Client Success Story

Engaged Benefit Design

picture of stethoscope

Background

The genesis of Engaged Benefit Design is the year 2001, a time of health care costs rising at double the rate of inflation, increasing numbers of uninsured Americans, and concerns about the viability of the employer-based insurance system and the stability of Medicare.

At that time, Dr. A.J. Kauver, a respected clinician and health care innovator in Colorado, and Jim Hertel, a respected health care expert and analyst also in Colorado, posed the somewhat controversial idea that health insurance should only pay for treatments that work. The Kauver Foundation then hired Engaged Public to assess the feasibility of a program that designed health benefits to vary consumer cost sharing based on evidence of clinical effectiveness.

This was when the typical health care setting saw patients making treatment decisions without fully understanding the risks, benefits and alternatives. In addition, doctors’ medical knowledge and experiences dominated the decision making process, causing patient preferences, values and goals to be little more than afterthoughts. Some clinicians believed these conditions were creating a climate of lesser quality care, often at higher costs, and that medical evidence can and should play a greater role in patient decision-making. In the age of information, patients were seeking out more data and wanted to be more involved in choosing treatments - placing a premium on access to high quality educational material at the right time and place.

Challenge

Engaged Public was challenged to create, test and scale a health care benefit design program that shares costs with the consumer depending on the clinical value of the treatment and uses medical evidence to educate patients so they could make the wisest health care decisions possible based on their values and preferences.

Solution

Engaged Benefit Design was created to modify or overlay existing health benefit plans, and its name comes from putting patient "engagement" at the crux of health care "benefit design."

The program combines two key components. The first is shared decision making, a collaborative process that allows patients and providers to make decisions together based on the best scientific evidence and patients’ values and preferences. The second component is value-based insurance design, which prices high value treatments such as preventive and disease management care lower than low-value treatments that medical evidence shows to be less effective and costly.

Today, Engaged Benefit Design is the only program in the nation marrying the two ideas and demonstrating that engaged patients - those who have relevant information about benefits and risks of treatments choices - make, in partnership with their doctors, better choices that reflect their preferences, values, and medical evidence.

Results

During the first 10 years, Engaged Public developed and refined the Engaged Benefit Design concept first by working with a major health insurer, and later by establishing coverage programs, including Health Access Pueblo, to build the benefit package using an interactive online health plan selection tool that educated and engaged members.

picture of money

In 2011, Engaged Public received a combined $1.25 million in funding from the Robert Wood Johnson Foundation and the federal government to develop and test Engaged Benefit Design. With that funding, it conducted a pilot study from 2012-2014 at the San Luis Valley Health Regional Medical Center. The study combined education, financial incentives and medical outcomes research with the goal of delivering higher quality care at a lower cost. The results of the study demonstrated that patients clearly felt an increased sense of ownership in their own care and that the overall approach was highly acceptable to consumers, providers and the employer.

In 2013, the Colorado Medical Society Foundation awarded Engaged Public $1.1 million in funding to test the concept in additional coverage settings. The funding supported the launch of the program in Grand Junction, CO., by a nationally respected group of health care leaders. CNIC Health Solutions, Primary Care Partners and Healthwise teamed up to help Hilltop Community Resources implement Engaged Benefit Design to provide better health care at a better cost to its 800 employees - and ultimately other Mesa County employers.

"We believe that all patients should be presented with medical evidence that explains the effectiveness of various treatment options and then work together with their physicians to determine the best course of action," said Lisa Martin, vice president of human resources at Hilltop. "Studies show that patients who are fully informed often choose less-invasive treatments, which in many cases translates into better outcomes, less-expensive options, and cost savings."

Engaged Public is now demonstrating Engaged Benefit Design can be scaled and automated to meet the needs of consumers across Colorado and nationwide.

Engaged Benefit Design by the Numbers

  • 2013: Year Engaged Benefit Design was featured in Health Affairs, a leading national peer-reviewed journal on health, health care, and policy.
  • 4,339: Number of cost-utility analyses on a wide variety of diseases and treatments in the Cost-Effectiveness Analysis Registry at Tufts University.
  • 21: Members of the Engaged Benefit Design medical advisory council.
  • 725: Covered employees and dependents in San Luis Valley pilot study.
  • 300: Amount of co-pay for patients in the San Luis Valley pilot study who selected health care services considered of limited value and overused, (examples include upper endoscopy for heart burn, magnetic resonance imaging for low back pain, hip and knee replacements.)
  • 50: Dollar amount of incentives given to patients for completing decision aids in the San Luis Valley pilot study.
  • 2,750,000: Dollars in public and philanthropic in funding over 12 years to support development of EBD.

Engaged Public: Capabilities and Expertise

The Engaged Public team brings a specific and unique set of skills to the table that help make public engagement campaigns a success, including:

  • Comprehensive leadership
  • Impeccable understanding of the policy environment
  • Negotiation, consensus and relationship-building skills
  • Conversation architecture creation, logistics, and group facilitation
  • Transparency to ensure integrity of process
  • Research, report writing, policy analysis and content production
  • Public relations and media relations support
  • Innovative methodology utilizing technology tools, including:
  • Rapid response, flexibility and adaptability to change process to meet changing results
  • Synthesis of old tools (written analysis) with new tools (keypad polling, budget simulation)
  • Political "savvy" to develop implementable recommendations
  • Ability to facilitate ideologically diverse viewpoints and opinions for any organization, event or community
  • Responsiveness to parties whose views may or may not carry the day
  • Delivery of meaningful, actionable policy recommendations
  • Willingness to go the extra step and work harder, even outside original template