Transcript January Member Meeting: Year-end Review

Year End Review
New Year Preview
January 20, 2016
Welcome!
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Leadership in Action
The Action Group Board of Directors
Nathan Moracco
Assistant Commissioner Human
Services
Deidre Serum
Sr. Director of Employee Benefits
Rewards Team / HR
Jon Born
Director, Health and Welfare Benefits
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Ken Horstman
Director, Benefits and Compensation
Human Resources
Karen Chapin*
Health Programs Manager
Jon Schloemer
Benefits Manager
Gretchen Lennon*
Benefits Manager
Our Members
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The Action Group Value Proposition
We understand and address top-of-mind business concerns
related to health care:
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Cost pressures
Workplace and community health
Legislative burdens
Ineffective, confusing, expensive care delivery
Value of providing related benefits
Vendor performance
We help purchasers take action that will lead to:
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More affordable and predictable health care costs
Improved quality of care and services
Enhanced employee satisfaction with benefit offerings
Improved and new policies and programs that drive the system
The Year in Review
2015 Highlights
Minnesota Bridges to Excellence
MNBTE
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Care Delivery Learning Network
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Learning Networks
Becoming Better Purchasers
Deep dive into overuse, high cost, and variability
2012
2013
2014
2015
Back Pain/Surgery
Early 2012 – June 2013
Maternity/
Infertility
July – December 2013
Hip and Knee
Replacements
January – July 2014
Specialty Pharmacy
Phase I
October 2014 – April 2015
Specialty Pharmacy
Phase II
May – December 2015
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Typical Learning Network
MARKET
ASSESSMENT
•What’s wrong
•What’s right
•Who’s doing what
•Identify key providers
PURCHASER’S
GUIDE
•Current state
•Questions for providers
•Questions for vendors
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VALUE
STATEMENT
COMMUNITY
DIALOGUE
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Key note expert
Respondents
Health plan
Purchaser
Providers
Facilitated discussion
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Evidence-based
Consumer engagement
Transparency
Aligned incentives
HEALTH PLAN
CONVERSATIONS
PROVIDER
CONVERSATIONS
• Value statement feedback
• Current approach to
increasing value
• Future plans
• Leading providers
• Value statement feedback
• Comparison to value
Why the Specialty Pharmacy Learning
Network is different
© Minnesota Health Action Group; confidential – do not copy or distribute without permission
Phase I Learning Network Key Informants
2014/15 Key Informant / Agenda
October
November
December
January
February
March
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Goals
The Pharmaceutical Landscape
Dr. Stephen Schondelmeyer
Orientation, supply chain, relationships, key problem areas, possible
solutions as individual organizations, collectively in this market,
public policy actions and positions
Medical and Business Ethics
Understanding key ethical issues
What Does the Data Say?
Understanding the medical side of specialty pharmacy and
recent cost saving interventions
Specialty Pharmacies
• Prime Therapeutics
• Fairview
• Lumicera
• US Bioservices
Compare models, operations, services, revenue sources,
outcomes, organizational relationships of specialty pharmacies;
how to evaluate performance and value
PBM Consultants
Key interventions to increase value: benefit plan designs, narrow
networks, PBM performance, carved-out specialty pharmacies,
evaluating, managing and integrating the medical side
HealthPlan Medical Directors
& Pharmacists
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BCBSMN
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HealthPartners
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Medica
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PreferredOne
Compare and contrast health plan overall specialty pharmacy
strategy and management of medical specialty pharmacy,
operations and value
Phase I Wrap-Up and Next Steps
National organizations and trends, key lessons learned, possible
individual, collective and policy actions
Phase II Learning Network Key Informants
2015
Key Informant / Agenda
May
June
July
Employee Survey Summary
Compare practices across employers
Data Analysis Priorities & Presentation
Hear data analysis capabilities of vendors to drive priorities
and decisions, determine next steps
NDC Market Strategy & Tactics
What to Expect for Reporting from
PBMs and Health Plans
PCSK9 Facts
Improve quality, transparency of medical specialty reporting with NDCs
Manage new PCSK9 drugs
Employer Survey Results—Deep Dive
Learn from others
Employer Ongoing Pipeline Management
Prepare for financial aspect of all new drugs
Review NDC statement
NDC Value Statement
August
September
October
December
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Goals
Receive actionable, useful vendor reports
Clinical & Utilization Management
• PA/Step Therapy
• Carve Out Vendor Proposals
• Coverage, Quantity Limits,
Reference Pricing
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Prioritize Vendor Meeting Agendas
Plan for vendor meetings
Vendor Meetings
• Medica
• Prime Therapeutics
• HealthPartners
• CVS
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Understand and compare current practices
Communicate employer goals, time frames, and specific deliverables
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Understand provider perspective
Communicate employer goals and perspective
Policy Actions through Direct Communication
with State and U.S. Policy Makers
Develop 2016 Mobilization Plan
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Understand current practices, strengths, weaknesses, identify new needed
capabilities
Develop Clinical and UM principles-contract language
Review PA outsource options
Brainstorm new models around patients and employers
Annual Employer Benefits Survey
2015
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Minnesota Health Action Group Survey
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The only resource that provides comprehensive health benefit
benchmarks from Minnesota employers; designed by employers.
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Deliverables
– The report from survey responses compares and summarizes
participant views on:
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Health benefit planning and goals
Medical plan costs and contribution rates
Local health plans
Prescription drug coverage and costs
Health improvement solutions
Incentives
Other services and vendors − strategies and tactics
Retiree medical benefits
Eligibility
Thoughts on how to improve the health care system and health reform
Survey participant organizations
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Executive Summary
• Minnesota is slightly higher on health care costs when
compared to national averages
• Action Group members outperform non-members on cost
• Virtually all employers surveyed offer incentives for wellness
programs (94%, versus 56% nationally)
• Companies are sticking with their health plans, despite
average satisfaction
• No overwhelmingly consistent cost-savings strategies. Lots
of tactics. Lots of vendors. Neutral ratings
• Worried about reporting and tax burdens of ACA
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Do you set annual goals for your health
benefit planning?
2014
Premium
Trend
Planned
Budget
Increase
2015-2016
Yes. Concrete
and measurable
2.6%
2.9%
Yes. Less formal
and more
directional.
3.7%
5.8%
No
3.7%
9.7%
One quarter of respondents report having concrete and measureable goals for their health
benefit planning. Nearly six in ten say they are directional. Those that have set concrete goals
have experienced lower premium trend and smaller increases to their budgets.
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What is your contribution strategy for this
coming year 2016?
Defined contribution approach to shifting premium, sharing additional costs with employees through plan design changes,
and covering less for dependents are leading means to sharing additional health care costs with employees. Other
responses were adjustment to premium credit calculation, add smoking surcharge, and union negotiated contributions.
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What health plan and contribution design tactics have
you or are you planning to use to control trend
increases?
Currently Using
Contemplating
Implementing
Not Interested
Consumer education
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2
1
0
Consumer directed health plans
30
1
1
3
Dependent eligibility audits
24
6
0
5
Added additional health plan options
23
2
1
6
Increased deductibles
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7
3
3
Consolidated plan designs
14
7
1
9
Defined contribution
12
7
0
9
Increased copays
12
11
0
8
Eligibility changes for employees
11
2
0
17
Increased coinsurance
10
11
1
9
Changes to definition of dependents
5
3
0
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Smoking surcharge*
5
9
0
15
Spousal surcharge*
5
8
0
14
Value-based plan designs
5
12
1
7
Spousal exclusion
2
8
0
17
Exit strategy for health benefits
1
2
0
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*Average monthly amount for smoking surcharge = $43.50
*Average monthly amount for spousal surcharge = $108.50
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For value based plan designs, which of the
following are you rewarding with a richer
design?
Disease management programs and generic Rx are used the most frequently as a mechanism for
a value based plan design. Specific health conditions mentioned were diabetes and joint
replacement. Other responses included health assessment and wellness activities.
*Variation in year to year results will be partially due to changes in survey participants year over year. Please note when
making comparisons on a year over year basis.
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Who is your health plan vendor?
82% of respondents have HealthPartners, BCBSMN and/or Medica as a health plan vendor.
Only 16% of respondents offered more than one health plan vendor.
Other responses were Humana and MCHS
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What prescription drug tactics do you have to control
costs, especially for high-priced medications?
Currently Using Contemplating Implementing
Not Interested
Prior authorization for specific drugs
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1
0
0
Step therapy for specific drugs
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1
1
1
Limit supply / partial fill programs
15
3
0
5
Negotiated percentage of rebates
14
5
0
6
Carve-out specialty pharmacy
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6
1
8
Customized formulary based on employer goals
8
5
0
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Narrow retail pharmacy networks
5
8
0
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Guarantees on medication adherence
2
8
0
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Other
3
0
0
0
The two most popular tactics for controlling prescription drug spending among respondents are
requiring prior authorization for specific drugs and step therapy, although a lot of thought is being
given to narrow networks and medication adherence guarantees. Nothing was listed for any
respondents who chose other.
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Which of the following wellness components/strategies
do you have or plan to use?
Currently Contemplating
Implementing
Using
Adding
Average
Effectiveness in
Not Interested
Participation / Achieving Goals
in
Engagement
(1=Poor,
Implementing
Rate
5=Excellent)
Competitions
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1
0
2
19%
2.9
Health risk assessments
28
1
0
1
55%
3.1
Nurseline
25
0
0
4
17%
3.0
Biometric testing
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4
0
2
63%
3.4
Telephonic condition
management programs
23
1
0
2
34%
3.3
Online wellness programs
22
1
1
3
40%
2.9
Measuring health outcomes
and improvement
19
3
2
3
55%
3.0
Onsite fitness programs
18
2
0
3
15%
2.7
Online condition management
programs
16
3
1
4
17%
2.7
Onsite fitness center
12
1
1
8
18%
3.0
Onsite wellness coach
6
3
1
10
47%
3.3
Onsite nurse
6
3
0
13
22%
3.8
Although a number of wellness programs/strategies/tactics are currently being used,
approximately 6 per company, overall effectiveness for the majority of them hovers around neutral
APPENDIX: See appendix to see specific wellness vendors and ratings by employer (de-identified)
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What type of incentives have you offered?
Strong carrot-type incentive are most popular in gift cards and paycheck premium
differential incentives. Penalties lag behind. Other responses were paid time off, cash,
reimbursement of up front fees, and lump sum on paycheck.
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What is the trigger for a participant to earn
the incentive?
Engagement is still king for earning wellness incentives, but outcomes-based incentives are gaining
momentum.
*Variation in year to year results will be partially due to changes in survey participants year over year. Please note when
making comparisons on a year over year basis.
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APPENDIX: See appendix to see specific vendors
and ratings by employer (de-identified)
Other Program Usage
Disease Management
Telemedicine/Virtual Provider Visits
Centers of Excellence
Retail Clinics
Mobile Devices/Applications
Transparency Around Price
Medication Therapy Management
Transparency Around Quality
Treatment Decision Support
Reporting Specific to Quality
Second Opinion Service
On-Site Clinics
Sex Reassignment Exclusions
Bridges to Excellence (Action Group Pay-for-Performance)
High-Performing Health Plan Narrow Networks
ACO/Accountable Care Organization
Healthcare home
Outsourcing Annual Enrollment
Outsourcing Call Center/Customer Service
Outsourcing New Employee Enrollment
Private Exchange for Retirees
Referenced-Based Pricing
Private Exchange for Actives
Public Exchange for Retirees
International Medical Tourism
Private Exchange for Part-Time
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Public Exchange
for Part-Time
Public Exchange for Actives
Currently
Using
Contemplating
Adding
Implementing
Not Interested in
Implementing
30
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25
24
21
17
16
14
13
13
11
9
9
8
8
7
7
6
5
5
4
3
1
1
0
0
0
0
2
1
0
2
5
9
3
10
10
5
4
7
0
8
7
8
4
0
1
0
5
7
8
2
3
3
3
1
0
0
0
0
0
1
0
1
0
1
0
0
0
0
0
0
0
1
1
1
0
0
1
0
0
0
0
0
1
2
4
5
3
2
9
2
4
9
13
9
16
12
13
15
13
19
20
20
19
16
17
24
23
23
23
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Effectiveness in
Achieving Goals
(1=Poor, 5=Excellent)
3.1
3.1
3.2
3.3
2.9
2.6
3.3
2.6
2.8
3
3.3
3.3
2.7
3.8
3.3
3.4
3
3.2
3.4
3.5
N/A
3
4
N/A
N/A
3
N/A
N/A
Action Group Members outperform
Non-Members
HEALTH CARE COSTS
Action Group Member
Non-Members
2014 Total Health Care Cost Trend
2.8%
9.0%
2014 Health Plan Premium Trend
3.1%
4.3%
2015-2016 Planned Health Benefit Budget Increase
4.5%
8.0%
Action Group Member
Non-Members
82% / 72%
73% / 66%
66%
73%
EMPLOYER / EMPLOYEE COST SHARE
Percent of Premium Covered by Employer (single/family)
Percent of Health Plan Total Cost Covered by the Employer
*Action Group members cover more employee premium cost, but less total health plan cost. Action Group members engage in move valued-based and overall
health plan designs aimed to drive greater consumer behavior (those with more health care costs pay more).
INNOVATION & COST SAVING STRATEGIES
Average Number of Cost Control Programs & Tactics Employed (full list
found in the Other Services & Vendors, Strategies and Tactics section)
Action Group Member
Non-Members
9.3
5.8
*Action Group member to non-member comparisons do not take into account company differences such as size, selfinsured vs. fully-insured or other existing dynamics
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Issues, Workgroups and Meetings
2015
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Influence and reach of The Action Group
Issues, Workgroups and Meetings 2015
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Eighth Annual Leadership Summit
All Payer Claims Database
MNBTE Recognition Event
Specialty Pharmacy Learning Network
Health Care Financing Taskforce
National Diabetes Prevention Program
Choosing Wisely Campaign
Prior Authorization Legislation
End of Life Care and Advanced Directives
Cadillac Tax
Payment Reform
MNBTE Guiding Coalition
MNBTE Champions Best Practices
A Look Ahead
2016 Highlights
Programs and Initiatives
 Minnesota Bridges to Excellence
 Employer Benefits Survey
– Launch Feb 8: Due Feb 24
 Specialty Pharmacy Action Network
– First Meeting Feb 16
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Open Notes
Advanced Directives, Palliative and End of Life Care
Health Care Innovation
Payment Reform
National Diabetes Prevention Program
Health Literacy
Specialty Pharmacy Key Informants
Phase I
Stephen Schondelmeyer – U of MN
Katerina Glac – University of St. Thomas
Donald Brunquell – Children’s Hospital
Corey Belken, Shannon Ambrose – Artemetrx
Pete Wickersham – PrimeTherapeutics
Tim Affeldt - Fairview Specialty Pharmacy
Alan Van Amber – Lumicera/Navitus
Kevin James – USBioservices
Brian Bullock, Shawn Patterson – Burchfield
Kevin Host – PSG Consulting
Bill Gerardi MD – BCBSMN
Charles Fazio, Rick Bruzek – HealthPartners
Howard Epstein, Al Heaton - PreferredOne
Jana Johnson, Jim Hartert - Medica
Brian Klepper – NBCH
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Phase II
Corey Beklen, Shannon Ambrose, Brenda
Motheral – Artemetrx
Brian Burchfield, Shawn Patterson – Burchfield
Sara Drale – MN Medicaid
Rick Bruzek, Christine Strahl – HealthPartners
Jana Johnson, Jim Hartert - Medica
Ray McMahon - PrimeTherapeutics
Rick Bruzek, Kevin Ronnenberg –
HealthPartners
Surya Singh, CVS
Ed Greeno, Marie Brown – UMP
Kyle Skiermont - FVSP
John Rother - NCHC
Megan Sharp – Office of Amy Klobuchar
Samantha Mills – Office of Al Franken
Holly Iverson, Randy Chun, MN House of
Representatives
Howard Epstein, Al Heaton - PreferredOne
Alan Van Amber, Laura Jester - Navitus
Findings, Surprises and Conclusions that
Shape 2016 Action Network Agenda
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Magnitude of spend on outpatient drugs is higher than expected; more than PBM costs
– PBM traditional (non-specialty) +
– PBM specialty +
– Medical specialty +
– Medical traditional (non-specialty)
No current single vendor meets all the employer or consumer needs
– Health plans lack pharmacy expertise and data of PBMs
– PBMs lack relationship to providers
– Specialty pharmacies serve as vendors to PBM, not employer or consumer
NDCs are cornerstone of all medical specialty activities; necessary for
– PA, step therapy and clinical management
– Rebates
– Granular and accurate reporting of costs and utilization
– Quality measurement and management of providers
Variation among health plans’ transparency, price, knowledge and capabilities; medical management is
piecemeal if it exists
Employers not at the table when decisions are made by PBMs or health plans; on the side lines (menu)
Understanding “long arm” of manufacturers: hubs, coupons, rebates, patient support/assistance programs,
paying premiums for insurance on ACA exchanges
“Silver bullet” site of care approach, moving patients, is short sighted; need provider re-contracting, pricing
parity
Conflict of interest between PBMs and owned specialty pharmacies; especially problematic if exclusive
No current, standard method to establish value of drugs Cost Effectiveness, not used to determine drug
prices
2016 SPRx Action Network Goals
1.
2.
3.
4.
NDC Codes on Medical Claims
Cost of Site of Care Management
Pipeline Management
Standard Expectations of Vendors and
Providers
5. Senior Management and Employee
Communications
6. Policy Actions
7. New Model Development
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2016 SPRx Action Network Deliverables
• Tools, Checklists and Guides for vendor (PBM and health plan)
expectations
• RFPs
• Contracts, definitions, terms
• SPDs
• Assessment and Evaluation
– Drug price transparency tools
– Pipeline management
– Media
• Initiatives
– NDCs, cost of site of care expectations
– Specialty pharmacy direct relationship
– New care models
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What is OpenNotes?
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Patients invited to review their providers’ notes of visit by email or text
through secure patient portals after a visit
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Not a specific vendor product or software.
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Started with a research and demonstration project in 2010
– 100 PCPs and 20,000 patients
– Boston (BIDMC), rural Pennsylvania (Geisinger), and the Seattle inner
city (Harborview)
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Multiple providers now implemented with state-wide adoption in Oregon
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Ambulatory visits only but pilots for inpatient, ER and elsewhere
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Good notes include:
– Patient history
– Physical exam findings
– Lab and x-ray
– Assessment and diagnoses
– Plan for next steps
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Office Note Example
History: XXXXX is a 64 y.o. male who comes into clinic with a chief complaint of pain at the right posterior
heel. Pain has been present for several months. Pain is described as aching and burning. It is aggravated by
day to day activities and specifically long drives. It does not hurt with activity, including running and long
hikes. Sometimes it will be sore first thing in the morning. It is unchanged recently.
History of injury: none known
Past medical history: I have reviewed and confirmed the past medical history in the chart.
Medications: reviewed medication list in the chart
Allergies: reviewed allergy section in the chart
Review of Systems: Review of all other systems is negative
Exam: Patient is alert and oriented x3, in no apparent distress.
BP 131/87 mmHg | Pulse 52 | Wt 89.812 kg (198 lb)
Musculoskeletal: soft tissue swelling noted over the posterior medial heel with palpable bursa only painful
over the superior calcaneal process, and not where it overlies the soft tissue., tenderness at Achilles tendon
insertion
Vascular: normal pulses, normal capillary refill and warm
Neuro: intact
Derm: Mild swelling at the bursa site.
X-ray: Ill defined enthesiophyte noted at the achilles insertion. Soft tissue swelling over the medial aspect of
the calcaneal process seen. No fractures or other issues noted.
Assessment: Chronic bursitis right heel
Plan:1. Discussed pathology and biomechanical findings in detail with patient. Conservative options
include; doing nothing, shoe gear modifications, shoe inserts, physical therapy, local injection, casting, oral
anti-inflammatories and avoiding all aggravating activities. Surgical options discussed. Patient elects for
contrast soaks, RICE, and continued diclofinac gel at this time.
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43 2. Return to clinic to discuss efficacy of treatment or on an as needed basis.
Why OpenNotes?
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More complete and relevant to visit than summaries & MyChart
Supplement and record information from face to face visits that are often inefficient,
rushed, and ineffective*
– Clinician tells patient 80% of relevant information
– Patient remember 50% of what they are told
– So 40% is retained????
Patient reported results
• 82% opened at least one note
• 20-42% shared notes with others
• 70 – 80% reported better care, understanding, prepared for visits, more in control, taking
meds as prescribed
• 1-8% reported confusion, worry, or offense
Provided reported results; Expectations vs. Results
• Visit longer: 24% vs. 2%
• More time outside visit: 42% vs. 3%
• More time documenting: 39% vs. 11%
• Impact costs
• Reduced churn
• Increased portal use
• Reduced errors
• Improved adherence
44 *Kessels, RPC “Patients’ Memory for Medical Information” Journal of the Royal Society of Medicine
2003, 96:219–222
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What’s Next
• 12/2015 Four Foundations announce $10 million in grants
to OpenNotes for dissemination, innovation and research
• Strategic partnership discussions underway with multiple
organizations to encourage voluntary spread
• Multiple consortiums to be launched; MN, WI considering
• Vendor capabilities to be assessed. Epic and Cerner can
implement OpenNotes. Working with other vendors on
their capabilities
• Support materials available
• Seeking employers to join the movement; become a
champion for open notes
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March 15, 2016 Minnesota Kick Off
MN Health Action Group & MAPS (Minnesota Alliance for Patient Safety)
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Invitees:
– Health system CIOs and Chief Medical Information Officers
– Community clinics
– Medical and Hospital Associations
– Minnesota Alliance for Patient Safety
– Epic
– Employers
Agenda
– Convince MN providers to adopt
– John Santa and OpenNotes staff present what, why, how
– Employers advocate for implementation ASAP
• Providers to encourage engaged patients and adopt OpenNotes
ASAP
• Reported measures of provider OpenNotes utilization
• Other
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Ongoing Meetings and Outreach
 9th Annual Leadership Summit – April 22
Turning Vision Into Action
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Member Meetings
Community Dialogue
Weekly Express
Monthly Members Only fyi
Social Media Outreach
Additional Toolkits
Consumer Engagement Resources
Doing together what no single
organization can do alone
Affordable,
predictable
health care
costs
Improved
health and
health care
quality
Policies and
programs
that work
for all
Employee
satisfaction and
accountability
A powerful force for positive change
The Action Group is the only Minnesota organization whose sole
purpose is to align and represent the collective voice of those
who pay the bill for health care – employers, public purchasers
and individuals. We drive innovation, collaboration and
engagement in ways that improve health and ensure the
economic vitality of all Minnesota communities.