Innovative Strategies
in Transparency
November 2006
Nancy Nankivil Bennett
Director of Strategic Health Policy
WI Department of Employee Trust Funds
nancy.nankivilbennett@etf.state.wi.us
Presentation Objectives
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To convey activities and results from the
Wisconsin Transparency push
To stimulate thinking and action on
Transparency Innovation
To disprove playwright, Jean Kerr’s words:
“If you can keep your head about
you when all about you are losing
theirs, it’s possible you just
haven’t grasped the situation.”
ETF as a Significant
Healthcare Purchaser
ETF Statistics
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More than 250,000 insured lives in
group health program; over 526,000
members in WI Retirement System
9th largest public pension fund in
United States; 23rd largest in world
Total assets currently valued at
$77 billion
Annual health care expenditures of
$800 million
Secretary is non-partisan &
appointed by Board
ETF Mission
Develop and deliver
quality benefits and
services to our
customers while
safeguarding the
integrity of the Trust
ETF Value-based
Purchasing Principles
“Getting best healthcare for best price”
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Leverage group purchasing power to
implement common quality & patient safety
standards
Gain transparency (disclosure) of comparative
information at health plan/provider level
Reward superior value through Pay for
Performance contracting with Plans/Providers
Engage consumers to make more informed
decisions regarding their health care
What is Being Said About
Transparency?
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“Transparency in health care means public reporting. The most
important way to improve the state of our health is in aligning
our quality and cost containment agendas. We need to identify
quality providers and drive market share to them.”
“Purchasers of health care need to have this kind of data so
they can make apple to apple comparison on price and quality
with respect to all providers in our health care marketplace.
Then we will have real transparency and real competition in our
health care system.”
“Informed consumers, given adequate cost, safety and quality
information, and a financial stake in their purchasing decisions,
will prove to be an effective driver of quality improvement and
cost containment if our health care system.”
ETF’s Push toward
Redefining Value
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Began in 2002 with Group Insurance Board Charge
focused on value-based purchasing tenets
In 2003 became active in National and State Initiatives
like Leapfrog, WI CheckPoint, WI Collaborative, WI
Healthcare Purchasers for Quality & IFEBP
2004 Plan Year implemented Tiered Premium
Contribution, Rx Partnership and Consumer
Engagement Strategy
2005 Plan Year implemented Quality Composite System
2006 public-private collaboration passed legislation
supporting WI Health Information Organization
2007 retaining “Medical Director” role in agency
Health Plan
Tiering Methodology
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Health Plan data analyzed by utilization
areas (inpatient, outpatient, Rx, etc) and
based on Uniform Benefits
Data risk adjusted for age/sex differences,
geographical cost variances, high-cost
claims & Rx utilization
Premium contribution levels established
through “Break-points” (three tiers)
Plans received premium incentive based
on Quality Composite System ranking
Quality Composite System
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Health plans compared on overall HEDIS and
CAHPS (HCAHPS in future) performance
Specific weight given in 5 areas:
• Disease Management (Diabetes, Asthma)
• Preventive Care/Wellness (cancer
screenings, tobacco cessation)
• Technology/Automation (CPOE, diabetic
registry, eHealth)
• Patient Safety (NQF Safety Measures)
• Customer Service (billing, grievances)
Pharmacy Carve-out
Program
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Centralized administration of three level copayment benefit structure based on formulary
adherence--drive market share to rebated Rx
State-wide P&T committee determines
formulary through evidence-based decisions
“Quality trumps Cost”--Secretary Stanchfield
All (100%) savings achieved through program
passed back to purchaser
All PBM records open for purchaser audit ,
including retail and manufacturer contracts
It’s Your Choice Booklet
It’s Your Benefit Newsletter
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Comparative reporting on cost, quality and
patient safety across plans using HEDIS &
CAHPS/QCS results
Comparative reporting on specific plan features
supporting improved patient care/outcomes
Use of Quality designation for plan hospitals; copay differential for quality-future consideration
Promotion of web-based resources for
ambulatory quality and safety information at
system level only
Transparency Push
Return on Investment
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2005 plan year premium increase at 4.9%; 2006
plan year premium increase at 9.8%; 2007 plan
year premium increase at 7.4%
Medicare premiums declined in plan years 2005
& 2006 and again in 2007
Enrollment shifts continue to occur based on
cost, quality, and patient safety information
Continued legislative support in budget for
value-based purchasing initiatives ($300k in
2005-07; BadgerRx Gold, addition of MD, WHIO)
WI Health Information Organization
A Statewide Data Warehouse
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Non-profit consortium (501C3) of health care
payers, purchasers and providers formed in 2005
State appointed to BOD in 2006 with passing of
“Transparency Bill”
Finalizing Vendor Selection Process; January
2007 anticipated contract start date
Initial data-medical and pharmacy claims,
physician identifiers and patient demographics;
clinical quality data will be merged in 2008
Episode of Care reporting for Cost Efficiency
reporting
Other Wisconsin
Transparency Initiatives
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WI Collaborative for Health Care Quality
WI Hospital Assoc Checkpoint/Pricepoint
• both at wisconsinhealthreports.com
Governor’s eHealth Board
• ehealthboard.dhfs.wisconsin.gov
Pharmacy Society of WI
• new initiative to be piloted in 07
• Pharmacy-based Pay for Quality program
Alignment is key issue for these initiatives
State Role in Health Care
Transparency
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Support voluntary, market-based health care
solutions/initiatives vs legislated/mandated
Convene and participate in public/private
Collaboration around value-based purchasing
Push for efforts that achieve continued
transparency of health care information
Lead by example with well defined, credible
Benefit Plan Designs that strategically integrate
Pay for Quality programs
Use “Bully Pulpit”, especially to align emerging
initiatives for effective Public Policy purposes
Conclusion
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Conveyed activities and results from the
Wisconsin Transparency push
Stimulated thinking and action on
Transparency Innovation
Disproved playwright, Jean Kerr’s words:
“If you can keep your head about
you when all about you are losing
theirs, it’s possible you just
Thank you for your attention and interest.