Collaborating for Health

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Collaborating for Health Productivity

• William Molmen, JD
• General Counsel and Co-founder
• Integrated Benefits Institute
• www.ibiweb.org

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About IBI

• National, not-for-profit membership organization
• 460 corporate sponsors
• Health Productivity Programs
• Health productivity research
• Measurement/modeling tools
• Benefit program Benchmarking
• Education/Forum
• Visit www.ibiweb.org

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Patient Centered Medical Home

• The Collaborative believesthe patient centered
  medical home will improve the health of patients
  and the viability of the health care delivery
  system.
• Employers, consumers, patients, clinicians and
  payers agree that it is essential to support a
  better model of compensating clinicians.
• Compensation under the PCMH model would
  incorporate
• Enhanced access and communication
• Improved coordination of care
• Rewards for higher value
• Expanded administrative and quality innovations
  and
• Promote active patient and family involvement.
• PCMH will improve the quality of care delivered
  and help control the unsustainable rising costs
  of healthcare for both individuals and plan
  sponsors.
• Clinicians have agreed to the following Joint
  Principles for patient-centered primary care
• Option to develop an ongoing relationship with a
  personal physician
• Physician-directed medical practice
• Whole person orientation
• Coordinated care across the health system
• Ongoing, voluntary pursuit of quality and safety
• Enhanced access to care and
• Payment recognizing the value added.

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Value-based Insurance Design

• Supply side service delivery financing promotes
  fragmented visits to multiple providers
• A VBID approach targets people (including their
  co-morbid conditions)
• To provide demand side incentives for a
  coordinated system of targeted and effective
  treatments.
• VBID naturally aligns with initiatives such as
  the patient-centered medical home and electronic
  medical records.

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Patient Centered Medical Home / Value-based
Insurance Design
Shortcomings in traditional definitions From
employer/payor viewpoint
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Value-based Benefits Design
VBID promotes the use of services when the
clinical benefits exceed the cost
Source Sipkoff, M. Value-Based Insurance Design
Spend a Little More on Selected Patients For
Payoff Down the Line. Managed Care. August 2009.
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Value-based Benefits Design
VBID promotes the use of services when the
clinical benefits exceed the cost...
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Total Medical, Pharma Productivity -- per
1000/FTEs --
(HPBS Phase 2 Employers)
400,000
300,000
100,000
200,000
Source Health and Productivity as a Business
Strategy, JOEM. Vol. 51, No. 4, April 2009
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Co-Morbidity and Lost Time
37.4
29.4
26.5
19.5
14.2
12.7
11.9
7.8
4.9
1.7
Source Health and Productivity as a Business
Strategy, JOEM. Vol. 51, No. 4, April 2009
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Value-Based BenefitsThe Impact of Pharmacy Plan
Design
IBI Research - 2007
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Source A Broader Reach for Pharmacy Plan Design,
Integrated Benefits Institute, 2007
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Results Attract Broad Media Attention
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Savings in Lost Productivity Costs-- For
No-Script Group --
-26

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Source A Broader Reach for Pharmacy Plan Design,
Integrated Benefits Institute, 2007
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Health Productivity Focus for Patient-centered
Medical Home

• Recognize employers are a critical part of
  healthcare
• Provide 60 of coverage/workplace funds 55 of
  total costs
• Demonstrate the nexus between the Physican,
  patient, employer funder, and value, broadly
  defined
• Patient-centric not just medical needs
• Quality of life Includes work/family life
  healthy/active
• Clearly align PCMH / VBID with health-related
  productivity enhancement thats truly important
  to Payor
• ? support for better coverage
• Demonstrates that medical care/prevention are an
  investment in workers, not a cost to be avoided
  or shifted
• Huge long-term impacts on post-retirement medical
  costs and quality of life from focusing on obesity

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Challenges to Health Productivity

• Effective education/Information
• Credible measurement/Shared understanding
• Speaking in C-Suites language
• Showing it as a competitive edge

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Strategic Health Productivity Collaboration

• Collaborators Integrated Benefits Institute
  (IBI) The American College of Occupational and
  Environmental Medicine (ACOEM) and the Center
  for Health Value Innovation (CHVI)
• Work together to better articulate the value of
  health and productivity management (HPM)
• Working together, we will
• create standardized data and result metrics for
  value-based health productivity management
• Present educational HPM Clinics to educate and
  inform employers, insurance brokers and industry
  consultants on their opportunities to enhance
  employer competitiveness and health in the
  community, and concurrently bend cost trends.

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Center for Health Value Innovation

• CHVI An information exchange for value-based
  design - dedicated to sharing the evidence of
  improved health and economic outcomes through
  value-based designs for sustainable health and
  financial improvement.
• www.vbhealth.org

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Center for Health Value Innovation
Publishes white papers with evidence on sectors,
innovation, outcomes
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Center for Health Value Innovation
New book on Value-based Design Goals, Benefits,
Levers, and Plan
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American College of Occupational and
Environmental Medicine

• ACOEM is an organization of occupational and
  environmental physicians, to promote and protect
  the health of workers through preventive
  services, clinical care, research, and
  educational programs.
• www.acoem.org

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American College of Occupational and
Environmental Medicine

• HPM Clinic Educational program with IBI
• HPM Toolkit
• Journal of Occupational Environmental Medicine
• Blueprint for Health modeling tool

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Integrated Benefits Institute

• IBI programs include benefits performance
  research and analysis, measurement, practical
  solutions, and forums for information and
  education to advance understanding about the link
  betweenand the impact ofhealth-related
  productivity on corporate Americas bottom line.
• www.ibiweb.org

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Integrated Benefits Institute

• Health, productivity, absence and disability
  management research
• Absence/disability and lost-productivity modeling
  and measurement tools
• Education programs

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IBI Research

• Recent publications
• More than Health Promotion How Employers Manage
  Health Productivity
• The Full Costs of Depression in the Workforce
• Health and Productivity as a Business Strategy
• Employer Incentives for Workforce Health and
  Productivity
• Upcoming Research
• HPM and Corporate Measures of Success
• Health, Productivity, Employee Performance and
  Engagement

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Programs in Progress

• ACOEM/CHVI/IBI HPM Clinic for regional brokers
  and consultants around the country showing them
  how to bring a competitive edge to clients
  through health productivity.
• ACOEM/IBI upcoming meeting of self-reported
  health information tool developers and users to
  determine whats useful about the tools and
  reports, what should be changed. First stage of
  subsequent efforts to standardize metrics and
  measures.
• ACOEM/IBI follow-on to JOEM study to assess the
  impact of drug adherence on health productivity.

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Program in Progress

• IBI project with Mark Fendrick to develop a white
  paper outlining the data and analytical
  requirements for next-step empirical work to
  connect VBID to health-related lost time (absence
  and presenteeism) and lost productivity.
• IBI/ACOEM/other thought leaders Employee health
  and productivity on the balance sheet. Initial
  meeting with employers, analysts, consultants,
  associations to map out a strategy and determine
  how to proceed.
• IBI Research with John Riedel on how employers
  are using the variety of self-reported health
  information tools how are the tools used, what
  information is useful, what are the challenges
  and how may they be avoided.

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To Contact IBI

• Bill Molmen
• wmolmen_at_ibiweb.org
• www.ibiweb.org