Community Dialogue on Value Based Benefit Design

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Community Dialogue on Value Based Benefit
Design

• Presented by Nathan Moracco
• March 3, 2009

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State Employee Group Insurance Program (SEGIP)

• 120,000 lives insured
• covering
• Judicial, Executive
• Legislative Branches
• 1.5 billion biennial budget
• Largest employer group in
• the state
• 1,200 clinics
• 55 care systems
• 90 Union

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Does the State Use VBBD?

• Depends on your definition. But we do use plan
  design to motivate our members.
• Tiered Networking
• Centers of Excellence
• Prevention Care
• Health Risk Assessments
• Medical Therapy Management
• MN Advantage Health Advisors

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Cost and Quality Vary
Level 3
Level 1
Level 4
Level 2
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Incent the Member

• Not all clinics are the same. POS costs are
  strong drivers. SEGIP saved 13 (53M in todays
  costs) on MN Advantage

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Centers of Excellence

• Identify conditions were members are best served
  by the health care community
• Cardiac Care
• Lower Back Pain
• Transplantation
• Weight Loss Surgery
• To do list Build COE into plan design.

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Prevention Care Model

• In 2007 average costs for Preventative Services
• 184.32 per Year
• In 2007 average costs for Hospital Admission
• 13,257 per Episode
• To do list Find ways to incent more
  prevention. Zero cost not enough!

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Health Risk Assessment

• Make members more aware of health status.
• 70 participation over last 3 years
• 5 office co-pay reduction
• Free health coaching and online courses
• Links to Advantage Health Advisor
• To do list
• Measure the value of HRA
• Increase participation
• Indentify ways to link HRA results to action

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Medical Therapy Management

• The state of MN initiated a diabetic MTM program
  in July 2007.
• 776 members joined the program
• Administered by Health Partners and Fairview
• 39 fewer ER, 24 fewer hospital admissions
• Waive co-pay for drugs, office visits, etc.
• Diabetic measurements (first 6 months)
• 20.4 to 34.9 (compared to 20.7 )

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Advantage Health Advisors (AHA)

• AHA professionals are phone-based healthcare and
  benefit experts who work one-on-one with State of
  Minnesota employees to support their unique
  healthcare needs.
• Understanding a new diagnosis or treatment
  options
• Accessing the care you need
• Finding a doctor, clinic or hospital right for
  you
• Understanding your benefits
• Making informed decisions

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Does the State Use VBBD?

• Depends on who you ask. The State will continue
  to
• Purchase services based on outcomes, not just
  cost.
• Motivate members to seek prevention care,
  understand their health, maintain compliance and
  seek appropriate care at the right time.
• Participate in community initiatives which strive
  to improve community health

• BTE
• DIAMOND
• Health IT
• Quality Tiering
• Baskets of Care
• Medical Home

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For more information

• Websites
• MMB http//www.mmb.state.mn.us/pay-bene/ins
• AHA http//www.advantagehealthadvisors.com/
• Contact
• Nathan Moracco, Director
• nathan.moracco_at_state.mn.us
• [phone]