Want to Contribute to the Industry’s Discussion on Value on Investment?

By Michael Connor, Dr.P.H., Senior Vice President, Alere Health and Bruce Sherman, MD, Medical Director, Employers Health Coalition

The Population Health Alliance (PHA) Quality & Research Committee has identified Value on Investment (VOI) as a key initiative for this year. The goal of this work group is to empower purchasers of population health management (PHM) programs to adopt a comprehensive value proposition, which more broadly captures the business impact beyond healthcare costs.  Initial objectives include defining the scope of the VOI construct and determining a compelling rationale that is embraced by PHM purchasers.

The Health Enhancement Research Organization (HERO) and PHA led a collaborative effort to develop guidelines related to value domains and corresponding core metrics. The VOI model encompasses all of these domains as outputs as well as a broad view of investment or inputs beyond program vendor fees and incentive costs.

The domains are organizational support, participation, health impact, productivity and performance, financial savings and satisfaction. The Organizational Support domain addresses the degree to which an organization commits to the health and well-being of its employees. Participation recommends measures and definitions related to meaningful program interventions. The Health Impact domain covers measures associated with preventable health conditions.  The Productivity and Performance domain provides an employee continuum ranging from absenteeism through optimal performance at work. Financial Health Care Savings incorporates claims data and modeling estimates.  Satisfaction addresses participant and provider perspectives.

Initial reactions have been very positive related to both the domains and the VOI approach. Most stakeholders are intrigued with the concept, and some have enthusiastically volunteered to pilot the process. Others have suggested the need to develop a more compelling business case to discuss with purchasers.  There are clearly data implications related to a broader set of outcome measures beyond the more traditional and narrower focus of financial health care savings.

Work group discussions have questioned whether organizational support is an outcome or rather an input within the VOI framework. Additional considerations have raised the need for a greater focus on participant program engagement as well as assessing program impact on employee engagement at work and other business outcomes.

So what are your thoughts regarding …

  1. What are the barriers to a purchaser acceptance of a broader value proposition and how these can be addressed?
  2. What practical measures and methodologies best assess value components and will be readily adopted?
  3. How do the value domains align with purchasers’ (employers, health plans and government) strategic priorities?

Comment here or email us your thoughts at kmoseley@populationhealthalliance.org


2 Responses to Want to Contribute to the Industry’s Discussion on Value on Investment?

  1. Pingback: Who Is Hubbub Health? | Enabling Healthy Decisions

  2. One can’t help wondering whether the “broader value proposition” associated with the VOI approach is called for by PHM’s inability to more conventionally demonstrate value. Certainly, given claims and productivity data, most businesses will seek to determine whether a given program has saved more than it cost. A realization that it hasn’t should raise alarms.

    PHA’s Quality and Research Committee may have decided that VOI need to be a key initiative. But they may also need to consider that the iffy proposition presented by most population health management programs may be less due to an inability to measure results and more a function of poor impact.

    There are many areas of waste in American health care, brought on by an array of perverse incentives, that have relentlessly driven up cost and that threaten the nation’s future. True medical management at the population and individual levels must also focus on the mechanisms of institutionalized waste – e.g., overtreatment, egregious unit pricing – to bring health care back to rights.

    Changing the definition of value may be a step in the right direction, but it may also be a way of avoiding grappling with the core reasons for our health care crisis.

    Striving for improved health outcomes and lower cost may miss key areas of value, but these are straightforward and understandable metrics categories. Equally importantly, they are more closely aligned with the more pressing problem, which is that a failure to correct systemic health care excesses now constitutes a direct threat to our national economic stability.

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