To encourage efforts around value driven health care and to speed the adoption of aligning incentives with provider performance and consumer health care decision-making, the National Business Coalition on Health, The Leapfrog Group and Bridges to Excellence announced the presentation of the second annual Driving Value in Health Care Awards at the Advancing Value Driven Health Care Incentives and Rewards Symposium today.
The first award—presented to Priority Health for its Physician Incentive Program (PIP) and sponsored by Thomson Healthcare—is given to a health plan or health care purchaser that offers direct rewards to providers in the health care delivery system for providing high quality and cost effective care. The second award—presented to the University of Michigan for its MHealthy: Focus on Diabetes initiative and sponsored by Booz Allen Hamilton—is given to a health care purchaser or health plan that has created an innovative strategy for encouraging better health care decisions on the part of consumers.
Priority Health—Physician Incentive Program
Priority Health's Physician Incentive Program (PIP) began in 1997 and rewards primary care providers (PCPs) for superior performance, clinical quality and patient satisfaction. This program measures outcomes by physician organization and provides financial rewards based on the efficient use of health care resources and savings achieved through improved performance.
The program is developed and reviewed annually by its Network Advisory Committee which is comprised of physicians and administrators. The guiding principles include: equity—the size of the reward is based on the work required to manage patients in program measures; inclusion—eligibility requirements are kept to a minimum to enable most physicians to participate; excellence—rewards are based on benchmarks set at the HEDIS 90th percentile; practice support—incentive program success requires an excellent office practice system; and performance improvemen—PIP measures are designed to assist in improving office practices and to better the health of patients.
"Priority Health's core purpose is to improve the health of our communities by providing access to excellent and affordable health care," said Frank Marre, D.O., M.S., FAOCOPM, associate vice president of Clinical Programs for Priority Health. "This lofty goal can only be achieved through multidimensional initiatives that are well aligned across all stakeholders including patients, providers, employers and communities. By applying these principles we have been able to double our rate of improvement and achieve remarkable results. It is the right work for the right reason."
University of Michigan—MHealthy: Focus on Diabetes
MHealthy: Focus on Diabetes is the first of its kind program that eliminates or reduces the cost of selected medications for University of Michigan employees and dependents that have diabetes. The two-year pilot program was launched in July 2006 and encourages the proper and sustained use of specific drugs that help people manage their diabetes and help prevent or reduce the long-term complications of diabetes. Reduced co-pays are provided for specific drugs that affect blood sugar, blood pressure, cholesterol and depression, translating to free co-pays for generic drugs and reductions of 25-50 percent for brand name medications. Participants receive educational materials on the health benefits of medication adherence and the benefits of the drugs selected for co-pay reductions.
"We're very honored to receive this recognition," said Allison Rosen, M.D., Sc.D., an assistant professor of internal medicine and health management and policy at the University of Michigan (U-M) and principal investigator of the U-M program's evaluation. "We implemented this program to improve both the quality and value of care for our workforce with diabetes. In turn, it is our hope that a rigorous evaluation of the impact of these targeted value-based co-pay reductions may help inform the efforts of other employers and insurers trying to improve the value of their health care spending."
The objective of this targeted intervention is to remove financial barriers to evidence-based, proven-effective interventions for those with diabetes, resulting in improved processes and outcomes of care, more efficient use of resources, and improved health-related quality of life and productivity. This program currently benefits more than 2,500 of the 69,700 University of Michigan employees and dependents.
Meredith Rosenthal, Ph.D., an associate professor of health economics and policy at Harvard School of Public Health and award judge stated, "We're encouraged to see programs like these being implemented in an evidenced-based way to enable other purchasers to create similar programs. Employers' efforts to impact consumer health behaviors by providing the education and tools to help people better manage their health represent a promising avenue to keep employees healthy and more productive."
The applications received for the awards represented the full gamut of value based purchasing initiatives including pay-for-performance programs targeting hospitals, physicians, and health plans, and consumer incentive programs promoting wellness, prevention, disease management, and appropriate provider and health plan selection. Award applications were scored on criteria including: transparency (the public reporting element of the applicant program), performance measurement composition (measures include those endorsed by national measure-making organizations like the National Quality Forum), incentive or reward methodology (the program includes both financial and non-financial rewards), target reach (those for whom the program is intended are aware of the program and actively participate), and impact (documented savings and quality improvement). Board members from Leapfrog, NBCH, and Bridges to Excellence comprised the judging team.
About the National Business Coalition on Health
NBCH is a national, non-profit, membership organization of more than 70 employer-based health care coalitions, representing over 10,000 employers across the United States. NBCH and its members are dedicated to value based purchasing of health care services through the collective action of public and private purchasers. In developing, identifying and disseminating best practices in value based purchasing strategies, NBCH seeks to accelerate the nation's progress towards safe, efficient, high quality health care. For more information, call 202-775-9300 or visit www.nbch.org.
About The Leapfrog Group
On behalf of the millions of Americans for whom many of the nation's largest corporations and public agencies buy health benefits, The Leapfrog Group aims to use its members' collective leverage to initiate breakthrough improvements in the safety, quality, and affordability of health care for Americans. It is a voluntary program aimed at mobilizing employer purchasing power to alert America's health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. The Leapfrog Group was founded in November 2000 by the Business Roundtable and has support from the Robert Wood Johnson Foundation, as well as its members and other funders. For more information, visit www.leapfroggroup.org.
About Bridges to Excellence
Bridges to Excellence (BTE) is a not-for-profit, coalition-based organization created to encourage significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they deliver safe, timely, effective, and patient-centered care. BTE works with large employers, health plans, providers and a wide range of organizations that have a shared goal of improving quality and patient outcomes. For more information, go to www.bridgestoexcellence.org.