CCA Quality & Research Update – Focus on Partnerships

Quality & Research March Update

Population Health Management in Health Insurance Exchanges

The Affordable Care Act requires health insurance exchanges (HIX) to be established and working by 2014 in every state. Currently, 17 states are pursuing a state-run marketplace, while the remaining 33 states will allow a federally facilitated marketplace or partner for a state-federal marketplace. These exchanges will function as a transparent and competitive marketplace where buyers of health insurance, mainly individuals and small businesses, can buy affordable and qualified health benefit plans.

This move toward increased health care access for broader populations provides an opportunity to apply population health management (PHM) beyond Medicare and Medicaid populations to the commercial market. As employers shift the ways in which they provide health benefits, this work will be applicable to any population health model trying to gain access to broader populations through broader access models such as state and private exchanges.

CCA and its members have already laid the groundwork for population health management as the cornerstone for this broader access model. PHM strategies and tactics will be important to the success of the health insurance exchanges. As the voice of population health, CCA will develop tools and guidance to address three main objectives: 1) help PHM vendors to understand the health insurance exchanges and the opportunities that may exist in these new markets; 2) demonstrate the value of PHM to the health insurance exchanges; and 3) inform policy makers about the value of PHM for the HIX and differentiate the payment models used.

The Quality & Research Committee has formed two work groups for this effort. If you are interested in participating, please contact Karen Moseley, kmoseley@carecontinuumalliance.org.

  1. HIX Assessment. This work group will perform the environmental scan of HIX, including participating states, design decisions, product offerings, populations served, measurement, health information technology, and other exchanges such as private exchanges and state-federal marketplaces.
  2. Exchanges 101. This work group will develop guidance around the value proposition of HIX as a new business opportunity for PHM organizations as well as the value proposition of PHM for the success of HIX.

HERO-CCA Employer Dashboard

CCA’s collaborative effort with HERO is progressing and will be in the final stages of review within the next few months. The project leadership group plans to meet for a full-day working session in April to finalize the document for review by experts in the industry and stakeholder groups within HERO and CCA. If you have expertise in measures for employee health management programs—specifically the domains of health impact, satisfaction, participation, financial outcomes, productivity, organizational support, and value of investment—please contact Karen Moseley, kmoseley@carecontinuumalliance.org, if you would like to serve as a reviewer of the work prior to release. The final review will include public comment, so stay tuned.

Workplace Wellness

The CCA data aggregation buzz has been quiet for several months, but it is becoming louder as we await the release of RAND’s Report to Congress on the effectiveness of wellness programs in the workplace, including factors such as the incentives offered, the impact participation has on employee behavior, and programs’ ultimate impact on employees’ health. We expect to have the full report in April, and RAND has offered to brief the CCA data advisory board as well as the data contributors on the report findings post release.

On a similar note, CCA Quality & Research is collaborating with CCA Advocacy to develop a detailed, comprehensive, and evidence-based response to a recent article in Health Affairs titled, Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy. The authors draw several conclusions that merit a response, and CCA members are called to submit case studies to increase the evidence. Read the Call to Actionand act now!

 

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