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Margaret E. O’Kane, President November 16, 2011

Implementing V-BID. Margaret E. O’Kane, President November 16, 2011. Overview . Our starting point: measurement and evidence-based care What should count as V-BID? V-BID’s connection to ACOs and PCMH V-BID works in Oregon. What NCQA does. Our Mission

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Margaret E. O’Kane, President November 16, 2011

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  1. Implementing V-BID Margaret E. O’Kane, President November 16, 2011

  2. Overview • Our starting point: measurement and evidence-based care • What should count as V-BID? • V-BID’s connection to ACOs and PCMH • V-BID works in Oregon

  3. What NCQA does • Our Mission • To improve the quality of health care • Our Method • Measurement • We can’t improve what we don’t measure • Transparency • We show how we measure so measurement will be accepted • Accountability • Once we measure, we can expect and track progress

  4. Bravo!IOM Essential Health Benefits Report • Says keeping the EHP affordable is necessary • To maximize the number of people with insurance: • Consider population’s health needs as a whole • Encourage better care by ensuring good science is used to inform coverage decisions • Emphasize judicious use of resources • Use economic tools to improve value % performance

  5. Our starting point: HEDIS tracks the quality of care of 118 million Americans.

  6. Keys to successful measurement • Scientific soundness: Clinical evidence, reproducible, valid, accurate, case mix adjustment/risk adjustment • Relevance: Meaningfulness, health importance, financial importance, cost effectiveness, strategic importance, controllability, variance among systems, potential for improvement • Feasibility: Precise specification, reasonable cost (emphasis on administrative measures), confidentiality, logistical feasibility, auditability

  7. How much care is evidence-based? Effective care (15%) Making health plans and delivery system accountable, reward results Preference-sensitive care (25%) Comparative effectiveness research, shared decision making and patient activation Supply-sensitive care (60%) Accountability mechanisms at the delivery system level, use incentives to drive results Source: Wennberg estimates based on Medicare claims

  8. Let’s think broadly on V-BID.

  9. What should count as V-BID?

  10. What should count as V-BID? • Tiered pharmacy • Reference pricing • Free evidence-based benefits (e.g., preventive services, tobacco cessation) • Shared decision-making • Incentives to use patient-centered medical homes (PCMH) or accountable care organizations (ACO) • Participation in Chronic Disease Management/Self-Management (e.g, CDSMP)

  11. ACOs are a V-BID vehicle: ACOs mean more health for the health care dollar.

  12. PCMH is a V-BID vehicle: Medical homes are the foundation of ACOs.

  13. V-BID in Action: Oregon Public Employees and Oregon Educator Benefits Board • Require in contracts that health plans report HEDIS, engage in pilot programs (PCMH) • Engage consumers with • Free preventive services • Lower copays for using a PCMH • Online calculator comparing benefits to out-of-pocket costs • Free talks explaining major cost drivers

  14. V-BID in Action: Low-Value, Top-Cost Tier in Oregon Program • $500 copayin addition to deductible and out-of-pocket maximum • Spine surgery, hip and knee replacement, shoulder and knee arthroscopy and upper endoscopy • $100 for MRI and CT • Exclude cancer and emergency treatment

  15. Thank You

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