MANAGED CARE December 2006. ©MediMedia USA
The National Business Coalition on Health has a head start on Uncle Sam's new insistence on transparency and accountability
In the ongoing quest for transparency in health care, some of America's biggest employers will lock arms with the federal government in 2007 to shine a bright light on the performance of U.S. health plans.
In conjunction with President Bush's executive order to increase transparency in federally sponsored health insurance programs, the National Business Coalition on Health will help carry the initiative into the private sector.
"We are working with other purchaser groups, including the Human Resources Policy Association, to craft a private-sector parallel to that executive order that would gain the endorsement of many Fortune 500 companies who would sign on at a very high level," says Dennis White, senior vice president for value-based purchasing at the coalition.
In addition to its own extensive request for information (RFI), the 2007 version of the NBCH's eValue8 tool for comparing and monitoring health plans will incorporate the elements and language that the federal sector will use as it carries out the president's marching orders.
Tracking plan performance
The coalition's move marks an alignment of the federal and private sectors to sort out one facet of the health care marketplace — health insurance — by jointly tracking certain aspects of health plan performance.
In a sense, the effort mirrors and complements what's done by the National Committee for Quality Assurance. Both eValue8 and the NCQA's HEDIS measures track health plan performance, but in different ways. The eValue8 tool is driven by employers, who work with clinical experts to incorporate evidence from the literature to decide what is important to them. Employers don't have any control over HEDIS measures, many of which focus on clinical issues.
Both efforts are in line with what the federal government is doing. In August, President Bush issued an order directing the federal agencies that run the Federal Employees Health Benefit Program, the Medicare program, the TRICARE program for the Department of Defense, and the health care program operated by the Department of Veterans Affairs to make transparency a priority. Specifically, the order mandates four initiatives:
- Increase transparency in pricing by telling beneficiaries about prices paid to health care providers for procedures.
- Increase transparency in quality by reporting the quality of services provided by doctors, hospitals, and other providers.
- Encourage adoption of health information technology standards to advance the exchange of health information.
- Provide incentives that promote quality and efficiency in health care.
While the details behind those bullet points have yet to be worked out, NBCH is close enough to the action to salute. White says the U.S. Department of Health and Human Services seems encouraged that the private sector has stepped forward to embrace the executive order's principles.
"Secretary Mike Leavitt has become very eager to pursue this idea of a private sector parallel and is reaching out to multi-stakeholder groups," he says. "We're pleased to be part of the discussion. And of course we've contributed our own thoughts about it. We will be very early out of the chute to have that tool embedded."
The business coalition's eValue8 tool, launched more than a decade ago, is used by many employers across the nation to help with their health care purchasing decisions.
EValue8 — a term that encompasses an electronic data-gathering system, a process for reviewing the data, and the eight founding coalitions — uses an annual survey to collect information on a wide range of clinical quality and administrative topics. It goes into great detail. Among the topics, health plans are asked:
- If their network physicians use electronic prescribing technology
- How they communicate claim costs to employers
- What type of provider qualifications and performance indicators are measured, reported to providers, and made available to plan members
- Whether educational information and targeted reminders are pushed by e-mail to educate members about specific health conditions
- How pharmacy safety is ensured at the prescribing level
While some employers use the tool to weed out poor-performing health plans from consideration, White says that eValue8 is more commonly used to monitor a health plan's performance over time.
"It gives a very clear idea of the strengths and weaknesses of that plan and gives a working template for measuring progress," he says.
For example, General Motors ranks the health plan options available to its workers, based on their eValue8 scores and other factors, and makes the highest-performing plan available at the lowest out-of-pocket premium cost to the employee.
Incorporating the federal government's criteria in its 2007 RFI is the latest step in eValue8's ongoing adaptation to the changing needs and priorities of the employers who use it.
"It has evolved over time in a way that I would describe as a learning process and a learning tool," says MaryAnn Stump, senior vice president at Blue Cross Blue Shield of Minnesota, 1 of nearly 250 health plans around the country that responded to the eValue8 RFI in 2006.
Minnesota is among a handful of states and local markets in which eValue8 has emerged as a powerful tool for improving the quality of health plans. The Buyers Health Care Action Group, an influential employer health care purchasing coalition that has used the tool for years, in 2005 issued the first public report of health plan performance as a way of encouraging plans and providers to adopt common performance measures and practice guidelines. A year later, Minnesota health plans posted "national best" scores in six of eValue8's 10 survey areas.
To be specific, HealthPartners' HMO and PPO set the national benchmark in three categories — adopting health information technology, measuring and publicly reporting individual provider performance, and managing pharmacy quality — while Patient Choice earned the highest PPO score for consumer engagement and support. The Minnesota Blues plan, meanwhile, ranked first among PPOs for managing chronic disease and in the overall plan profile category, which measures community collaboration and accreditation.
"The Minnesota marketplace — the purchasers, the health plans, and the providers — have a deep-seated commitment to performance measurement," says Andrea Walsh, executive vice president of HealthPartners. "That translates into a marketplace able to put eValue8 to use more quickly than other marketplaces."
The state of Minnesota uses eValue8 during the annual renewal process for the insurance contracts that cover state employees. The Minnesota Department of Human Services, which spends $3 billion a year on its Medicaid program, is working on a way to use eValue8 for that program as well, says Susan McDonald, director of the Governor's Health Cabinet.
"Public reporting is very effective in improving performance because no plan wants to be seen as the worst, and therefore the performance improves and health improves for all Minnesotans," she says.