1. Leveraging
Health:
A Primer for Health
Promotion
Practitioners Using
Value-Based Designs
Cyndy Nayer
Co-founder and CEO: Center for Health
Value Innovation
John Riedel
President: Riedel and Associates
Consultants, Inc.

2. 2010 Board of Directors
Buck Consultants
Caterpillar [Michael Taylor MD] Johns Hopkins HealthCare
City of Cincinnati Journal Communications
City of Springfield Or Jack Mahoney ~ Pitney Bowes
Detroit Regional Chamber of Commerce Cyndy Nayer
Genesis Health System Partners in Care
Goodyear/Whirlpool Plumbers and Pipefitters Local 525 H/W Fund
Group Health Cooperative Premera BC/Vivacity
Bob Holben ~Gulfstream Quad/Graphics; QuadMed
Peter Hayes ~Hannaford Quest Diagnostics
Health Alliance Med Plans State of Colorado
HEB Univ of Colorado Health Sciences
Horizon BCBS NJ WellPoint
Humana Whirlpool
IBM Yum!
IHP/Battle Creek
©VBHEALTH.ORG Jan-Feb 2010

3. Our Mission
 Our mission is to drive the value of
every dollar invested in health
 Our goal is to identify and link innovators and innovation that
broaden the boundaries of health value
 Our work is focused on defining value, creating relevance to
shareholders and stakeholders, and improving the health and
economic viability of communities.
©VBHEALTH.ORG Jan-Feb 2010 3

4. Center publishes the first book on
levers of VBD; white papers, evidence
Also publishes evidence on sectors, innovation,
outcomes www.vbhealth.org
©VBHEALTH.ORG Jan-Feb 2010 4

5. Fundamentals of Value-Based Design
Value-based design is an ENGAGEMENT TOOL
for the CONSUMER AND PLAN SPONSOR AND PROVIDER
DESIGN DIVIDENDS
• Direct • HIT
• Health/Productivity
• Indirect • Insurance • Services
• Performance
• Incentives • Communication
• Quality
• Cost Trend Reduction
DATA DELIVERY
Uses Data to invest in …and services for improved health,
incentives… that change quality, performance
behaviors and financial trend
VBD is focused on OUTCOMES
April 2008
©VBHEALTH.ORG April-May 2010 5

6. Evolution of the Health Value
Continuum© 2007
©VBHEALTH.ORG Jan-Feb 2010 6

7. Value-Based Template
Data Incentives
Plan Design
Resources
Prevention Chronic
and Care Mgt Care
Wellness Delivery
Jan-
Feb
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201

8.  Objective: Understand the experience of
companies with value-based designs in place
for 2 or more years
Center contracts with  Over 100 companies responded
Buck consultants to  Represent over 1 million employees
 Jumbo to small, public/private, non-profit
verify our work and governments-as-employers
 Levers cover all 3 domains
 87% Use levers in prevention and wellness
 60% Use levers for chronic care
management
 26% Use levers for guidance to appropriate
care delivery
 54% use levers for Depression management
 NOTE: some numbers may not add up to 100: this could
be due to rounding errors or because companies were
allowed to choose more than one response
©VBHEALTH.ORG April-May 2010

9. What We Now Know…
 No VBD succeeds without a primary focus on prevention and
wellness
 All successful adoptions and accelerations of VBD are linked to
the level/timing of communications
 And no one succeeds when only communicating 1 time per year
 Acceleration occurs when aligned incentives drive outcomes
 This includes patient-centered coordinated care
 This includes use of community-based assets
 This includes communication no less than quarterly to keep stickiness
of behavior change across all stakeholders
 Sustainable and measurable value occurs across silos, into the
community (when providers achieve improvement in health and
financial outcomes) and into families
©VBHEALTH.ORG April-May 2010 9

10. VBD Are Economically Sustainable…
79% said no changes
were made in 2009-
2010 due to
economic downturn
©VBHEALTH.ORG April-May 2010 10

11. …VBD Are Economically Sustainable
56% said no
changes due to the
economic downturn
were anticipated for
the next plan year
©VBHEALTH.ORG April-May 2010 11

12. Communication is Key to Behavior
Change and Better Utilization
69% of companies
communicate at least
quarterly
Most use a variety of
media to reach and retain
“stickiness”
©VBHEALTH.ORG April-May 2010 12

13. Challenges to the VBD Benefit
Deployment are Varied
Employee Engagement is Key to Success
©VBHEALTH.ORG April-May 2010 13

14. What Could They Have Done
Better?
Better Employee Communication and Communication with the
Physicians/Pharmacists/Clinicians for Aligned Messaging
©VBHEALTH.ORG April-May 2010 14

15.  Objective: Streamline the decision
process for levers and designs
Center Launches the  Showcase examples of Levers for all 3
Decision Matrix for domains
VBBD  Use levers in prevention and wellness
 Use levers for chronic care
management
 Use levers for guidance to
appropriate care delivery
©VBHEALTH.ORG April-May 2010

16. Fundamentals of Value-Based Design
Value-based design is an ENGAGEMENT TOOL
for the CONSUMER AND PLAN SPONSOR AND PROVIDER
DESIGN DIVIDENDS
• Direct • HIT
• Health/Productivity
• Indirect • Insurance • Services
• Performance
• Incentives • Communication
• Quality
• Cost Trend Reduction
DATA DELIVERY
Uses Data to invest in …and services for improved health,
incentives… that change quality, performance
behaviors and financial trend
VBD is focused on OUTCOMES
April 2008
©VBHEALTH.ORG April-May 2010 16

17. Leveraging Health Matrix
©VBHEALTH.ORG Jan-Feb 2010 17

18. Decision Matrix Follows the Health
Value Continuum examples of levers
Solve for: Waste Future Risk Individual Health
Reduction Reduction Competency
Underuse/ Compression of Decision Support
Overuse/ Morbidity for Health-Wealth-
Misuse Performance
Prevention and Remove Incentive for Incentive for use of
Wellness barriers to early risk PHR
primary care reduction
Chronic Care Remove Incentive for Incentive for
Management barriers to adherence counseling
chronic care
Guide to Incentive for care Disincentive for ER
Care
efficient care coordination use
Delivery
site
©VBHEALTH.ORG Jan-Feb 2010 18

19. Value-Based Design Is Sustainable
When It’s Mapped to Productivity
 Example: Back Pain
 20% loss in productivity in high
risk group
 Waster Reduction Lever:
mandatory fitness/rehab
 Chronic Care Lever:
EAP/Behavioral health coach
 Care Delivery Lever: Physical
Therapy
 Example: Smoking
 9% loss in productivity in high
risk group
 Waste Reduction Lever:
mandatory cessation classes
 Chronic Care Lever: reduction
in Tx copays
 Care Delivery Lever: Weekly
IVR/ phone calls with counselor
©VBHEALTH.ORG April-May 2010 19

20. Value-Based Design Can Drive
Productivity Outcomes thru Levers
 Reduction in Total Risks
 At the Person level [SMALL Er]
 W/3 risks costs $5952
 W/1 risk costs $4480
 Difference = $1494/year
 At the Population level [Mid-Large ER]
 100 people moved from 3 risks to 1
risk= $298,700 savings
 Comparison Opportunity:
 Waste Reduction: Behavioral Health
and EAP education/screening
 Chronic Care: Dx drives intensive
screening/coaching; copays are
reduced when enrolled in behavioral
health coaching
 Care Delivery: Increased
reimbursement to care mgt teams for
chronic care; reduction in copay for
care by these teams
©VBHEALTH.ORG April-May 2010 20

21. What Is the Value of 100+ Levers?
 Individual Health Management: up to 50% trend reduction
 1:1 to 1:1.5+ Dividend
 $1mm in dividend including productivity losses
 Condition Management: up to 50% trend reduction
 21% decrease in sick days/unscheduled absence
 Overall adherence improved in medications/treatment compliance
 Provider Selection (Care Delivery): up to 35% trend reduction
 Improved compliance with evidence-based guidelines
 Suites
 Up to 50% reduction in trend sustained for 4 years and more
April-May
©VBHEALTH.ORG 21
2010

22. Value of Health is Driven by
Sustainable Behavior Change
 Quality Improvement effort to develop predictability,
alignment in care, and transparency for choice
 Risk management focus to reduce inefficiencies and
variability in care and outcomes
 Challenge in plan design v incentives leads to innovative use
of levers
 Alignment of incentives between delivery system and
consumer decisions reduces friction
 Communication that is visible, public and promotional
 VBD = PCPCC = Outcomes that drive sustainable behavior
change and predictable reduced trend
Nayer, Mahoney. Journal of Compensation and Benefits Mar 09
©VBHEALTH.ORG Jan-Feb 2010 22

23. Behavioral Change is the Key to
Sustainable Value

24. Obesity Example for Individual Health Competency
Sponsor Goal Lever Action HPP Role Metrics Report to Sponsor
Transfer Reduced Receive nutritional Provide nutritional counseling, P in modules, % participation
responsibility insurance cost counseling, participate provide coaching, changes in % completing
for personal for participation in coaching, complete design online module, eating patterns, interventions,
health or for achievements an online educational provide reminders for updated status % change in
management module, update updating the PHR, of PHR, eating behavior,
to individuals information in the PHR provide technical assistance. change In % change in weight
weight, BMI, % change in BMI
risks related to
obesity.
©VBHEALTH.ORG Jan-Feb 2010 24

25. Obesity Example for Condition Management
Sponsor Goal Lever Action HPP Role Metrics Report to Sponsor
Increase adherence Reduce cost ofTx Enroll in disease mgmt. Provide education about Improvement % change in weight
to chronic care when individual obtain lab values as obesity, perform ongoing in testing result, % change in BMI
management participates in required, adhere to lifestyle coaching related exams, and lab % change in chol.
approved program recommended care obesity, provide coordination results; % change in HbA1C
activities among care providers improvement
when necessary in indicators
(BMI, cholesterol,
level, HbA1C)
©VBHEALTH.ORG Jan-Feb 2010 25

26. Obesity Example for Care Delivery
Sponsor Goal Lever Action HPP Role Metrics Report to Sponsor
Use of appropriate Reduce cost of Use of PCP network defined Education about condition Degree of % in-network care
provider based upon primary physician by plan sponsor, adherence or lifestyle, provide referrals adherence to PCP utilization
evidence and care and selected to Tx protocols that are to appropriate providers, recommended patterns,
efficiency specialist care evidence-based coach on care mgmt. and providers; % change in diet
communicating with your improved % change in weight
physician about obesity- testing results % change in chol.
related issues exams, and lab fractions,
results; % reduction in ER use
improved
disease indicators
and health status
indicators (BMI,
cholesterol level,
HbA1C)
©VBHEALTH.ORG Jan-Feb 2010 26

27. Alignment: If Value Is Built on
Outcomes, then Purchasing Must Be
Built on Outcomes
 Outcomes can be measured by determinants
 Health (clinical)
 Wealth (financial)
 Performance (operational)
 Outcomes-Based Contracting must align incentives between
or across the signers of the contract
©VBHEALTH.ORG Jan-Feb 2010 27

28. Innovator DNA
 Innovators embrace a mission for change.
 Make mistakes
 Take risks
 Display courage
 Transform ideas into powerful impact
 Provide to the general community in order to
change the ecosystem
HBR Vol 87 #12, Dec 2009

29. Cyndy Nayer
John Riedel
www.vbhealth.org
info@vbhealth.org
©VBHEALTH.ORG April-May 2010 29