Purchaser Learning Group (PLG) May 10, 2016 Record of Learning
Coordinated by HCGC:
NOTES Welcome & Introductions (Tani Mann, The Dispatch Printing Company, HCGC Board) Purpose: To create a safe learning environment where leaders representing purchasers of health services (private and public self-insured employers, public retirement systems, health plans, regional employer health coalitions, and benefit consultants) discuss healthcare best practices and lessons learned. Aligning Public and Private Payment Innovations (Jeff Biehl, HCGC) Discussion Panel: • • • • •
Peter Accetta, MD, OhioHealth Group Jamie Brown, Ohio State University Physicians Sean Gleeson, MD, Nationwide Children’s Hospital Ben Shaker, Mount Carmel Health Partners Bill Wulf, MD, Central Ohio Primary Care
Discussions: From a provider perspective: What payment innovations are being used/tested/implemented in Greater Columbus to improve the value of healthcare? • Bundled payment models in alignment with Centers for Medicare/Medicaid • Full (pediatric) capitation for patients in/out of network. • Incentives for avoidable services that are not provided. • Population Health pilots - management of health of those seen and not seen in the doctor’s office. • Primary care with shared savings, leading to full risk. • Reducing gaps in care, aligned with quality measures. • Using information/analytics to improve discussions between providers, employers, plans. • Value based discounts from providers for payers who meet operational incentives (e.g. timely payment of claims)
NOTES What are we learning about what is working/making an impact? • • • • •
Care teams perceive shift to value will provide more time to manage/improve population health – it takes time to deliver high quality care. Disease management programs from payers work well when they are done in collaboration with PCP care teams/care coordinators. Impactful when positive patient outcomes & stories are shared to show value of investment. More effective to have provider colleagues share data/feedback with providers. They can present information in a way that is meaningful rather than just handing providers a report. Success with meeting patients where they are; example school based patient care.
What are we learning about what is not working? • • • • •
Attribution continues to be a challenge – hard to identify panel of patients with no standard across health plans. There was some common agreement that the single most helpful thing that employers could is require all employees to choose a PCP and then notify the PCP. Attribution method must be flexible enough to allow/recognize patient choice to change providers. Need to integrate telemedicine/on-demand access to primary care – move away from current model that requires travel to doctor’s office. This gains efficiency so that there is increased capacity in primary care and also provides a better patient experience as this is the preferred method of contact for many patients. Overutilization of ER as a result of inability to see physician when a need arises. PCPs recognize their responsibility to make themselves more available to patients when they need them. Behavioral health system is broken and patients are suffering. Self-insured employers challenged by analyzing data and making sense of what is/is not improving value.
Next Steps (Sarah Durfee, Ohio Public Employees Retirement System, HCGC Board) •
2016 Purchaser Learning Group Sessions: August 30, November 15
From your unique perspective, what was the value of today’s learning session? • • • • •
Very High Value: 56% High Value: 43% Medium Value: 1% Low Value: 0% No Value: 0%
NOTES As a purchaser, what topics would have the most learning value at future sessions? • • • • • • • • • • • • • • • • • • • • • • • • • • •
A data definition session of acronyms and their meaning. Behavioral Health physician on panel. Better use of data, providers of information systems and software. Continue dialogue regarding data/analytics. Continuing today’s discussion. CPC+/SIM synergies going forward. Effective strategies in changing employee behavior. How can the provider community help patients be better consumers? Can providers share the financial impact to patients for services? How do you evaluate physicians/systems given the shift from volume (discounts) to value? How members get attributed to providers and the differences there is from payor to providers. It’s nice hearing what all the providers are doing. How to better integrate value-based healthcare into plan design – preferably working with providers. Impact of care coordination and managing costs and outcomes. Learn more about attribution. Loved this discussion! Bringing representatives for each component (provider, employer, consultant, payor) is critical to finding solutions. Managing pharmacy spend and controlling the cost of specialty medications. Patient point of view and feedback. Paying to keep women of child-bearing age healthy – reduce infant mortality. Providers – learning what they may be doing: 1) direct to employee strategies, 2) virtual visits – are they developed their own options like the Cleveland Clinic Express Care on-line? Reduction of non-urgent emergency room – strategies that really work. Same as today, very helpful, explore best practices within the panel. Specialty drug perspective. Specialty drugs. Telemedicine. The overall value of payors, employers, and providers working together to provide quality affordable care while eliminating much of the waste. Ways to reduce waste in spending – what are payers paying for that we should not? What does the future look like for care delivery from a provider perspective? Fast forward 10 years. What we pay managed care to manage?
NOTES What are your ideas for engaging more purchasers in the learning sessions? • • • • • • • • • • • •
“Bring a friend” requirement. As the payers to invite. Ask each currently participating organization to provide the names of xx other organizations to be invited by HCGC and the current participant. Ask the payers to invite customers. Continued collaboration with employer collaborations. Emails to the audience with a hook on what will they get out of attending. Health plans talk to purchaser employers about what group is doing and its value/how can they help impact and affect change. Increase awareness. Integrated conversations between providers, employers, plans. Possibly expand discussions to broader areas of mutual initiatives. Providing a summary of the learning group and invitation to each session that can be shared with other purchasers. Use social media more to communicate the learnings and questions being addressed.