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NBCH Awards Grants to Two Member Coalitions to Further Patient-Centered Medical Homes

Coalitions receive resources to implement value-based insurance design to support uptake of strong primary care in greater Kansas City and Portland, ME communities 

WASHINGTON – April 23, 2012 – To further efforts to center the individual’s health care experience around strong primary care, the National Business Coalition on Health (NBCH), through its nonprofit affiliate organization, the Community Coalitions Health Institute, announced that two member coalitions have been selected to receive funding for the Value-Based Insurance Design (VBID) for the Patient-Centered Medical Home (PCMH) Seed Grant Program. The $120,000 in seed grants will provide the coalitions with the resources to encourage employees to use the PCMH within their communities through implementation of innovative insurance designs. The coalitions selected to participate after a competitive application process including independent review by a panel of experts are the Maine Health Management Coalition and the Mid-America Coalition on Health Care.     

“By encouraging strong primary care systems that focus on keeping patients healthy rather than treating them only when they are ill, leads to better outcomes, reduced emergency room visits and hospitalizations, and ultimately lower overall health care costs,” said Andrew Webber, NBCH president and CEO. “The patient-centered medical home is an important strategy to revamp the way care is delivered and paid for, bringing order to a health care system that is dangerously fragmented. By implementing value-based insurance design strategies to support the PCMH, coalitions such as MHMC and MACHC and their employer members are playing a critical role in encouraging greater use of medical home models.”                    

This NBCH seed grant program was supported by a charitable donation from Abbott. The selected coalitions plan to implement the following programs:

Maine Health Management Coalition (MHMC)

In collaboration with the City of Portland GetBetterPortland Pilot, MHMC will provide a VBID template to help speed adoption and standardize claims administration for the State’s health care providers. The initiative will include development of an MHMC-endorsed VBID model that Maine employers and the state insurance exchange can use and education to City of Portland opinion leaders about communicating with their own employees as well as other area employers about the importance and benefits of VBID.

Mid-America Coalition on Health Care (MACHC)

MACHC will convene Blue KC, the largest plan in the greater Kansas City area, the American Academy of Family Physicians, and five employers representing 23,000 eligible members to launch an employer-focused education program to highlight the benefits of PCMH; facilitate strategic planning on VBID options and model plan designs; support efforts to implement VBID; and gauge employees’ experience to improve communications.

About the National Business Coalition on Health

Celebrating its 20th anniversary, NBCH is a national, non-profit, membership organization of purchaser-led business and health coalitions, representing over 7,000 employers and 25 million employees and their dependents across the United States. NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. For additional information visit: www.nbch.org.

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Nonwage compensation provided to employees. The National Compensation Survey groups benefits into five categories: paid leave (vacations, holidays, sick leave); supplementary pay (premium pay for overtime and work on holidays and weekends, shift differentials, nonproduction bonuses); retirement (defined benefit and defined contribution plans); insurance (life insurance, health benefits, short-term disability, and long-term disability insurance) and legally required benefits (Social Security and Medicare, Federal and State unemployment insurance taxes, and workers’ compensation). Health benefits made be more widely defined within the scope of value-based benefit design to include for example, free or reduced gym memberships, health education and smoking cessation classes, and free vaccinations.
Nonwage compensation provided to employees. The National Compensation Survey groups benefits into five categories: paid leave (vacations, holidays, sick leave); supplementary pay (premium pay for overtime and work on holidays and weekends, shift differentials, nonproduction bonuses); retirement (defined benefit and defined contribution plans); insurance (life insurance, health benefits, short-term disability, and long-term disability insurance) and legally required benefits (Social Security and Medicare, Federal and State unemployment insurance taxes, and workers’ compensation). Health benefits made be more widely defined within the scope of value-based benefit design to include for example, free or reduced gym memberships, health education and smoking cessation classes, and free vaccinations.
An advanced primary care model in which physicians actively work with patients to help them manage and improve their health status. Also referred to as ""patient-centered medical home."" Definitions of medical home vary, but typically include features such as care coordination, use of healthcare information technology, convenient communication (e.g. email), tracking and acting on gaps in care, and open scheduling.
Value-based insurance design bases an individual's out-of-pocket costs according to the value of a medical service or product for a specific patient population. Although cost-sharing still occurs in this design, it is used to encourage use of the clinical intervention, mitigating adverse health consequences that may lead to even higher cost interventions. The value of the clinical intervention will vary across patient groups and their demographic differences and therefore be subject to different cost-sharing levels.
Value-based insurance design bases an individual's out-of-pocket costs according to the value of a medical service or product for a specific patient population. Although cost-sharing still occurs in this design, it is used to encourage use of the clinical intervention, mitigating adverse health consequences that may lead to even higher cost interventions. The value of the clinical intervention will vary across patient groups and their demographic differences and therefore be subject to different cost-sharing levels.
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