Reducing Lo Low Valu lue Ca Care in in a Post Pandemic World A. - PowerPoint PPT Presentation

Reducing Lo Low Valu lue Ca Care in in a Post Pandemic World A. . Mark Fendrick, MD University of f Mic ichigan Center for Valu lue-Based In Insurance Design www.vbidcenter.org @um_vbid

Hail to the Frontline So many selfless people are doing truly wonderful things to successfully defeat this pandemic. Thank you. 2

Health Care Costs Are a Top Iss Issue For r Purchasers and Poli licymakers: Solu So lutions must protect consumers, reward providers and preserve inn innovation • Every ryone (a (alm lmost) ) agrees th there is is enough money in in th the US S health care system; ; we ju just sp spend it it on th the wrong se services and in in th the wrong pla laces • Poli licy deli liberations focus pri rimarily on alt lternative payment and pri ricing models • Moving from a volume‐driven to value‐based system requires a change in both how we pay for r care and how we engage consumers to se seek care

Th Then Ca Came Co Coronavir irus …

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• Build ild on exis xistin ing alt lternativ ive payment models ls that base reim imbursement on patie ient-centered outcomes. increase reimbursement for r high-valu lue se servi vices and reduce or r cease payment for r known lo low-valu lue care • Le Leverage th the wide idespread adoptio ion of f elec lectr tronic ic healt lth records (E (EHRs) ) to make it it easie ier to order hig igh-valu lue care with ith sim simpli lifie ied processes and disc iscourage th the use se of f lo low-valu lue care with ith aler lerts • Ali lign patie ient cost-sharin ing with ith th the valu lue of f th the underly lyin ing se servi vices; reduce out of pocket cost on hig igh valu lue se servic ices and in increase patie ient cost t on lo low valu lue care 7

Paying for r More Generous Co Coverage of f Hig igh Valu lue Ca Care: Reduce Sp Spending on Low Valu lue Care

Paying for r More Generous Co Coverage of f Hig igh Valu lue Ca Care: Reduce Sp Spending on Low Valu lue Care • In Increase premiums – poli litically not t feasible • Rais ise deductibles and copayments – ‘tax on the sick’ • Reduce sp spending on lo low valu lue care

https://vbidhealth.com/docs/States-LVC-Paper-FINAL-Draft(1).pdf 11

V-BID X: : Be Better Co Coverage, Sa Same Premiums and Deductibles

V-BID X: Expanding Coverage of Essential Clinical Care Without Increasing Premiums or Deductibles

HHS 2021 Payment Rule le St Strongly ly Endorses V-BI BID X https://www.govinfo.gov/content/pkg/FR-2020-05-14/pdf/2020-10045.pdf

Enhancing Access an and Affordability to Ess ssential Cl Clinical Se Services: A A Need to Reduce Lo Low Valu lue Ca Care in in the ‘New Normal’ • Exp xpand pre-deductible coverage/reduce consumer cost-sharin ing on hig igh- valu lue cli linical COVID-19 rela lated care and oth ther essential chronic dise isease se serv rvic ices • Id Identify fy, measure and reduce lo low-value care to pay for r more generous coverage of f hig igh-value care • Im Implement cli linically-driven pla lan payment reform, technologies and benefit it designs that in increase use of hig igh-value se services an and deter lo low valu lue care

Multi-stakeholder Efforts to Reduce Low Value Care: Smarter Care Virginia https://www.vahealthinnovation.org/scv/