WASHINGTON, Nov. 16, 2010 /PRNewswire/ -- Today at its annual conference the non-profit National Business Coalition on Health (NBCH) released the 2010 eValue8™ findings, an annual survey and evaluation used by health care purchasers to assess and manage the quality and efficiency of America's health plans. The overall 2010 findings identified opportunities to reduce waste, address gaps in care, structure payment reforms and improve consumer engagement.

A critical element of a purchaser's value-based purchasing strategy, eValue8 was used by employers and coalitions to gather health care data from 64 health plans across the nation, representing more than 100 million Americans. A publicly available report on the 2010 results is available on NBCH's website.

"To truly reform the U.S. health care system requires a triple aim approach: improve health, improve health care and lower costs," said Andrew Webber, president and CEO, NBCH. "To accomplish this it's critical to have a strong interaction between the health care purchasers and their health plans. The collaboration and discussion that takes place as part of eValue8 plays a vital role in efforts to improve quality and cost."

2010 eValue8 Findings

Reducing waste

• There was wide variation among plans reporting diagnostic test procedures such as those used to determine cardiac stress, with some conducting relatively few tests (two per 1,000 members), to plans conducting a significant number (99 per 1,000). These are often expensive and overused diagnostic tools and some plans have been more successful than others in reducing their (over) use.
• Given that pharmaceutical costs account for roughly 12 percent of overall health care costs and can impact other costs such as hospitalizations, plans have made tremendous progress with high generic dispensing rates. Specifically, 75 percent for HMOs and 68 percent for PPOs – a 2.5 percent improvement just since 2008. Some plans have achieved generic dispensing rates of over 85 percent.

Identifying gaps in care

• Plans could be doing a much better job when it comes to monitoring whether members are taking their medication as prescribed – 33 percent of plans report having optimal plan monitoring of depression medication adherence; only five percent of plans report optimal plan monitoring of substance abuse medication adherence; and 49 percent of plans report monitoring of diabetes and coronary artery disease medication adherence.

Implementing payment reform

• Plans are paying doctors more money for higher quality care – 67 percent report administering incentives to physicians for better performance and 58 percent of all plans offer financial incentives that are based on either clinical process or outcome measures.

Improving consumer engagement

• Identification rates for chronic conditions were low – on average plans have identified only two percent of members as obese and 0.5 percent as tobacco users. This can be due in part to low personal health assessment completions, averaging only three percent.
• Participation rates for various behavioral health disease management programs were reported at or below five percent of estimated prevalence for alcohol problems and less than 20 percent for estimated depression prevalence.

2010 Top Performing Plans

eValue8 asks health plans to submit responses and documentation on their performance for the following clinical areas and administrative practices: Health Plan Profile (i.e. plan's accreditation status, how it works with employers to promote safe and effective care), Consumer Engagement, Physician Performance Measurement, Pharmaceutical Management, Prevention and Health Promotion, Behavioral Health and Chronic Disease Management and Member Identification. The information is then verified, and scores are tabulated so that purchasers can compare their health plans against regional and national benchmarks. While the top performing 15 percent of plans for each category are included in the report, five plans garnered the top performing HMO and PPO spots across the various domains:

• CIGNA New York
• HealthPartners Minnesota
• Kaiser Permanente Northern California
• Kaiser Permanente Northwest
• Kaiser Permanente Southern California

"We first began requiring our health plans to participate in the eValue8 survey process in 2004, which enabled us to make purchasing decisions based on performance," said Mary Bradley, director of Health Care Planning, Pitney Bowes, Inc. "As a result of our employees receiving better care through our value-based purchasing efforts including eValue8, we estimate that our cost of care is five percent below our competitors in similar industries and eight percent below Fortune 500 companies."  

eValue8 and the Patient Protection and Affordable Care Act

The landmark Patient Protection and Affordable Care Act contains requirements to increase measurement, accountability and public reporting, which is in keeping with the value-based purchasing goal of eValue8. The Act also includes provisions designed to promote competition based on value and to ensure access to comparative quality information – both core aspects of the eValue8 survey. This presents opportunities for eValue8 to further become part of the health care landscape to promote community-wide action on key health issues.

What is eValue8?

An annual health care purchasing and quality improvement assessment process, eValue8 was developed by NBCH to help purchasers buy health care products and services while controlling costs and ensuring top quality care. eValue8 asks health plans to submit information on areas such as how doctors are paid, gaps in care, consumer engagement, price transparency and administrative efficiency across hundreds of measures of quality and performance. This enables purchasers (such as public and private employers and union trusts) to compare plans against one another and against national benchmarks.

Ensuring Solutions, a division of The George Washington University Medical Center, analyzed much of the eValue8 data and The Centers for Disease Control and Prevention in Atlanta also contributed to the content.

About the National Business Coalition on Health

NBCH is a national, non-profit, membership organization of 53 purchaser-led business and health coalitions, representing over 7,000 employers and 25 million employees and their dependents across the United States. NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. For additional information visit: www.nbch.org.

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Andrew Webber

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SOURCE National Business Coalition on Health