DDP 2010: Utilize Outcomes Based Contracting in Payment Reform for Improved Health and Reimbursement Rates in More Costly Delivery Products

Moderator: Cyndy Nayer, President and Chief Executive Officer, Center for Health Value Innovation
Thom Stambaug, VP and Chief Clinical Officer, Pharmacy Management, CIGNA
Peter F. Hayes, President Healthcare Solutions, Hannaford Brothers and Chair, Maine Business Coalition
Kevin O’Brien, Chief Executive Officer, Partners in Care

Value based design. Getting people engaged in the appropriate care to manage chronic condition that costs employer lots of money.

Three principles:
-Can we influence waste reduction?
-Can we get ahead of future risk?
-How can we link health to wealth and performance? How does this influence community health?

Potential partners for adherence and persistence
Virtual care networks

Patients: what is individual responsibility to the health?
-Accountability, good choice, health based status. How do we get the patients engaged to start taking care of themselves. If they’re not, should they be paying more into the system? A day will come when employers think about what therapies will be included on plans. What can we afford? Retail pharmacies, employers, and the global market place will probably change pricing structure.

Questions: What is new now?
Why didn’t we do public healthcare ten years ago? When we look back, how do we purchase drugs? On rebates. How do rebates work? Cereals put on racks based on pricing. This is an equation for how drugs work. Can we get more performance and productivity out of every dollar that we spend? Health outcomes and productivity have to be looked at together. When we encourage patients to be compliant, the price of their care goes dramatically down because their care is better. Generics is encouraging the industry to look at this again. How can we present value for new products?

Incentives in system encourage sick care instead of healthcare.
Q: How long will it be before the consumer actually knows how much the drug is costing?
When you go to the doctor, you pay $30, however, it actually costs the healthcare company $200. The panelist believes that the consumer will be seeing how much different things cost via different avenues within the next 12-18 months. The market place should also provide the value of the care. Value and cost of treatment will soon be available to the customer. Total cost must be known by the consumer, as healthcare knowledge should know price and value.

Huge trend in smaller employers to a co-insurance instead of a co-pay. People are realizing what it costs. Electronic medical records will show gaps in care. The doctors own electronic medical records. So what about the individuals? They don’t own them.

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