Transcript Value-based Benefits

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
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Joan M. Kapowich
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Our Search for Quality
Two benefit boards in Oregon responsible for 275,000 covered lives
Both Boards, by statute, seek health plans that offer:
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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.
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Value-based Benefits
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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
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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
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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
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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
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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 Csections and vaginal deliveries
• Letters of support – Governor or other leaders
• Share successes – metrics are key
• Look for your next collaborative project
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NASHP 24th ANNUAL
STATE HEALTH POLICY CONFERENCE
THANK YOU
AND
BE WELL!
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