Place Your 1 NASHP 24th ANNUAL STATE HEALTH POLICY CONFERENCE Quality Care and Timely Benefits: A Purchaser Perspective Joan M. Kapowich, R.N. Administrator Public Employees’ Benefit Board Oregon Educators Benefit Board Joan M. Kapowich

Place Your 2 Our Search for Quality Two benefit boards in Oregon responsible for 275,000 covered lives Both Boards, by statute, seek health plans that offer: -Creativity and innovation -Improvement in employee health -Plan performance and information -Affordable care -Flexibility in benefit design Boards focus on encouraging evidence-based care and improved health outcomes through value-based benefit design. Joan M. Kapowich

Place Your 3 Value-based Benefits Incentives & disincentives encourage evidence-based care 17 free preventive services since 2006 Free tobacco cessation Free weight management (minimum participation requirement) Free value medications – generics for chronic conditions Low cost office visits for chronic care treatment An additional cost for preference-sensitive care (spine surgery) Education shared decision support modules for members Extra $100 or $500 not subject to deductible or out-of-pocket Imaging, sleep studies, spinal surgery, hip and knee replacement, shoulder and knee arthroscopies, upper endoscopies Health engagement – mandatory health assessment & action steps Joan M. Kapowich

Place Your 4 Contracts Promote Value and Quality Patient safety – no reimbursement for never events Added requirement to use surgical checklists Patient Safety Commission told us our contract encouraged better compliance with their recommendations Decrease C-sections and elective inductions prior to 39 weeks fits with our patient safety focus and evidence-based care Contract language will include promotion of Baby Friendly Hospital certification or meeting the criteria without certification Use leverage as a large purchaser through contract language to improve the system Joan M. Kapowich

Place Your 5 Elective Inductions Before 39 Weeks In Oregon, it started at a lunch meeting early in 2011 A local physician with a plan (covered care for 8% of the births in Oregon) and a nurse with a local health plan started to talk Their shared interest in elective inductions led to a larger meeting with Portland area obstetricians and the March of Dimes (MOD) MOD offered to take on a collaborative effort and take on measurement Letters of support were solicited and mailed to all facilities Within six months, all facilities in the largest metropolitan area in Oregon agreed to ban elective inductions prior to 39 weeks Now we are moving that work to other parts of the state Joan M. Kapowich

Place Your 6 A Collaborative Venture Physician community Oregon Health Leadership Council – evidence-based committee State employees & their carriers are including contract language for facilities across the state to support a hard stop Oregon Health Plan – to adopt a hard stop for elective inductions MOD staff and a national ad campaign Local media, television and national news articles – National Public Radio Joan M. Kapowich

Place Your 7 Simple Tools Conversations with interested parties – facilities, MOD Use leverage of large purchasers – state employees, large companies Got a toehold – a wedge – using contract language to promote change with contract requirements Benefit coverage – can use reimbursement or non-coverage policies to modify care provision, same reimbursement for C- sections and vaginal deliveries Letters of support – Governor or other leaders Share successes – metrics are key Look for your next collaborative project Joan M. Kapowich

Place Your NASHP 24th ANNUAL STATE HEALTH POLICY CONFERENCE THANK YOU AND BE WELL! Joan M. Kapowich 8