Suzanne Delbanco is Executive Director of Catalyst for Payment Reform, a non-profit corporation working to catalyze employers, public purchasers, and others to implement strategies that produce higher value health care. Delbanco will be the keynote speaker of the Quality Institute’s All Council Conference: Power of the Purchaser, on May 16.
For large employers that self-fund their health benefits, what are your top recommendations to drive affordability and quality?
First, choose a health plan partner carefully. Employers, historically, have chosen health plan partners that can get them the best discounts. That old way of thinking hasn’t led to better value. So it’s important to ask the health plan what they’re doing to change the way care is delivered. Ask about payment methods. Ask about the administration of new provider network designs, and benefit designs.
And look where there’s money spent on low-value care and try to reduce that. You can institute reference pricing, or use centers of excellence for some procedures. Look where there’s huge variation in cost — and where the quality also varies.
And the third area? Promote the use of alternative sites of care, where you can get the same level of care but at a lower price. An example is using telehealth instead of an emergency room.
In New Jersey, we have mostly small employers, often with fewer than 10 employees. How can these employers better engage their employees in their health and health care coverage options?
There’s still work to be done to convince people that sometimes less expensive care is as good, if not better, than more expensive care. Quality is really what you want people to be thinking about when they’re making healthcare choices. A small employer is unlikely to contract with say, Castlight, or another vendor, to provide that quality and price information about health care providers to their employees directly. So it’s really about selecting a health plan that has good tools and programs to educate employees.
And smaller companies can also look at some of the new products that are coming out from insurers, such as narrow networks, as options to offer on their own or alongside a traditional plan.
What’s your advice about controlling costs while also ensuring that employees have access to often life-changing medications?
As I talk to the employers and other purchasers in our membership, it is heartening that they really want to ensure access to these potentially life-changing medications for their populations. But they’re concerned about the economic implications. There’s more work to do to make sure these expensive medications are used appropriately. That means being specific about which patients would most benefit from particular drugs, and making sure that they’re gaining access to those drugs at a point in their illness when they’ll be most useful. And we need to think about the setting in which the drugs are administered. Getting an infusion at a hospital or doctor’s office, versus a freestanding center or at home, could mean a big difference in cost.
A decade from now, which of today’s innovations will have the most impact on improving the healthcare system?
I’ll say greater transparency. And I’m not just talking about access to information about provider quality or prices. Also transparency for the employer-purchaser about how well their health plans are performing. As an example, CPR just released a standard plan ACO report, a template report, that we want health plans to use in reporting the results of their ACOs to their employer customers. Our view is that health plans have been cherry-picking the results they are sharing.
And I also mean transparency for patients in additional ways. My dad [Tom Delbanco] is leading a national program called Open Notes, where patients can read what their doctors write about them during their visit. This is empowering patients not only to be able to recall what they discussed with their doctor, but to be reminded of to-dos, and to have a chance to check accuracy. Ultimately these notes are going to become shared notes where the patients get to write in and report to their doctor between visits about how they’re handling a medication, or questions they have.
Your organization is piloting its payment reform Scorecard 2.0 in three states, one of which is New Jersey — where you are working with the Quality Institute. What insights do you hope to gain from this project?
We’re interested to see how payment reforms are taking root in three diverse states – New Jersey, Colorado and Virginia. On top of that we’re very excited to begin a process to see, at a macro level, the impact that payment reform is having on the healthcare system through the addition of some new metrics that we added to the scorecard methodology. It’s one thing to look at one payment reform program at a time and ask, for example, ‘Did the pay-for-performance program that one specific insurance company did with a particular health center lead to better outcomes for patients?’ It’s another thing to go up to the 20,000 foot view and ask, “Are sweeping changes to payment in the state leading to the kind of improvements in the health system that we’d expect to see?’ We think it’s important to look at the forest as well as the trees.