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Gaining Traction with PEBB’s Vision Through the eValue8 ™ RFI

Gaining Traction with PEBB’s Vision Through the eValue8 ™ RFI. PEBB Board Meeting July 17, 2007. What is eValue8 ™?. Evidence-based request for information Uses standard annual survey to gather hundreds of benchmarks in critical areas Offered through National Business Coalition

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Gaining Traction with PEBB’s Vision Through the eValue8 ™ RFI

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  1. Gaining Traction with PEBB’s Vision Through the eValue8™ RFI PEBB Board Meeting July 17, 2007

  2. What is eValue8™? • Evidence-based request for information • Uses standard annual survey to gather hundreds of benchmarks in critical areas • Offered through National Business Coalition on Health (NBCH) • Offered in Oregon in 2007 through the Oregon Coalition of Health Care Purchasers (OCHCP)

  3. eValue8™ Objectives • Implement standardized performance expectations that • Are evidence-based, defendable in the Board Room • Increase the “signal strength” for multiple purchasers • Align with major stakeholders: HHS/CMS, OPM • Reduce redundancy by consolidating purchaser requests • Promote health plan accountability • Differentiate plan performance • Encourage health plans to evaluate the delivery systems that compromise the network • Promote consumer engagement and informed decision making • Provide a community-based forum for communication between purchasers and plans

  4. eValue8™ Collaborators • Centers for Disease Control (CDC) • Centers for Medicare and Medicaid Services (CMS) • Substance Abuse and Mental Health Services Administration (SAMHSA) • Agency for Healthcare Research and Quality (AHRQ) • National Committee on Quality Assurance (NCQA) • Joint Commission for the Accreditation of Health Care Organizations (JCAHO) • URAC • American Board of Internal Medicine (ABIM) • eHealthInitiative (eHI) • The Leapfrog Group • Pennsylvania State University • George Washington University

  5. Participating Coalitions in 2007 • Memphis Business Group on Health • HealthCare 21 (TN) • Buyers Health Care Action Group (MN) • Colorado Business Group on Health • Greater Detroit Area Health Council • Michigan Purchasers Health Alliance • Midwest Business Group on Health • Indiana Employers Health Alliance • New York Business Group on Health • Mid-Atlantic Business Group on Health • Oregon Coalition of Health Care Purchasers • South Carolina Business Coalition on Health • Pacific Business Group on Health • Alliance for Health (MI) • Health Action Council of NE Ohio • Hawaii Business Health Council • Virginia Business Group on Health

  6. Participating Oregon Plans in 2007 • HMOs • Kaiser • PPOs • CIGNA • HealthNet • LifeWise • ODS • Providence • Regence BCBS • United

  7. A-dec, Inc. Benton County Bethel School District Blount International City of Corvallis City of Eugene City of Springfield Eugene School District 4J Evraz Oregon Steel Mills Harry & David Operations Corporation Intel Corporation Lane County Lane Transit District Oregon Educators Benefit Board Oregon School Boards Association Portland General Electric Public Employees’ Benefit Board SAIF Corporation SEIU Local-49 Seneca Sawmill Tektronix, Inc. TOC Management Services United Metal Trade Association Trust Participating Oregon Purchasers

  8. 2007 Evaluation Areas • President’sExecutive Order: 18 Questions in 3 Modules • Profile • Consumer Engagement • Provider Measurement • Prevention & Health Promotion • Pharmaceutical Management • Chronic Disease Management • Behavioral Health

  9. Executive Order • Significance • Alignment with federal agencies, including CMS • Private sector Value-driven health care partnership • Purchaser Guide • Follow up on progress • Four Cornerstones • HIT • Quality measurement & transparency • Price transparency • Incentives for quality and efficiency • 18 Questions in 3 Sections • Profile: HIT • Consumer: HIT support, price transparency • Provider: HIT support, quality transparency, incentives

  10. Plan Profile • Basic Information (Contacts, Structure, Enrollment, Scope) • Accreditation • Plan Design/Admin/Purchaser Reports • Provider Contracting • Health Information Technology • High Deductible Health Plan (Considered Separately)

  11. Consumer Engagement • Provider Performance Transparency • Practitioners and/or Groups • Hospitals • Shared Decision Making Support • Electronic Personal Health Record • Price Transparency • Pharmaceutical Management • Racial and Cultural Competency • CAHPS Ratings

  12. Provider Measurement • Community Collaboration • Physician Support • Practitioner Performance Measurement • What is measured (very granular list)? • How is it used (feedback, transparency, incentives)? • Practitioner Differentiation/Incentives • Types of measures used • Types of incentives • Facility Performance Measurement • Facility Differentiation/Incentives • Centers of Excellence and High Performance Network

  13. Prescription Drug Management • Organization and Formulary Management • Efficiency • Generic dispensing • Utilization mgmt (prior auth, step therapy, etc.) • Specialty pharmacy • Quality and Safety • Antibiotic use • Drug conflict measurement and initiatives • Pharmacy audits & ISMP survey use

  14. Prevention & Health Promotion • Worksite Health Promotion • Risk Factor • Education for children/parents • HRA content, use, promotion & incentives • Screening: Immunizations, Cancer, Other • Tobacco Use • Obesity • Obstetrics & Maternity

  15. Chronic Disease Management • Program Scope and Coordination • Member Identification • Member Support • Medication compliance monitoring • Interventions, especially outreach • Practitioner Support • Member-specific reminders • Comparative reports • Performance Measurement • HEDIS • Non-HEDIS

  16. Behavioral Health Screening & Mgmt • Program Organization & Member Access • Member Identification and Screening • Alcohol • Depression • Member Support (Depression only) • Rx compliance monitoring • Interventions, especially outreach • Coordination of Co-morbidities • Practitioner Support: Non-BH and BH • Clinical guidelines • Member-specific reminders • Comparative reports • Tracking appropriate anti-depressant prescribing • Performance Measurement

  17. Use of eValue8™ in Oregon • Used to identify plan performance against other plans in Oregon and against national benchmarks • In 1st year, use is for quality improvement (no public sharing of results) • OCHCP uses to establish priorities for plan action (site visits)

  18. Use of eValue8™ Results by PEBB • Reinforce PEBB priorities • Assist in identifying areas for improvement • May wish to eventually use in plan selection and/or contracting

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