As part of the Coalition’s work on the State of Maine’s State Innovation Model award, the Maine Health Management Coalition convenes three Value-Based Insurance Design (VBID) Workgroups. The workgroups build on the findings of the Cost of Care Workgroup and the Accountable Care Implementation Workgroup to identify best practices in the emerging field of VBID, and to encourage the use of high quality delivery systems like the Patient-Centered Medical Home.
Wellness Workgroup – The focus of the Wellness Workgroup is on patient engagement and activation. This team is exploring how to align wellness promotion activities at the workplace and for the community at large. They are examining how health coaching can be supported through a benefit plan, meaningful disincentives and incentives that serve to engage consumers in healthy lifestyle activities, and other approaches that encourage prevention, shared decision-making participation and self-management. Finally, this dedicated group is considering how to pool community resources to improve social determinants of health and support evidence based health promotion activities to benefit the greater population in Maine.
Administrative Simplification Workgroup – The focus of the Administrative Simplification Workgroup is to identify opportunities to streamline processes between providers and health plans using LEAN concepts to ensure the value-based insurance design is easy and not costly to administer. In addition, the group is also considering the value of current administrative actions to apply streamlining opportunities to current business when it is appropriate.
Clinical Workgroup – The focus of the Clinical Workgroup is on the benefit design to assure that high value services are encouraged and low value services are discouraged by providing patient-specific care options and cost. This information will be made available through the electronic medical record at the point of the patient/provider visit. The benefit design will also support the use of shared decision making to ensure patients understand their treatment options and the benefits of high value services over low value services.
At the conclusion of the VBID Workgroups, the MHMC will provide a VBID template to help speed adoption and standardize claims administration for the State’s healthcare providers. The initiative will includes the development of an MHMC-endorsed VBID model that Maine employers and the state insurance exchange can use and education to opinion leaders about communicating with their own employees as well as other area employers about the importance and benefits of VBID.