The Unique Opportunity Employer Coalitions Have to Drive Convergence


Previously unavailable analytic insights at heart of successful collaboration

Author: Heather Lavoie, Geneia, Chief Strategy Officer

LVBCH has a 37-year tradition of successful collaboration. We know that only by bringing together employers, payers and providers can we make meaningful and sustainable improvements in health outcomes and costs as well as deliver better care to individual patients. The availability of new analytic insights is enriching and focusing our collaborations.

-- Carl Seitz, President, the Lehigh Valley Business Coalition on Healthcare (LVBCH)

Let me begin by highlighting some of the previously unavailable analytic insights that now fuel the work of the Lehigh Valley Business Coalition on Healthcare (LVBCH) to drive employer, payer and provider collaboration and convergence:

  • The population skews younger and is concentrated in families.
  • 35 percent have not seen a primary care physician in the past 12 months.
  • One of the top 10 conditions driving costs is pregnancy complications, and two of the most costly claims resulted from premature births. But only half of pregnant women received pre-natal care, and even fewer, approximately 25 percent, received post-partum care.
  • Cancer and cancer-related treatment are the third highest cost condition. Oncology treatments are the fourth highest cost condition, costing nearly $13 per member per month (PMPM). Among high-cost members, cancers and malignancies with related chemotherapy drugs are 27 percent of total health costs or $16 million. Yet essential breast, cervical and colorectal screenings that could identify cancers before they progress are below Pennsylvania quality benchmarks established by the Agency for Healthcare Research and Quality.
  • Despite the fact that the Greater Lehigh Valley has more people of working age who have type 2 diabetes compared to the rest of Pennsylvania and the country, the data shows far too many diagnosed diabetics are not receiving their annual diabetes checks.
  • To slow disease progression, the standard of care for diabetics includes an HbA1C/blood glucose test every six months and annual foot and eye exams, yet 15 percent lack HbA1C/blood glucose tests, 33 percent lack foot exams and 62 percent lack eye exams.

The LVBCH Theon® Platform Program

Geneia generated these analytic insights using data from nine Lehigh Valley-area employers representing more than 55,000 covered lives. Working through the Geneia – LVBCH partnership, these nine employers use the Theon® analytics platform to access actionable insights, such as population demographics, emergency department utilization and primary care usage, that are necessary to improve the quality and cost of employee healthcare.

To say it was not easy to get to a place in which nine employers are sharing data and comparing performance against benchmarks and norms would be an understatement. In the words of Bob Johnston, LVBCH chair, benefits manager, East Penn Manufacturing,

“A combination of patience and persistence was required along with a strong belief that regional performance data and benchmarks were necessary to challenge what seemed like the contention of every provider that they were the lowest cost, highest quality. We also needed to be able to demonstrate the value of a shared data initiative to the leadership in our respective organizations.”

Even after the initiative moved from discussion to action, critical success factors emerged, including an ability to work towards consensus, a willingness to remain open to new ideas and a commitment to understanding how to best represent and utilize LVBCH data. As Denise Moyer, chair of the LVBCH Data Analytics Steering Committee and associate director of corporate benefits, B. Braun Medical Inc., offered,

“With a goal towards making the new analytic insights meaningful to each of the employers as well as to LVBCH, it took us two half days discussing data with representatives from the six initial employers to agree on common data elements.”

Convening a Learning Collaborative to Improve Diabetes Care & Outcomes

Fast forward to fall 2017.

LVBCH has a relatively new president, Carl Seitz, and under his leadership, the coalition has convened a Learning Collaborative that extends well beyond employer participants to collectively address the prevalence of pre-diabetes and diabetes within its population. This diverse group of stakeholders includes employers like B. Braun Medical Inc. and East Penn Manufacturing, Capital Blue Cross, a payer, the two primary hospital systems in the region, pharmaceutical companies and Geneia. Because the coalition, the employers, the payer and the providers all can access the data in the Theon® platform to inform action, Seitz is confident the effort will demonstrate a level of engagement and results that was previously not possible.

There is some existing research for LVBCH to leverage in its collaboration project. Intel, for example, decided to “use its purchasing power in markets where it had operations to influence healthcare players – care providers, health plan administrators or insurers, and other employers – to rise above their competing self-interests and work together to redesign the local healthcare system.”

Intel initiated its pilot Healthcare Marketplace Collaborative (HMC) in metropolitan Portland, Oregon, and had positive results:

“Over five years, it successfully implemented new clinical processes for treating six medical conditions and for screening patients for immunization status and illnesses such as diabetes and high blood pressure. Although assessing the HMC’s full impact was not easy—and in a number of cases impossible given how the experiment was designed—the results that could be measured were significant: The HMC reduced the direct costs of treating three of the conditions by 24 percent to 49 percent—a tremendous accomplishment in an industry where slowing the rate of cost increases is considered a major achievement.”

Inventorying Existing Diabetes Efforts

A key first step for LVBCH was to inventory the existing diabetes efforts by the stakeholders on the Learning Collaborative. For example, Capital Blue Cross has provided the Theon® analytics platform to employers and its value-based providers who are contractually incented to improve quality metrics such as preventive cancer screenings and comprehensive diabetes care (HbA1c testing and attention to nephropathy). The platform supports comprehensive care for diabetics by cueing providers in advance of and during patient visits about open care gaps. The health plan also has increased its focus on identifying pre-diabetics and connecting them with appropriate care management resources.

Among Geneia’s contributions are ongoing support and training of Theon® platform users to maximize value and assigning population health consultants to work with physician leadership within Capital Blue Cross’ value-based care provider partners and employers.

Employers also have existing programs to address diabetics within their employee populations. B. Braun Medical Inc., for example, introduced the CVS Caremark Transform Diabetes Care Program, which offers personalized support and coaching to improve medication adherence, better track and control A1C levels, and support healthy lifestyle behaviors to mitigate unfavorable drug trends for antidiabetic medication. East Penn Manufacturing has rolled out the ESI-Tower Health Pilot Program, which features real-time data-sharing with nurse navigators who work individually with diabetics to control medication.

Stay tuned.

Moving Forward

In short order, the Learning Collaborative will be using the inventory of existing efforts to create SMART goals, determine action steps for each existing stakeholder, monitor and measure progress towards goals, quantify the impact of our collective efforts, engage additional stakeholders and ultimately apply the lessons learned and processes to other conditions such as COPD and specialty pharmacy.

The leaders of LVBCH acknowledge they have some hard work to do, but remain hopeful that, perhaps for the first time, they are positioned to reverse more than 20 years of increasing health costs and declining employee health. Convergence of payers, providers and employers, supported by rich analytic insights about the target population, is well within our grasp.