Controlling care costs while keeping employees happy and healthy has been tough for both employers and consumers, who have struggled to keep up with rising expenses. One strategy that employers can use is to focus on the value of health care – the quality of care they get for the money they spend. Put another way, value-based purchasing focuses on methods to get a better ROI for an employer's health care benefits and related health and productivity programs.
Three Things That Employers Can Do
to Get High-Value Health Care:
- Provide employees with trusted information they can use to make better health care decisions and manage their health conditions better. Research shows that consumers believe that more health care is better and that more expensive health care is better. As more employees choose high-deductible plans offered by employers or shift to health insurance exchanges, they must be better informed consumers.
- Create incentives to encourage smart use of health care resources. Design health benefits that lower or eliminate co-pays for important services, such as prenatal care, and increase co-pays for services that often are unnecessary, such as imaging for low back pain, which actually can lead to harm.
- Work with other health care stakeholders – health plans and health care providers – to support care delivery models that have produced better health outcomes at lower costs with patient-centered coordinated care. Leverage the investments made by the State of Ohio and Better Health provider members to transform health care delivery by participating in value-based purchasing initiatives.
How Better Health Works with Employers
in Greater Cleveland
Better Health has a range of resources available to assist employers in strategies to help them and their employees get more value for their health care expenditures. These include:
- Employee communications. Provide free resources to help your employees use their health benefits more wisely. Incorporate consumer-friendly materials from Consumer Reports on the Choosing Wisely® campaign, which features hundreds of recommendations on tests, treatments and procedures that frequently are unnecessary, overused and can be harmful. Also available are other resources developed by the National Business Coalition on Health and American Institutes for Research for employee populations that can be tailored to employers' communications needs.
- Identify opportunities to add value. Analyses of utilization, cost and quality data to identify opportunities in benefit design to drive smarter use of health care resources and interventions that can improve population health and control costs.
- Provide web-based information on the quality of health care delivered in our community to help employers and employees make informed decisions.
- Help develop partnerships with key stakeholders. Facilitating discussions with brokers, health plans and providers to craft partnerships that produce better outcomes, rather than just higher volume of care, from your benefits budget.
Three Local Employers Partner for More Value with Patient-Centered Primary Care
Progressive Corp., Lubrizol Corp., and Lake County Schools Council are partnering with Lake Health System to ensure patient-centered, coordinated care for their employee populations. The three employers will fund nurse care coordinators located in primary care practices of Lake Health that have adopted the Patient Centered Medical Home model, which has demonstrated better outcomes at lower costs.
Better Health and Health Action Council, an association of self-insured employers, are facilitating the value-based purchasing project. Better Health provides technical support for the care coordination services and data analytics to monitor the effectiveness of the initiative.
How the Buckeye State Will Change the Way it Buys Health Care
The state of Ohio is putting its money on high-value care. Plans are underway to launch Gov. John Kasich's Office of Health Transformation "innovation model" to pay for value instead of volume across Medicaid, state employee and commercial populations and to spread the Patient Centered Medical Home model across the state.
Better Health is playing a major role in these initiatives and currently sits on the PCMH Model Design team.
- The goal is to have 80- 90% of Ohio's population in some value-based payment model and 80% of patients enrolled in primary care practices that have adopted the Patient Centered Medical Home model of care.
- The state of Ohio is applying for a State Innovation Model grant from the Center for Medicare & Medicaid Innovation, which will allocate up to $700 million to as many as 12 states to test innovative payment and service delivery models over four years.