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Report Compares Minnesota Health Plan Quality

A report comparing the quality and efficiency of Minnesota's major health plans was released today by the Buyers Health Care Action Group (BHCAG), a Twin Cities-based employer health care purchasing coalition. Intended to guide employer purchasing and consumer health plan selection, this first-of-its-kind study is based on health plan performance data collected through eValue8, a nationally recognized survey that asks health plans to submit information about their clinical quality and administrative efficiency. Seven health plans doing business in Minnesota participated in the survey including Blue Cross Blue Shield of Minnesota, HealthPartners HMO, HealthPartners PPO, Patient Choice, Medica HMO, CIGNA PPO and Sioux Falls-based Sioux Valley HMO. BHCAG conducted individual meetings with each participating plan to share the results and to identify areas for improvement and collaboration.

�The eValue8 tool measures the steps Minnesota�s health plans are taking to adopt electronic medical records, manage chronic diseases, help consumers chose high-performing providers and reward providers who provide high-quality care,� explained BHCAG CEO Carolyn Pare. �eValue8 shifts our current health care system�s fee-for-service focus to a pay-for-performance system where doctors and hospitals have strong incentives to improve care, consumers have comparative information to choose high quality doctors and employers voice common expectations to the health care marketplace.�

By using eValue8, Pare says employers are able to influence the health care marketplace both locally and nationally by placing a common "purchase order" for clinical specifications that have been proven to stabilize costs and keep quality high. eValue8 is a national initiative supported by the Washington, DC-based National Business Coalition on Health. More than 250 health plans in the nation now participate in the survey process and it has been used successfully by ten employer purchasing coalitions as well as companies like General Motors and Pitney Bowes to negotiate pricing, determine employee premiums and collaborate on programs to improve treatment of costly chronic health conditions such as diabetes, asthma and cardiovascular disease. The Minnesota report can be obtained at www.bhcag.com.

How eValue8 Works

Hundreds of benchmarks are gathered through a rigorous survey that measures a health plan�s effectiveness in such areas as information technology, member communication, disease management, measuring provider performance, behavioral health treatment and management of pharmacy costs and safety. For information technology, health plans are asked if the physicians and nurse practitioners within their network have access to portable handheld devices and computer software to order patient prescriptions and prevent drug conflicts. Plans must also disclose the sophistication of the information systems they use to process claims and how they communicate claim costs to employers. In the consumer engagement section, health plans submit information on the extent of their member outreach activities such as 24 hour/ seven day a week nurse advice lines, the type of provider qualifications and performance criteria they list in their consumer catalogs and whether or not they use �push� email technology to educate members about their specific health conditions and the disease management programs offered to help members control their disease. Pharmacy management is another important category where plans report on the steps they take to ensure pharmacy safety at the prescribing and patient level, their relationships with pharmacy benefit management firms, how they manage costs through generic equivalent prescriptions and whether or not they have programs to address the fast-growing category of specialty pharmaceuticals that are used in chemotherapy and to treat diseases such as Hepatitis C.

Other Key Survey Areas

Provider quality incentives, healthy lifestyle promotion, and behavioral health treatment are also part of the eValue8 survey. For example, plans are asked what they do to track and compare performance for both doctors and hospitals and if they partner with other health plans in the community on patient safety programs. The survey also requires plans to document the extent of their involvement in community health prevention programs on cancer, immunizations, tobacco cessation, weight management, and worksite health promotion. For behavioral health, plans are rated high if they demonstrate a commitment to promote established clinical guidelines and best practices for treating depression and alcohol disorders. eValue8 pays close attention to whether plans measure individual provider performance results in behavioral health and the extent of their patient support and education programs.

Minnesota Results

Minnesota plans compared favorably to the best performing national plan in most of the quality categories. HealthPartners HMO, HealthPartners PPO, Medica and Patient Choice received special national recognition for their performance in three survey categories. HealthPartners HMO and Medica were selected for their success in adopting health information technology while Patient Choice was recognized for its efforts in measuring and publicly reporting individual provider performance. HealthPartners PPO was also honored for its effectiveness in offering preferred provider plans for specific employer needs. These Minnesota health plans recently shared their strategies at a recent eValue8 best practices national conference held in Chicago, Illinois. One of the first Minnesota employers to include the eValue8 results in their health care purchasing decision-making is the University of Minnesota. �The eValue8 results allowed us to create a special quality-ranking matrix that we used in our health plan selection process,� explained Dann Chapman, Director of the University�s Employee Benefits. �We are now able to set performance and accountability standards with our health plan vendors that have both a financial and quality improvement focus.�

Cornerstone of a Comprehensive Value-Based Purchasing Strategy

The eValue8 survey tool is one of the major components of the Smart Buy Alliance � representing more than three-fifths of all Minnesota consumers - that was formed late last year by private sector employers, unions and the State of Minnesota. Pare said eValue8 allows employers of all sizes to make health care purchasing decisions using their own criteria. �Some employers use the eValue8 information to negotiate pricing with health plans. Some employers use the information to set employee premiums, with higher quality health plans costing employees less,� Pare explained. �Equally important to pricing - employers working with coalitions like BHCAG use the information to promote market wide improvements in health care quality through partnerships with the health plans.� "We are very pleased with the growing acceptance of a common tool such as eValue8 to measure health plan performance," said Kevin Goodno, Commissioner of the Department of Human Services and member of Governor Pawlenty's Health Cabinet. "This will lead to the recognition and rewarding of positive outcomes, which is a critical part of the Governor's agenda to reform the health care system." Survey Triggers Community-Wide Health Improvement Programs

�The ultimate goal is for all health care purchasers to use eValue8 so it can become a true, community-wide tool for health care quality improvement,� Pare stated. BHCAG will use the eValue8 results to develop community-wide programs between employers, providers and heath plans. Program areas identified by the Minnesota results include an effort to promote the use of established clinical guidelines for depression and alcoholism treatment, enhancing pay-for-performance through cash rewards to providers, the continuation of developing portable electronic personal health records and the promotion of RxHub, a common communications framework that links doctors, pharmacies, pharmaceutical benefit management companies and health plans for the purpose of sharing prescription benefit information. Health Plans Endorse the Process

�The eValue8 tool gives purchasers a comprehensive way to examine health plan capabilities and highlights those health plans who have made quality and performance measurement a priority. It provides a solid reinforcement for health plans and providers, and keeps us focused on continued improvements,� said Andrea Walsh, Executive Vice President and Chief Marketing Officer at HealthPartners. "The eValue8 process provides Blue Cross a useful way to hear from a segment of our customers. While scorecards always have limitations, this kind of dialogue is helpful in guiding our work," explained Richard Neuner, senior vice president and chief marketing officer.

About The Buyers Health Care Action Group

Formed in 1988, the Buyers Health Care Action Group (BHCAG) is a coalition of public and private employers working to recreate the health care system so consumers will get the care they need in the right place, at the right time and at the right price. BHCAG is a founding member of eValue8 that was created by leading U.S. employers and coalitions as a way for health care purchasers to buy and evaluate health plans based on their performance and value instead of solely on price.


Posted by: Duncan Kinder on Aug 11, 05 | 11:50 pm | Profile

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