HCTTF and PBGH release report and tool on care management contracting for high-need, high-cost populations

Contracting Tool Launched to Help Health Care Organizations Manage

 High-Need, High-Cost Populations

Report and Practical Guidance available to Payers and Providers

WASHINGTON (July 11, 2018) – The Pacific Business Group on Health (PBGH) and the Health Care Transformation Task Force (HCTTF), with support from The Commonwealth Fund and The SCAN Foundation, today released a report and contracting tool to help organizations effectively manage care programs that improve the health outcomes of high-need, high-cost (HNHC) patients. HNHC patients are a small percentage of individuals with complex medical, social, and behavioral needs, yet they utilize the largest proportion of national health care resources.

PBGH, a non-profit coalition of large health care purchasers seeking to increase the value of health care, and HCTTF, a consortium of leading health care payers, providers, purchasers and patient organizations dedicated to accelerating the industry’s move to value, studied best practices for high-need, high-cost populations by conducting in-depth interviews with organizations that operate sustainable, effective care management programs for HNHC patients. The report and accompanying tool explore different types of contracting and offer specific, practical guidance for payers and providers as they develop contracting relationships.

“Health care payers and providers recognize the need to better serve high-need, high-cost patients,” said David Lansky, CEO of PBGH and Chair of HCTTF. “But the prevailing payment models make it difficult to allocate the right resources and dedicate appropriate coordination efforts to their care. By establishing a deeper understanding of payment and contracting approaches, providers and payers can better sustain these programs.”

Research highlights include:

  • Identifying individuals with persistently high needs and costs through risk stratification, then further segmenting by specific need type, is critical to improved outcomes and financial sustainability.
  • Guaranteed access to data is critical for successful care management, as is ensuring contractual specifications on both the type of data and the frequency with which it is shared.
  • For an HNHC care management program to be truly sustainable, the program should provide an ROI over the course of multiple years and meet specified contractual targets.

“Effective care management for high-need, high-cost patients is critical yet often poses significant challenges for providers and health plans,” said Jeff Micklos, Executive Director, HCTTF. “Our hope is that this report and contracting guidance will equip providers and payers with the tools to overcome some of these challenges and help drive toward long-term sustainable financial models.”

Click here more information about the report and contracting tool.

About the Pacific Business Group on Health

The Pacific Business Group on Health (PBGH) is a non-profit organization representing nearly 70 private and public healthcare purchasers, including some of the largest U.S. employers. PBGH’s mission is to be a change agent creating increased value in the healthcare system through purchaser collaboration, innovation, and action, and through the spread of best practices. PBGH leverages the purchaser voice to transform the delivery of healthcare and promote policies that advance value-based care at the federal and state level. Current initiatives focus on high-cost high-need patients, better maternity care, care coordination and primary care, and payment reform.

PBGH MEMBERS: Bank of America • Bechtel Corporation • Boeing Company • CalPERS • Caltech • Chevron Corporation • Cisco • City and County of San Francisco • Comcast Cable • Costco • Covered California  • CSAA Insurance Services LLC • Gap Inc. • H-E-B • Hewlett Packard Enterprise • Intel • Levi Strauss & Co• Lowe’s • McKesson Corporation • Microsoft • Pacific Gas & Electric Company • Qualcomm Inc. • Safeway Inc. • Silicon Valley Employers Forum • Stanford University • Tesla Motors • Union Bank • Wal-Mart Stores, Inc.• Washington State Health Care Authority • Wells Fargo & Company • The Wonderful Company

ABOUT THE HEALTH CARE TRANSFORMATION TASK FORCE

Health Care Transformation Task Force is a unique collaboration of patients, payers, providers and purchasers working to lead a sweeping transformation of the health care system. By transitioning to value-based models that support the Triple Aim of better health, better care and lower costs, the Task Force is committed to accelerating the transformation to value in health care. To learn more, visit WWW.HCTTF.ORG.

TASK FORCE MEMBERS: Aetna • agilon health • Aledade •  American Academy of Family Physicians •  Anthem, Inc. • ApolloMed • Archway Health  • Ascension • Atrius Health • Blue Cross Blue Shield of Massachusetts • Blue Cross Blue Shield of Michigan • Blue Cross Blue Shield of North Carolina • Blue Cross Blue Shield of South Carolina •  CareCentrix  • ChenMed • Cleveland Clinic  • Community Catalyst • ConcertoHealth • Dartmouth-Hitchcock Health • Dignity Health • Encompass Health • Evolent Health • Greenville Health System • Heritage Provider Network • HRHCare • Kaiser Permanente • Mark McClellan • National Health Law Program • National Partnership for Women & Families • New Mexico Health Connections • OSF HealthCare • Pacific Business Group on Health • Partners Healthcare • PatientPing • Premier • Remedy Partners • SCL Health •  The Dartmouth Institute for Health Policy & Clinical Practice • Trinity Health • Tucson Medical Center • Washington State Health Care Authority  • UAW Retiree Medical Benefits Trust