On March 14, 2018, leaders from across the health care spectrum came together to discuss strategies for tackling some of the industry’s most relevant challenges at the University of Michigan Center for Value-Based Insurance Design‘s 2018 V-BID Summit.
Dr. A. Mark Fendrick, V-BID Center director, delivered the welcoming remarks to kick off Wednesday’s panel discussions. The day-long summit consisted of 4 interactive sessions: Aligning Clinicians and Consumers around Value, Creating a Smarter High-Deductible Health Plan, Expanding the Role of V-BID in Public Payers, and Eliminating Low-Value Care – A “Top Five” List to Galvanize Purchasers. All panels were moderated by Clifford Goodman of the Lewin Group.
For more information, please view the V-BID Summit Program and agenda.
Aligning Clinicians and Consumers around Value
Panelists:
- Michael Chernew, Harvard Medical School
- Kavita Patel, Brookings Institution
- Katy Spangler, Spangler Strategies
Moderator: Clifford Goodman, Lewin Group
In the first session, panelists kicked off the day by talking about the need to align value-based incentives for all stakeholders. Michael Chernew (Harvard Medical School) noted that there is a disconnect between those making benefit design and payment decisions, and that successful value-based initiatives will need to align these two groups. Kavita Patel (Brookings Institution) offered insights into the challenges facing physicians in the transition to a value-based health care system. Patel explained, “There is a state of disarray in the measures I have to report on…because, unfortunately, the [alternative payment models] I’m in don’t get me out of traditional reporting.” Katy Spangler (Spangler Strategies) echoed these sentiments when she said that the health care industry needs to set uniform quality measures that get health plans, clinicians, and consumers on the same page. Much of this work can be guided through the application of clinical nuance, which will need to be incorporated not only into benefit designs but into conversations between clinicians and patients as well. “Communicating [nuance], it’s a nightmare to try to put it in black and white. But it’s not impossible,” Patel said.
For additional information, please read the American Journal for Managed Care (AJMC) blog post: Aligning Around Value: Challenges With Quality Measures and Implementing Clinical Nuance
Creating a Smarter High Deductible Health Plan
Panelists:
- Adam Beck, AHIP
- Michelle Drozd, PhRMA
- Paul Fronstin, EBRI
Moderator: Clifford Goodman, Lewin Group
The second panel began with health experts discussing the growing role of high-deductible health plans (HDHPs) in the American insurance market and both the benefits and challenges that such plans present for consumers. Paul Fronstin (Employee Benefit Research Institute) reflected on how his research has revealed rapidly rising deductibles, likely as a result of employers trying to keep their costs down without instituting broader changes in how their plans are structured. One potential solution is the high-value health plan. Michelle Drozd (Pharmaceutical Research and Manufacturers of America) identified high deductibles as a barrier to long-term management of chronic diseases and argued that there should be more communication between manufacturers and payers about new medicines coming to market in order to give payers the predictability needed to cover these new drugs and, ideally, improve patient access. Adam Beck (America’s Health Insurance Plans) predicted that HDHPs would continue growing in popularity and advised that more plans should invest in addressing the social determinants of health that impact well-being.
For additional information, please read the American Journal for Managed Care (AJMC) blog post: Path to a Smarter High-Deductible Plan Includes Flexibility, Disruptive Innovation
Expanding the Role of V-BID in Public Payers
Panelists:
- Adam Finkelstein, Manatt, Phelps & Phillips, LLP
- Claire Levitt, NYC Mayor’s Office of Labor Relations
- Capt. Edward Simmer, Department of Defense
Moderator: Clifford Goodman, Lewin Group
After a break for lunch, the summit resumed with health care experts discussing how V-BID principles have been implemented in public payers and what challenges remain in expanding its role even further. Adam Finkelstein (Manatt, Phelps & Phillips, LLP) drew upon his previous experience at CMS’ Center for Medicare & Medicaid Innovation to highlight the “remarkable” expansion of benefit flexibility for Medicare Advantage (MA) plans under CMS’ MA V-BID Model demo. Claire Levitt (NYC Mayor’s Office of Labor Relations) shared insights into how strategically adding costs in specific areas and “changing plan design in concert with foundational V-BID principles” for New York City employees has resulted in over $3.4 billion in health care savings over the last 4 years. As chief clinical officer for the TRICARE program, Capt. Edward Simmer (Department of Defense) admitted that it has been challenging to implement V-BID principles in a program where beneficiaries have little to no cost-sharing, but the program has seen successes with non-financial incentives that steer beneficiaries to the right care.
For additional information, please read the American Journal for Managed Care (AJMC) blog post: How Public Payers Are Adopting VBID Principles Despite Constraints
Eliminating Low-Value Care: A ‘Top Five’ List to Galvanize Purchasers
Panelists:
- Beth Bortz, Virginia Center for Health Innovation
- Lauren Vela, Pacific Business Group on Health
- Daniel Wolfson, ABIM Foundation
Moderator: Clifford Goodman, Lewin Group
The final panel discussed how to address low-value care, a topic that was mentioned throughout the day. Daniel Wolfson (ABIM Foundation) provided valuable insight into the Choosing Wisely campaign that has spearheaded discussions of value in health care. Wolfson explained that the purpose of Choosing Wisely was to “enhance safety, quality, and affordability,” not necessarily reduce costs. “Cost effectiveness is a more difficult, nuanced thing to be able to look at. We wanted to be able to get people in the game first and then think about cost effectiveness,” said Wolfson. Beth Bortz (Virginia Center for Health Innovation (VCHI)) described how VCHI used the Choosing Wisely campaign as a starting block to discover that more than $700 million a year was spent on unnecessary care in Virginia. Lauren Vela (Pacific Business Group on Health) emphasized the importance of translating discussions about the value of health care services into something that is action-oriented for employers. All the panelists agreed that in order to get everyone on board with reducing low-value care, the discussion can not just be about cost, but rather about harm and value for consumers.
For additional information, please read the American Journal for Managed Care (AJMC) blog post: The Challenge of Addressing Low-Value Care Once It’s Identified
2018 V-BID Summit Infographics
Aligning Clinicians and Consumers Creating a Smarter HDHP Low-Value Care: A 'Top Five' List
V-BID in Medicare Advantage V-BID in the TRICARE program V-BID in Connecticut's HEP
V-BID at the Big House
The 2018 V-BID Summit was held at the University of Michigan Stadium, a.k.a. “The Big House” and attendees tweeted using the hashtag #VBIDatTheBigHouse. The V-BID staff and summit attendees took full advantage of the opportunity to tour the stadium, locker room, and football field – as evidenced by the photos below. (Click to enlarge)
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