PBGH Endorses Medicare Value Purchasing Act

PBGH endorsed the Medicare Value Purchasing Act of 2005, introduced by U.S. Senators Grassley and Baucus as an important step to set new standards in Medicare for measuring quality, reporting outcomes, and performance-based pay for physicians, hospitals, other providers, and health plans.  The implementation of this bill would reinforce Medicare's existing demonstration projects and provide support for efforts of private and public purchasers.  "The Medicare Value Purchasing Act will not only improve the quality of care for seniors, Medicare's leadership in providing usable information for consumers and rewarding quality care will change the market for all Americans and help rein in out-of-control health costs," said Peter Lee, President and CEO of the Pacific Business Group on Health (PBGH).

PBGH has recently helped bring together a broad coalition of employers, consumer groups, and labor through the Consumer-Purchaser Disclosure Project to support a broad set of Medicare quality and payment principles that are reflected in the Medicare Value Purchasing Act. These principles seek to improve our overall health care system and patient care by implementing nationally endorsed, risk-adjusted and scientifically valid measures addressing clinical quality, efficiency of care, use of quality enhancing information technology.  The Consumer-Purchaser Disclosure Group calls upon Medicare to publicly report the performance of its health care providers and differentially reward providers based on performance and improvement.

Earlier this year, PBGH President and CEO Peter Lee also testified before the House of Representatives Committee on Ways and Means - Subcommittee on Health about Promoting Quality and Efficiency of Care for Medicare Beneficiaries.  In his remarks were concrete examples of efforts underway to promote higher quality and more cost-efficient care through measurement and reward programs.  Read more.

PBGH Health Plan Chooser Provides Critical Decision Support
Recognizing the need to go beyond "report cards" to provide interactive tools to support consumer choice, PBGH conducted a study of users of a Health Plan Chooser tool used by a number of PBGH members that affirms its utility for assisting consumers in a complex decision making process.  The interactive tool allows users to specify individual weighting of doctor availability, total cost, plan quality, plan rules, and covered services.  Total costs consider the consumer's self-reported health status and expected use of service.  Large employers are increasingly using health plan chooser tools, such as the one developed by PBGH originally for use in its small employer purchasing group PacAdvantage, as a valuable addition to their suite of self-serve benefit tools.  Among the PBGH members using the PBGH Chooser are CalPERS, Bechtel Corp, the University of California, and Wells Fargo.   

Key findings:

• Eighty-seven percent think the tool includes features most important to employees.
• Eighty-one percent found the tool helpful.
• Eighty-seven percent said the tool is easy to use.

• Eighty-one percent found the information clear.
• Forty percent of the respondents intended to switch plans, which represents a segment for whom the tool was especially important. 

With the growing complexity of health plan options and benefit designs, it is important for consumers to make informed decisions about their choice of health plans.  Chooser tools, like PBGH's, can lower print and phone support costs, while bolstering employers' value-purchasing strategies by reinforcing key messages like disease management, nurse advise resources, and use of generic and mail order prescriptions.   Development of this web-based tool, along with on-going evaluations of other innovative applications, reinforces PBGH's mission to engage consumers in a transparent and accountable health system.  Read full report here.   

"eValue8" Gets National Boost and Continues to be RFI of Choice
Watson Wyatt Worldwide announced its exclusive adoption of the National Business Coalition on Health's eValue8 RFI for use with all its health plan RFI work.  Using a standardized RFI streamlines the process for health plans, and helps align purchaser priorities.   EValue8 is recognized as a premier tool in terms of ease of use and content, relying on leading national experts for the latest science in performance measurement, chronic disease management, prevention, health information technology, and consumer engagement.   

The Pacific Business Group on Health, a co-founder of eValue8, uses the tool as just one avenue for emphasizing and evaluating important elements of health plan services.  PBGH's "Breakthrough" elements are a critical set of health plan offerings, that when implemented together, have the potential to save up to 30% of premium.  They include:

• Health Promotion - keeping healthy people well
• Health Risk Management - systematically caring for the chronically ill
• Shared Decision-making/Treatment Options - preference sensitive informed choices by consumers
• Provider Options - using efficient, high performing providers
• Provider Incentives - paying for performance
• Consumer Engagement - using benefit design and incentives to encourage thoughtful utilization and healthy behaviors

Scoring of 2005 health plan RFP submissions is underway now and will be used by purchasers for rate-setting, determination of contribution strategies and negotiation of performance metrics.

CABG Mortality Rates Released
PBGH and the California Office of Statewide Health Planning (OSHPD) collaborated with 77 California hospitals to release the third report of in-hospital death rates following coronary artery bypass surgery.  This means that consumers now have access to information that will help them make better decisions about hospital selection.  The success of this voluntary effort helped catalyze the passage of Senate Bill 680, which now mandates that all hospitals will have their CABG performance publicly reported.  Moreover, Senate Bill 680 calls for the measurement and reporting of surgeon-specific mortality rates beginning in 2006. 

The study, reporting on 2000-2002 data, found that of the 77 participating hospitals, 60 performed "as expected", 8 performed "better than expected", and 9 performed "worse than expected" after adjusting for the clinical severity of their patients.  Further, the study repeated previous findings that participating hospitals generally had lower mortality rates (average 2.61%) than did non-participating hospitals (average 3.35%) and that hospitals with a higher volume of surgeries (>200 per year) tend to have better outcomes.  Read more. 

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PBGH Spotlight is published by Pacific Business Group on Health 221 Main Street Suite 1500 San Francisco, CA 94105 phone: 415.281.8660 For more info, contact info@pbgh.org www.pbgh.org © 2000-9 PBGH