Posts Tagged ‘value-based benefit design’

Infographic: Precision Medicine Meets Precision Benefit Design

October 18th, 2017 by Melanie Matthews

Advances in precision medicine may specify immediate use targeted therapies, nullifying recommendations for use of standard first line treatment, according to a new infographic by the University of Michigan Center for Value-Based Insurance Design.

The infographic examines how precision medicine benefit design removes administrative barriers and lowers cost-sharing to improve access to clinically indicated therapies.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

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Infographic: Implementing Value-Based Benefit Design in Medicare Advantage

December 14th, 2016 by Melanie Matthews

Implementing Value-Based Benefit Design in Medicare AdvantageOut-of-pocket Medicare Advantage costs are continuing to grow and higher cost-sharing can adversely affect health and worsen healthcare disparities, according to new infographic by the University of Michigan Center for Value-Based Insurance Design.

The infographic examines the increase in cost-sharing in Medicare Advantage plans, how this is impacting healthcare utilization and why lower cost-sharing on high-value services could impact Medicare beneficiaries.

Healthcare’s inevitable shift from volume to value-based reimbursement is reflected not only in Medicare’s alternative payment timeline but also in the waves of commercial payors now evaluating and rewarding providers on the basis of quality of care delivered rather than number of services provided. Adding to its roster of quality-centered payment models, CMS announced in 2015 plans to explore value-based reimbursement for Medicare Advantage and home health.

2015 Healthcare Benchmarks: Value-Based Reimbursement captures the healthcare industry’s reaction to payment formulas for value-added care, and how this shift away from fee-for-service is transforming care delivery and quality.

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Infographic: The Cost of Low-Value Healthcare

October 28th, 2016 by Melanie Matthews

The use of low-value care and the associated cost is a significant concern in the U.S. healthcare system—the National Academy of Medicine (formerly the Institute of Medicine) indicated an estimated $765 billion of wasted healthcare expenditures in 2013. However, solutions to measure, identify, and eliminate low-value care are challenging and complex. To date, most efforts aimed at reducing low-value care have been limited to areas where there is a high degree of consensus that the care rendered is low value, according to a new infographic by the University of Michigan Center for Value-Based Insurance Design (VBID).

The infographic examines how VBID can address the issue of low-value care.

Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial OutcomesWhile others wait for the healthcare industry to complete its transition to value-based reimbursement, Bon Secours Medical Group has already aligned itself with payment reform, leveraging its care team and providers and automating workflows to enjoy immediate rewards from its patient-centered approach.

Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial Outcomes describes how this 600-provider medical group has primed its providers to employ a broad mix of team-based care, technology and retooled care delivery systems to maximize quality and clinical outcomes and reduce spend associated with its managed patients.

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Infographic: Value-Based Health Enhancement Program Shows Promise

April 11th, 2016 by Melanie Matthews

One state’s employee insurance program designed to improve health while reducing costs has successfully encouraged more use of screenings and preventive services, increased medication adherence for chronic conditions, and reduced visits to the emergency department, according to researchers from the University of Michigan (U-M) School of Public Health.

Not unexpectedly, the researchers said it’s too early to tell after two years of study if the Connecticut’s Health Enhancement Program has saved the state money.

A new infographic by U-M describes the key features of the Health Enhancement Program and its impact.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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Infographic: TRICARE’s Potential for Value-based Insurance Design

March 4th, 2016 by Melanie Matthews

With TRICARE costs on the rise and increased cost-sharing leading to reduced use of high-value clinical services, TRICARE would benefit from a value-based insurance design (VBID) approach, according to a new infographic by the University of Michigan V-BID Center.

The infographic looks at the impact of VBID and compares the current TRICARE plans to VBID plans.

Healthcare’s inevitable shift from volume to value-based reimbursement is reflected not only in Medicare’s alternative payment timeline but also in the waves of commercial payors now evaluating and rewarding providers on the basis of quality of care delivered rather than number of services provided. Adding to its roster of quality-centered payment models, CMS announced in 2015 plans to explore value-based reimbursement for Medicare Advantage and home health.

2015 Healthcare Benchmarks: Value-Based Reimbursement captures the healthcare industry’s reaction to payment formulas for value-added care, and how this shift away from fee-for-service is transforming care delivery and quality.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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Infographic: Value-Based Payor Provider Partnerships

September 21st, 2015 by Melanie Matthews

The number of payer-provider partnerships built around value-based compensation has quadrupled since 2012, when Oliver Wyman began monitoring these types of health insurance products.

A new infographic by Oliver Wyman examines the geographic distribution of these partnerships.

Value-Based Payor Provider Partnerships

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability In today’s value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts—models that often seem confusing or contradictory. The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians’ skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

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Infographic: Medicaid Managed Care

August 5th, 2015 by Melanie Matthews

Medicaid health plans now serve more than 43.5 million low income individuals – nearly 66 percent of total Medicaid enrollment–and a growing body of research finds the tools and techniques they use show great promise in achieving better outcomes for Medicaid beneficiaries and cost savings for states.

A new AHIP infographic examines how Medicaid managed care plans are improving quality and promoting value as well as the type of cost savings these plans are delivering to states.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid PopulationTo locate, stratify and engage dual eligibles, Health Care Services Corporation (HCSC) takes a creative approach, employing everything from home visits to ‘street case management’ to coordinate care for Medicare-Medicaid beneficiaries.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population describes HCSC’s innovative tactics to engage this largely older adult and disabled population in population health management with support from a range of community partners and services.

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Infographic: Value-Based Insurance Design

August 25th, 2014 by Melanie Matthews

Value-Based Insurance Design

The healthcare cost discussion is shifting from “how much” to “how well,” when designing health insurance benefits, according to a new infographic by the University of Michigan’s Center for Value-Based Insurance Design.

The infographic describes this new approach, the benefits to stakeholders and the implementation and impact of this model.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and ProfitabilityIn today’s value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts—models that often seem confusing or contradictory. 6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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Support Outcomes-Based Health Incentives with Communication, Culture of Health

February 8th, 2013 by Patricia Donovan

More than half of U.S. companies offer financial incentives for participation in health management programs.

Even while rewards for biometric measures continue to proliferate, it’s best to review some behavior change basics before adding outcomes-based incentives to a wellness offering, advises John Riedel, president of Riedel and Associates.

Behavioral economics, a field built on the belief that people are susceptible to a wide range of influences, is a good place to start, he says. “An individual’s environment, work culture, emotions and social networks all have strong impacts on the decisions that they make,” said Riedel during a recent webinar on Health and Wellness Incentives: Positioning for Outcome-Based Rewards.

An individual’s motivation can be either extrinsic — motivated by what they will gain when the task is completed, which is usually money, or intrinsic: stemming from the individual’s own desire to accomplish and perform the task. With intrinsic motivation, the result is its own reward. Working with others, as in a team-based wellness competition, is one factor that can build intrinsic motivation, Riedel notes.

Ultimately, intrinsic motivation is the primary principle of behavior change, he stresses. However, money still talks when it comes to completing select wellness activities. A Towers Watson Staying@Work Survey Report found that in 2011, half of respondents offered financial rewards for participation in a health program. Biometrics, HRAs and team wellness challenges are particularly responsive to financial incentives, he adds.

Health coaching is another heavily incented activity, a strategy Riedel finds useful. “”If you’re using progress-based incentives, lifestyle coaching can help you to set the goals that are of the greatest interest to you.”

As health incentives evolve from participation-based to progress-based — created according to the individual’s place on the health continuum — to outcomes-based, healthcare companies need to keep an eye on the legal requirements surrounding these programs. One example is the ACA’s “reasonable alternative standard,” which protects individuals who are unable to meet an outcomes-based incentive.

For example, a morbidly obese employee might not be able to hit weight and blood pressure targets set for the overall workforce, so that employer would have to create a reasonable alternative standard for that employee.

The ACA also delineates wellness reward amounts and eligibility standards and distinguishes between participatory wellness programs and health-contingent wellness programs.

Ultimately, regardless of the incentives offered, participation in wellness activities is greatest when incentives are paired with a strong organizational culture of health and a compelling communications program that is “comprehensive, organization-wide (with a mix of information and inspiration), as well as the use of posters, the Internet, and social tools.”

And one final behavior change principle to keep in mind: people tend to follow the default option, so when designing health and wellness offerings, make the healthy choice the default.

For more advice on incentive benefits design, listen to this audio interview with John Riedel.