| PEBB's Vision for 2007 |
|
|
 |
| Frequently Asked Questions |
|
Q: What is a vision statement?
A: It is a statement of perhaps a half dozen sentences that describe a desired future, not a predicted future. For example, in 1962 President John F. Kennedy articulated a vision of sending a man to the moon and returning him safely within the decade of the ´60s. That statement served as the organizing concept through which the nation won the space race and achieved the vision of space as a frontier for free people.
Q: Why should PEBB create a new vision now?
A: The Benefit Board believes that the current environment threatens its ability to meet its statutory mission, which is to “…provide a high quality plan of health and other benefits for state employees at a cost affordable to both the employer and the employees.” In the absence of any other tangible solutions, PEBB believes it should use its purchasing power to help change the delivery system in Oregon in a way that will help improve quality and affordability for members and the state.
Q: What do you mean by “the current environment”?
A: The Board has to address significant negative changes in the regional and national healthcare environment. These challenges make up the current environment:
- Average annual healthcare premiums rising 10.5% from 1999 to 2005. PEBB’s health benefit costs have increased to $377 million in 2004, and are projected to be $435 million in 2005.
- Ongoing cost drivers: more, costlier prescription drugs; expensive new technologies; the aging population using more services; and healthcare market dysfunction including hospital and provider disagreements.
- A decline in competition among insurance carriers to bid on or negotiate for PEBB’s book of business.
- PEBB stakeholder conclusions that increased cost will be the greatest PEBB challenge in the next three to five years.
This environment is not unique to PEBB. In the last few years, national and regional publishers have issued hundreds of pieces on the crisis in the healthcare system. A recent report from the National Institute of Medicine Committee on Quality of Healthcare in America launched a rare overarching proposal that includes six aims for improvement: safety, effectiveness, patient centeredness, timeliness, efficiency and equity. After assessing the current healthcare system’s ability to achieve these six aims, the committee stated:
In its current form, habits and environment, American healthcare is incapable of providing the public with the quality healthcare it deserves”
In 2002, the Board agreed that the healthcare system is in crisis. From member to provider to carrier, the system is broken. PEBB is not confident that the current marketplace can offer a tangible statewide solution for the short or long term. As a result, the Board decided to envision a new, innovative solution of its own.
Q: What is the Board’s solution?
A: The solution the Board envisions is a new health and wellness system with the following components:
- Integrated care and teams – This means that all coordination, integration and efficiency of care cross all traditional boundaries. For example, a patient with a chronic disease has a seamless group of providers who, as a collaborative team, all have access to the same patient information, resources, technology and common best practices to provide the best and most efficient care.
- Patient-centered care – In the new system, the patients have a higher level of control and participation. They are given the information and the opportunity to exercise the degree of control and participation they want in making decisions that affect them. The new system should be able to accommodate patient preferences and encourage shared decision-making. The system should also provide patient-preferred methods of communication and treatment such as e-mail, telephone and group visits.
- Evidence-based treatment, formulary and other services – The new vision requires that patients receive care based on the best available scientific knowledge. It should not vary illogically among clinicians or clinics or regions. The focus will change dramatically to outcomes and results. This will improve care and reduce waste.
- Freely shared knowledge and information – Patients have complete access to their own medical information and clinical knowledge of their status. Practitioners communicate efficiently and share all information.
- System-wide transparency – All stakeholders have access to all information about health plans, hospitals and clinical practices to make decisions. The information includes safety, patient satisfaction, evidence-based practice, and quality and performance indicators.
- Enhanced information technology – Technology improves access to all information, and supports better clinical decision-making and patient information.
- Realigned incentives – The system provides incentives to providers to align their practice with system goals; it does not pay practitioners who continue to function as outliers.
Q: The vision calls for a new delivery system. What is a delivery system?
A: The healthcare delivery system is the combination of and interactions among
- Healthcare practitioners
- Insurance companies and managed care organizations
- Hospital systems, hospitals, clinics and other health service facilities
- Employers and other group medical plan purchasers
- Government regulators
Q: How does PEBB intend to accomplish such a large endeavor?
A: The Board is considering a variety of options. Among them
- PEBB could work with our existing carriers through annual renewals to achieve incremental changes to the system. In future renewals, for example, provider contracts could include additional provider incentives and tougher quality performance standards.
- PEBB could create or purchase the new delivery system model by releasing a request for proposal and inviting bids from both current and potential carriers.
- PEBB could also sponsor pilot projects by specific vendors, practitioners or independent physician associations.
- PEBB could expand its current infrastructure and Wellness Program. This might include self-insurance options and building additional staff and consulting expertise to achieve the vision.
The Board is well aware that it will take many years to achieve these results. It will require a multi-year, phased approach.
Q: Is the PEBB wellness program part of the vision?
A: The vision includes all elements of the wellness program – chronic disease management, Web-based tools, health education, health screenings and health system navigator. They will all be included and expanded upon in the new innovative delivery system. The promotion of healthy behaviors, consumer education and informed choices will be essential aspects of the new delivery system.
Q: As a state employee I am worried about how this affects me and my family. Is this another way to say I will receive fewer benefits or pay more for benefits?
A: Achieving the vision means achieving better quality and affordability. Hundreds of national health policy experts, regional leaders and PEBB board members believe that current healthcare funding will be used much more wisely if all elements of the vision are achieved. This means better, more-efficient care; fewer injuries and errors; reduction and elimination of waste and unneeded care; and better shared information. In short, the Board believes that if it continues to offer the same benefit package and maintains the current approach it will definitely result in higher costs and a decrease in covered services.
Q: In 2000, PEBB emphasized “managed care” and selected HMOs as the model plan. Isn’t the vision just another twist on the same approach?
A: Yes and no. Although most experts in health policy and economics are still debating the rise and fall of managed care, many would agree that the key principles of fully implemented managed care could in fact provide better quality and help hold price increases down. Unfortunately, the tight labor market and booming economy of the 1990s helped spur a higher demand for choice, access and services, which created significant negative reactions HMOs and managed care. Now we are in an environment when managed care offerings are rapidly declining and prices are dramatically increasing.
The new vision will focus on managing the overall health and well-being of each member. The integrated system will improve education, information, quality of care and interactions among providers. Rather than focus on limiting the numbers of tests, services and drugs, the new system will promote the use of benefits and technology that have been proven to improve health. Some services and drugs that have not been found scientifically beneficial may not be covered or covered at a cost to members.
Q: What will happen next?
A: The Board’s timeline is as follows:
- During 2003, the Board began a multi-year dialogue about the vision with stakeholders and began planning for necessary resources and infrastructure.
- In the spring of 2004, the Board contracted with the Foundation for Accountability (FACCT) to develop criteria for preparing requests for proposals to implement elements of the vision in 2006.
- In September, the Board issued a request for information to the healthcare market to survey its movement toward elements of the Board´s vision.
- Through the fall, FACCT conducted stakeholder forums with representatives of the healthcare delivery system to determine their interest in and readiness to deliver elements of the vision in 2006.
- The Board released a request for proposals in January 2005 for healthcare organizations to deliver services aligned with the Board´s vision beginning in January 2006.
- The Board’s Proposal Review Committee provided initial scoring on qualified medical services proposals in April. The scores were then used to determine which proposals would move to the next round of evaluation. The committee has interviewed those proposers and has entered into further negotiations to determine which will eventually be selected.
- The Board will consider committee recommendations at its June 21 public meeting. The PEBB Web site will report results before the end of the month.
|
|
| |
|
|
