1. Employers, Coalitions and Health System Transformation
Presentation to
Florida Commission on Healthcare and Hospital Funding
Laurel Pickering, MPH
President & CEO
Northeast Business Group on Health
August 31, 2015

2. Agenda Why Employers Matter in Transformation Coalitions and NEBGH
New York’s Health System Transformation
Commission Topics of Interest
Leapfrog: Transparency of hospital quality and safety

3. Transforming Healthcare Why Employers Matter
Employers pay for healthcare
Employers can improve access to high-value care solutions
Employers can implement health and wellness initiatives
Employers can use benefit design
Employers can engage employees and create a “culture of health”
Employers hire numerous vendors to fill gaps in the system

4. Supporting Employers as Purchasers: Regional Business Coalitions:
Groups of employers within a local or regional community collaborate to influence their healthcare delivery systems to achieve greater value
Coalitions began in the early 1980’s; Now more than 50 local and regional coalitions around the country
Vary in size, model, and member composition
Represented in Washington, D.C. by the National Business Coalition on Health (NBCH)

5. What do coalitions do? Education Leverage Commercial Purchasers
Products &
Services
Drive Value
And
Improvement
in the
System
Business
Community
Leadership
Delivery
System
Evaluation
Community
Stakeholder
Convenings

6. Northeast Business Group on Health
Represents 70 employers based in New York, New Jersey, Connecticut and Massachusetts – many are large national, self- insured employers
Employer driven and multi-stakeholder: 180 members also include health plans, providers, benefit consultants, suppliers and other stakeholders
Represents about 12 million covered lives
Use employer purchasing leverage to drive value in the system
Mission: Empowering our members to drive excellence in health and achieve the highest value in healthcare delivery and the consumer experience

7. NEBGH Employer Members7

8. NEBGH Activities Education Vendor Management
Health plan evaluation (eValue8)
User Groups: Aetna, Anthem, United, Kaiser and PBM
Multi-Stakeholder Collaboration
Diabetes
Weight Management
Cancer
Readmissions
Integrating Behavioral Health into Primary Care
Leapfrog
HealthPass
Future: Direct Contracting

9. “You have to have a collaborative force to push back on the status quo”
Don Berwick, former Administrator of the Centers for Medicare and Medicaid Services

10. One of the nation’s oldest, most successful small business, multi-carrier private exchanges (est. 1999)
2-50 employees (expanding to 100)
Public/private partnership; seed money from City of New York
Over 15 years, insured 14,000+ small businesses and 175,000+ members
Owned by NEBGH

11. New York State: Charting a New Course

12. The Vision Healthier New Yorkers (population health) Lower costs
Engaged consumers
Systems, programs, financing, policies that support and value these goals
Triple Aim
Wasn’t sure how to capture what she wanted here.

13. State Health Innovation Plan (SHIP) Goals
Identify and stimulate the spread of promising innovations in health care delivery and finance that result in optimal health outcomes for all New Yorkers.
Population Health Goal of the SHIP:
Improve population health through strengthened capacity and improved screening and prevention through closer linkages between primary care, public health, and community based supports.
2020 Goal: Achieve top quartile performance among states in prevention and public health

14. Shift to Payment for Value
Fee-for-Service
Payment for Value
More services and more complex services drive higher payments
Time spent coordinating care generally not paid for
No rewards for better quality and outcomes; ‘re-work’ rewarded
Focal point is the provider and the procedure
Better practice of medicine and better outcomes drive higher payments
Coordination of care paid for
Focal point is the ‘whole person’
Incorporates population health management

15. The Source of Funds (SHIP/DSRIP)
Strong, expert, coordinated state leadership can create value over the next four years
DSRIP
Advanced Primary Care
Capital Restructuring
Common Scorecard
Prevention Agenda
NY State of Health
Rate Review
SHIN-NY
PHIPs
SIM Testing Grant
Statewide leadership
Stakeholder alignment
Multi-payer business design and support
Workforce strategy
NY SHIP value-based purchasing
APD
Currently funded
Planned SIM funding
Multi-payer funding

16. The Acronyms ACA – Affordable Care Act
ACO – Accountable Care Organizations
APC – Advanced Primary Care
APD – All Payer Database
DSRIP – Delivery System Reform Incentive Payment Program (Medicaid)
PHIP – Population Health Improvement Program
SHINY-NY – Statewide Health Information Network for New York Systems
SHIP – New York State Health Innovation Plan (all payers)
SIM – State Innovation Model (all payers)
Wasn’t sure how to capture what she wanted here.

17. Why Advanced Primary Care?
Primary care is viewed as the foundation of value-based care and the Triple Aim, focused on:
Prevention
Care coordination (particularly for chronic conditions)
Management of complex/multiple conditions

18. SIM Grant
The Affordable Care Act (ACA) created State Innovation Model (SIM) grants
To qualify, States must demonstrate commitment to multi-payer health care payment and delivery reform to:
Improve health system performance
Increase quality of care
Decrease costs

19. SIM Grants

20. New York State SIM Grant
New York received a $100 million four-year grant
Two-thirds ($67 million) of the funds will be invested in practice transformation
The New York SIM grant is focused on transforming and strengthening primary care based on the Advanced Primary Care (APC) approach
State Goal: 80% of residents with access to primary care under a value-based payment model by 2019

21. Multi-Payer Collaboration is key
Greater impact on health care delivery
Less complexity for primary care practices – particularly smaller practices
More consistency for consumers/patients
“Successful multi-payer alignment can amplify the impact of payment and delivery system reforms by sending consistent incentives to health care providers and aligning performance measurement”
Millbank Memorial Fund/Pacific Business Group on Health
All Aboard: Engaging Self-Insured Employers in Multi-Payer Reform

22. Role of NEBGH with NYS Reform
How come about?
No long standing relationship
NEBGH had a vision and track record of working with self-insured employers and multi-payer projects
Our Role:
Engage and gather input from payers (health plans and self-insured employers) and regional collaboratives
Help move towards multi-payer approaches
Provide feedback to New York State

23. HIT, Transparency and Evaluation
SIM Structure
Health Innovation Council
Integrated Care
Create an advanced primary care delivery model, inclusive of behavioral and population health, and payment methodology that is reasonable, workable, and sustainable and achieves the Triple Aim to ensure access to high quality, cost effective care for all New Yorkers.
HIT, Transparency and Evaluation
Modernize care delivery to best maximize new technologies that enable enhanced communications between care providers and that are able to utilize data to inform care, assure quality and promote value.
Workforce
Support training the next generation of the healthcare workforce who will function in a system that is better integrated and includes a strong focus on behavioral and population health.
Access to Care
Elimination of financial, geographic, cultural and operational barriers to access appropriate care in a timely manner.

24. This initiative will create benefits across the system
Consumers
Employers
Primary Care Providers
Improved health
Better experience, more coordination
More sustainable costs
Higher productivity
Less need for vendors to fill in the gaps
More focus on the patient
Better practice of medicine
Resources for practice transformation and ongoing support
More aligned measures and reporting
Health Plans
Greater impact from primary care initiatives
Resources for practice transformation

25. Topics of Interest to the Commission

26. Convincing Providers to Share Data
What’s in it for them?
If data is just based on claims it will be inaccurate.
No one wants inaccurate data to be used for public reporting or payment
Better ability to manage health of the patient if data is collectively shared and used

27. Quality Measures
How important is for payers to use consistent measures? Critical, but very difficult
Does NEBGH have an interest in quality measures in Medicaid? Up until now we really haven’t. SIM project changes a lot
Readmissions…did we agree on a methodology among payers? We focused on resources, not rates initially

28. Challenges Measuring Quality
Hospitals easier to measure than physicians
Groups of physicians easier to measure than individual physicians
Individual physicians is what consumers care most about
If individual physician data is publicly reported, data accuracy is critical
Not many public sites report individual physician performance
Funding

29. APCD and Public Reporting
Reasons why All-Payer Databases are Critical
Benefit to State
Complete picture of what care costs, how much providers receive from payers for same and similar services, the resources used to treat patients and variations across the state and among providers in the total cost to treat an illness or medical event
Benefit to Providers
Providers get a complete picture of their population
If insurers provide their own reporting, providers may look different across insurers. Particularly problematic when tiering
Benefit to Consumers and Businesses
Performance and cost data available regardless of insurer
Can use information to make better-informed decisions about cost-effective care
Benefit to Insurers
Comprehensive data to make better-informed decisions about cost –effective care

30. Healthcare as a Business Challenge
Cadillac tax has made healthcare a major business challenge.
Employers at a crossroads: actively manage healthcare to get reductions in costs (wellness, care management, value-based benefit design, incentives, onsite clinics, work directly with providers, reference-based pricing, etc.) or go to a defined contribution approach and private exchange
Almost all employers are offering high deductible health plans

31. Purchaser-driven nonprofit publicly reporting on hospital quality and safety
Founded by purchasers in 2000 in response to 1999 IOM Report To Err is Human
The right care at the right price, while empowering consumer decisionmaking

34. The Leapfrog Hospital Survey
One-of-a-kind
A free, voluntary survey on measures of hospital performance important to purchasers
Completed annually by over 1,500 hospitals from across the country
Measures unavailable elsewhere on the national level
Gold standard in transparency
Used by plans, vendors, and purchasers

35. What’s in the Leapfrog Hospital Survey
How patients fare
Survival Predictors
Infection rates
Maternity measures
Resources used in caring for those patients
Readmission rates
Length of stay
Management practices that promote safety
NQF-endorsed safe practices

36. Breakthrough Legislation in Michigan to Require Hospitals Report to Leapfrog
On June 3rd , the Michigan Legislature passed a law effectively requiring hospitals to fully complete the Leapfrog Hospital Survey in order to be eligible to receive graduate medical education funding. 57 Michigan Hospitals receive this funding, and a good number of them currently decline to report. This is the first time any state has required Leapfrog.

38. Laurel Pickering President & CEO Northeast Business Group on Health x224