonio.

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