Purchaser Learning Group April 2015
‌ catalyzing the spread of healthcare best practices
www.hcgc.org
CO-LEARNING DISCUSSION
What is Price Transparency? • Price = an estimate of a consumer’s complete health care cost on a health care service that reflects: • Negotiated discounts • Inclusive of all costs to the consumer associated with a service • Identifies consumers out-of-pocket costs • Includes information that helps define the value of those services • Enables patients and other care purchasers to identify, compare and choose providers that offer the desired level of value SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Best Practice Features • Easy to use • Allow consumers to understand their share of cost, total cost and spending and utilization to date • Show quality measures • Side-by-side comparison of price and quality easily • Help consumers identify and understand value • Encourage consumer to use the tool
• Contain info on Rx and ancillary services • Help consumers avoid unneeded care and find less expensive options • Easily customized and easily integrated with other platforms and products • Give employers reports on utilization and savings and involves them in continuous quality improvement activities
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges 1. Incomplete definitions of medical episodes and small number of episodes and or procedures 2. Ignoring whether providers deliver needed versus unneeded care 3. Creating price estimates from a small number of cases 4. Not accounting for rate increases 5. Not using carefully chosen visuals that are easy to understand and accurately interpret SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions 1. Incomplete definitions of medical episodes and small number of episodes and or procedures Solution: • Have well constructed episodes of care • Help consumer distinguish between typical services and those associated with avoidable complications • Show estimate of average price of complications for long duration episodes • Provide consumers with complimentary quality information, especially outcomes where available SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions What challenges and opportunities exist to implement the suggested solutions?
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CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions 2. Ignoring whether providers deliver needed versus unneeded care Solution: • Take steps to education consumers about needed/recommended care • Create standard episode price based on recommended care and compare that standard to providers actual price • Help consumers identify potentially unneeded care SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions What challenges and opportunities exist to implement the suggested solutions?
www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions 3. Creating price estimates from a small number of cases Solution: • Don’t show price estimates when sample size is small • Include confidence intervals with the price estimate that make sense to a consumer • Disclose to consumer which provider’s price information is blocked due to contractual restrictions
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions What challenges and opportunities exist to implement the suggested solutions?
www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions 4. Not accounting for rate increases Solution: • Ensure published prices are adjusted to reflect most recent negotiated fees or indicate the year for which the price was calculated
SSource: Catalyst for Payment Reform – Accuracy of Price Transparency Tools Brief www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions What challenges and opportunities exist to implement the suggested solutions?
www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions 5. Not using carefully chosen visuals that are easy to understand and accurately interpret Solution: • Experiment with most effective means of communicating price info to various audiences
www.hcgc.org
CO-LEARNING DISCUSSION
Price Transparency Tool Challenges and Solutions What challenges and opportunities exist to implement the suggested solutions?
www.hcgc.org
About HCCI HCCI is a non-profit, independent, non-partisan research institute dedicated to creating the United States’ most comprehensive source of information on health care activity and promoting research on the drivers of health care costs and utilization. Founded in 2011
•Public mission - improving US health system by creating comprehensive data infrastructure and analytics •Research - We currently hold claims, with allowed amounts, for more than 50 million Americans, from 2007 onward which we make available for academic, non-commercial research •Support from Aetna, Assurant Health, Humana, Kaiser Permanente, UnitedHealthcare. Foundation support/contracts with Robert Wood Johnson, Pew, Commonwealth Fund, John and Laura Arnold Foundation
Current and Future HCCI Data HCCI currently holds claims data on 50 million people per year (2007 – 2013)
2014 •
Administrative Claims
2015 •
– employer-sponsored insurance – individual insurance; – Medicare Advantage (Part C)
• • • •
All 50 states and D.C. Updated annually HIPAA-compliant, de-identified Vermont data for public reporting purposes – other APCD data
By end of 2014: – Medicare (2009+) through Qualified Entity Program • Part A (100%) • Part B (100%) • Part D (~40%)
• • •
In 2015, data from State APCDs Other commercial data from additional insurers SGR fix – Medicaid and CHIP
Everything HCCI does is HIPPA and anti-trust compliant and protective of company information
We do have to keep in mind when publishing cost data that Cost and Quality do NOT Correlate
“Unfortunately, the published literature does not provide clear input on [the relationship between quality and cost]. Our systematic review found inconsistent evidence on both the direction and the magnitude of the association between health care costs and quality.�
Hussey PS, Wertheimer S, Mehrotra A.The Association Between Health Care Quality and Cost: A Systematic Review. Annals of Internal Medicine, 2013, 158(1):27-34.
Bill Frist, M.D.!
CO-LEARNING DISCUSSION
LEAPFROG GROUP: Predicting Patient Survival
www.hcgc.org
Our Strategic Areas of Focus PATIENT-CENTERED MEDICAL NEIGHBORHOOD …improve care coordination between providers & social services
QUALITY TRANSPARENCY …improve the use of quality data
…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers
PATIENT ENGAGEMENT …improve engagement between patients and providers
www.hcgc.org
COLLABORATIVE LEARNING …improve the application of learning in Greater Columbus
Advisory Discussion
• Regional Quality Reporting Project • State Innovation Model (SIM) Report Update • Benefit Consultant Learning Group
www.hcgc.org
Regional Quality Reporting 2015 Approach voluntarily demonstrating their value hospital-owned practices private practices federally qualified health centers Sharing all-payer quality data from Electronic Medical Records (EMR) Cancer Diabetes Heart
Regional Quality Reporting Website (refreshed every 6 months starting Q4 2015)
promote regional website
Regional Consumer Reports Insert Q1 2016
Healthcare professionals identifying opportunities for improvement Purchasers seeing value from the care they are buying Patients making better informed choices about their care
primary audience www.hcgc.org
OHIO: Public-Private Healthcare Innovation Plan (SIM grant)
5-Year Goal for Payment Innovation Goal State’s Role
Year 1
Year 3 Year 5
80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years
▪ ▪ ▪
Shift rapidly to PCMH and episode model in Medicaid fee-for-service Require Medicaid MCO partners to participate and implement Incorporate into contracts of MCOs for state employee benefit program
Patient-centered medical homes
Episode-based payments
▪
In 2014 focus on Comprehensive Primary Care Initiative (CPCi)
▪
▪
Payers agree to participate in design for elements where standardization and/or alignment is critical
▪
State leads design of five episodes: asthma (acute exacerbation), perinatal, COPD exacerbation, PCI, and joint replacement
▪
Multi-payer group begins enrollment strategy for one additional market
Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year
▪ ▪ ▪ ▪
Model rolled out to all major markets 1. ▪ 2. 50% of patients are enrolled 3. 4. ▪ Scale achieved state-wide 5. 80% of patients are enrolled
Perinatal 20 episodes defined and launched across Asthma payers acute exacerbation COPD exacerbation Joint replacement 50+ episodes defined and launched across Percutaneous coronary intervention (PCI) payers
OHIO: Public-Private Healthcare Innovation Plan (SIM grant)
OHIO: Public-Private Healthcare Innovation Plan (SIM grant)
What are your reflections and questions?
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