Foundation focus

Wednesday, July 01, 2015 12:35 PM

EBD program to help more Coloradans make better decisions, receive more effective care

by Michael J. Campo, PhD, support staff, Colorado Medical Society Foundation

With support from a $1.2 million grant from the Colorado Health Foundation, the Colorado Medical Society Foundation entered into a contract with Engaged Public, a Denver-based public policy firm, in November 2013 to extend its Engaged Benefit Design program statewide with the goal of making Coloradans the best and wisest health consumers in the nation.

Engaged Public develops approaches to promote improved value and better-informed patients with insurance coverage that eliminates co-pays for high-quality, proven treatments. The program is based on the increasingly popular value-based insurance design philosophy.

The CMS Foundation’s mission is to administer and financially manage programs that seek to improve access to health care and health services, with the potential to improve the health of Coloradans. “Engaged Benefit Design represents a bold and innovative step toward the future of health and health care,” said Gary VanderArk, MD, CMS-F president. “We are proud to support this important work.”

Engaged Benefit Design:

• Removes financial barriers to evidence-based chronic disease care for specific services,
• Covers patient decision aids that help patients understand their treatment choices, and
• Provides objective information to patients to better understand the risks and limited benefits of services that in many cases are of questionable value.

“The funding enables us to build on a widely supported approach to improve decision-making for preference- and supply-sensitive health care,” said Dave Downs, MD, CMS past president and medical director at Engaged Public. “Prospects are excellent for statewide strategies to extend the concept and realize an increase in evidence-based care and cost containment.”

Engaged Benefit Design was initially piloted at San Luis Valley Health in Alamosa, Colo., from 2012-2014, testing the impact of patient decision aids and economic incentives on the health care decision-making processes of the medical center’s 725 covered employees and dependents. The results of the pilot study demonstrated that patients felt an increased sense of ownership in their own care as a result of the program and that the overall approach was highly acceptable to consumers, providers and the employer.

“Ten months into the study, the providers there, as well as other health care administrators and insurance providers, were asking how they could expand or implement the approach with all their patients,” Downs said.

Hilltop Community Resources, based in Grand Junction, Colo., is the latest employer to implement the Engaged Benefit Design health insurance program for its 800 employees. Hilltop provides a continuum of community-based services meeting the needs of youth, adults and seniors in and around Grand Junction.

While the goal of Engaged Benefit Design is to inform patients so they get the care they need and want, the program could have a great effect on costs over the long term. Several studies have shown that patients who are fully informed when making treatment decisions often choose less-invasive treatments, which in many cases translates into less-expensive options and cost savings.

“As shared decision-making is studied further, it is becoming apparent that it may also address the third domain of the triple aim – per capita cost reduction,” Downs said. “The Institute of Medicine has estimated that broad implementation of shared decision-making could save the country as much as $9 billion. This is a new approach to health care that relies on better-informed patients and incentivizes people to make better, smarter health care decisions. We believe that programs like this are the way of the future.”

Engaged Public will work to demonstrate how the model can be scaled and automated to meet the needs of consumers across Colorado and nationwide. Visit EngagedBenefitDesign.org to learn more about this program and CMS.org to learn more about the CMS Foundation.