The Call to Action; If Not Now, When?

1. The Call to Action; If Not Now, When? Employer Payment Reform Workshop IJanuary 11, 2013Supported by Robert Wood Johnson Foundation’s Aligning Forces for Quality

2. The Call to Action; If Not Now, When? • Payment Reform project goals • Employers’ landscape today • Why employers should care

3. Project Goals Change payment to reward value instead of volume • Assess employers’ current level of understanding • Engage employers in changing payment models in Minnesota & nationally including TCOC, HCH, others • Identify and answer your questions of health plans & providers • Identify your goals for payment reform • Communicate to market with Consensus Statement

5. Employers’ Landscape Today • Most attention focused on numerous, short-term demands • Managing trend • Complying with multiple new regulations • Understanding impact of insurance exchanges • Promoting wellness programs • Staying in the game – in or out decision, when • Some attention on high level concepts • Quality improvement • Care delivery change • Less attention on details of care transformation and payment reform • Complex • Hidden and negotiated by suppliers • Varies by provider and market

6. Heard on the Street • “Payment for quality and shared savings is not enough to invest in new care models” – primary care clinic • “I’m going to do as many surgeries as possible and hope to retire before this affects me” - orthopedic surgeon • “The amount of revenue at risk today, low single digits, is not enough to really change behavior; we still win by providing more services” – large care system CEO • “Public and private purchasers are the only stakeholder that cares if costs go from $38 billion to $40 billion; everyone else grows” - local policy wonk

7. Employers’ Call to Action is Needed Now • Dartmouth Atlas: utilization varies by provider supply • 30-50% of spending is waste • NY Times 1/6/2013 – “Health Insurers Raise Some Rates by Double Digits” • 20-26% increases by Anthem, Aetna, BS CA • Easier to pass costs along than figure out, and implement, changes in payment • Collective employer effort can influence health plans to address payment reform • Potential cost shifting from public to private purchasers with Federal and state reform

8. Today’s Meeting Goals • You know enough to know what you don’t know • Your key questions are raised • You begin to define the employers’ role • You believe employers can have an impact • You are energized to take action

9. Understanding the Road to Payment Reform in Health Care Michael Bailit

10. What Employers are Saying so far… Six employer interviews • National & local, large & small, public & private • Varying levels of general understanding • Payers have mentioned changes in contracts, “on board” • Don’t know results of payment reform so far • Unsure of details, e.g., year end settlements, provider cash flow, pace of change • MN moving faster than rest of the country • Concerns about provider consolidation • Two employers have • Included questions about payment reform in RFPs • Had conversations with health plans and providers together • Learned about progress to date • Expressed desire to accelerate reform • Provided input on contracts that changed terms • All agreed collective action is more powerful than individual

11. Employer Survey Preliminary Findings Average on a scale of 1 (low) to 6 (high) • How well informed? (3) • How important to: • Know your health plan’s negotiated pmpm targets? (4.6) • Compare providers’ pmpm payment targets? (4.8) • Compare performance against targets? (5.1) • Set pmpm targets to decrease rate of increase or reduce costs over time (33%) • Include downside risk in provider contracts (5.3) • Roles: • Meet with key care systems and health plans (73%) • Have input on amount of revenue at risk for quality (73%) • Provide input on targets and trend (64%) • Input on amount at risk for savings (64%)

12. What Others Say Employers Can Do • United Health Care, December 2012 – Farewell to Fee for Service? • Be catalysts for testing new payment models • Explore value-based benefit designs • Deploy employee incentives for wise choices about health and health care • Institute of Medicine (IOM) September 2012 Report – Best Care at Lower Costs; promote transparency in quality, value, and outcomes to aid consumers in care decisions • Elliott Fisher MD, MPH, Dartmouth – Slowing the Growth of Health Care Spending: If Not Us, Then Who? • Slow medical arms race • Accelerate payment reform transition • Move market share to higher value providers • Other possible roles • Measure and reward health plan performance for • Reducing waste • Changing payment models to reward value, faster • Require health plans to reform payment • Contract directly with providers

13. Discussion Questions • Do you want to know: • Cost and quality targets of different care systems? • How providers perform compared to targets? • What are plans doing to address market share leverage of provider consolidation? • Wiling to offer narrower networks based on quality and cost targets? • Willing to challenge health plans to meet your company’s trend goals without more cost shifting to consumers? • Will payment reform really change how care is delivered and can providers perform to manage disease as a team? • How could employers accelerate the right kind of payment reform? • Would you be willing to set goals for pace of payment reform? • How to balance high deductible health plans and ACO/TCOC strategy? • Do you feel like you can influence the supply side?