CEO's Guide to Restoring the American Dream
Page 20
Good for employees and employers
We resolve to only implement programs and solutions that seek to improve the plan sponsor’s bottom line, the plan member’s bottom line, and most importantly, the plan member’s health.
Programs should do no harm
We resolve that brokers, consultants, and advisors should do no harm to employee health, corporate integrity, or employee/employer finances. Instead we will endeavor to support employee well-being for our customers, their employees and all program constituents.
Employee Benefits and Harm Avoidance
We will only recommend implementing programs with/for employees rather than to them, and will focus on promoting responsible practices for the health plans we serve.
Our choices of programs and strategies shall always prioritize best outcomes at the lowest cost, in that order, with a strong focus on the responsibility that an employer should provide affordable coverage for their employees while respecting the financial integrity of the business.
Respect for Corporate Integrity and Employee Privacy
We will not share employee-identifiable data with employers and will ensure that all protected health information (PHI) adheres to HIPAA regulations and any other applicable laws.
Commitment to Transparency
Our focus shall be to bring transparency to all levels of health care financing. From how we get paid to how insurance companies and PBMs get paid to how providers get paid.
Commitment to Valid Outcomes Measurement
Our contractual language and outcomes reporting will be transparent and plausible. The end goal is to improve outcomes and quality of care while lowering costs and the ability to do this shall be measured and reported on in a valid, consistent and accountable format.
Appendix C
Sample Compensation Disclosure Form
The following is a sample broker compensation disclosure form to help you improve your benefits purchasing process. The status quo is rife with conflicts of interest stemming from undisclosed compensation arrangements. This prevents benefits purchasers from making the most informed and intelligent purchasing decisions. We’ve found that the first step towards high-performance benefits is disclosure of incentives to minimize conflicts, create transparency, and increase trust in your advisors and process.
Calculation of Fees
In general, each fee should be calculated in one of five ways.
1. Premium based. Fees are based on the amount of premium for each line of coverage. This normally expressed as a predetermined percentage.
2. Claims-based. Fees are based on the $ amount or number of claims in the plan and generally are expressed as percentages or aggregate per claim fees for the period.
3. Per member, eligible, or employee (e.g. PEPM/PMPM). Fees are based upon the number of eligible employees or actual members in the plan.
4. Transaction-based. Fees are based on the execution of a particular plan service or transaction.
5. Flat rate. Fees are a fixed charge that does not vary, regardless of plan size
You can also access a regularly updated digital version on the Health Rosetta Institute’s website (healthrosetta.org).
HEALTH ROSETTA INSTITUTE
BENEFITS REPRESENTATIVE COMPENSATION DISCLOSURE FORM
Advisor: _________ Client: _________ Period: ___________
Overview
A key element of the Health Rosetta Institute’s mission is to help benefits purchasers build transparent, trusted relationships with benefits advisors that are critical to an effective benefits-purchasing process, particularly in today’s world of skyrocketing health care costs and limited ability to push those costs on employees. This form is one resource to help you.
Their compensation is a small portion of total spend, but the right one can guide the way to dramatically improving your plan costs and quality. The total amount shouldn’t be the primary focus. Instead, it should help build trust and identify potential conflicts.
High-value, forward-leaning advisors are worth their weight in gold. Plus, the strategies they use typically improve your bottom line, reduce your employees’ out-of-pocket spending, and improve the quality of care they receive. Think of it this way.
Would you rather pay 4 percent to an advisor who reduces total spending by 15 percent or 2 percent to one who “negotiates” a 15 percent increase down to a 7 percent increase? For every 100 employees on an average plan, you’d save $247,220 in year 1 and $1.2 million in 5 years (net of the higher compensation).
Unwillingness to disclose compensation is typically a red flag that recommendations may not align with your interests. The benefits world often has undisclosed conflicts and incentives that make intelligent purchasing decisions difficult. To help you get around this, we’ve created a free guide for selecting high-value advisors.
You can find more resources or contact us at healthrosetta.org to learn more about improving the cost and quality of your health plan, Certified Professionals, or how we help benefits purchasers. A special thanks to Eric Krieg at Risk International Benefits Advisory, David Contorno at Lake Norman Benefits, Josh Jeffries at Arkin Youngentob Associates, and Tom Emerick at Edison Health for helping create this form. Each is a worth their weight in gold type.
About Us: The Health Rosetta Institute is a 501(c)(3) nonprofit organization with a mission to help public and private employers and unions sustainably reduce health benefits costs and provide better care for the 150 million Americans who access care through their work. We accelerate adoption of practical, nonpartisan fixes to health care’s root causes of dysfunction—how we pay for care. We maintain the Health Rosetta, a blueprint for wisely purchasing benefits sourced from the highest-performing benefits purchasers and experts everywhere.
Overview of Services Provided
Some fees may be estimates and will vary throughout the course of the year. However, this shouldn’t vary significantly from estimates unless something significant and unplanned happens.
Are any compensation multipliers or other bonuses applicable to the above categories of compensation?
o Yes (please describe below)o No
If yes, are they included in the above dollar amounts?
o Yeso No
Do you or your firm accept any nonaccount specific financial compensation from any products, services, or vendors you’re recommending, including, but not limited to, contingent or bonus commissions, override or retention bonuses, and back-end commissions.
o Yes (please describe below)o No
Do you or your firm have any other financial or nonfinancial compensation, potential conflicts of interest, or incentives related to products, services, or vendors you’re recommending, including, but not limited to, ownership, equity stakes, revenue/profit sharing, GPO/coalition participation, preferred vendor panels, conferences or trips, or personal relationships.
o Yes (please describe below)o No
Are there any potential reasons that could result in the above costs of services or compensation to vary more than 10 percent from the above projections?
o Yes (please describe below)o No
Please describe details related to any questions to which you answered yes above, including the specific, expected, or estimated dollar value. Attach additional pages if necessary.
Total Expected Compensation
Appendix D
Health Rosetta Principles
The Health Rosetta Principles were created and curated with Leonard Kish. We drew these insights from dozens of the most forward-looking individuals in the health care industry. The Health Rosetta components in part IV of the book speak to how health care purchasers can be wise about their health care purchasing. The Health Rosetta Principles speak to how the health care industry should respond to changing purchasing and patient behavior to navigate uncharted terrain. They are the guide for how the industry can succeed in the future health ecosystem. Leading experts have written essays on specific principles that we invit
e you to read at healthrosetta.org/health-rosetta-principles. The essays expand on each principle to make them more actionable. In the open source spirit of the Health Rosetta, we invite other leading thinkers to contribute their essays to advance the cause.
A New Medical Science
1. A New Paradigm – A new social, psychological, biological, and information-driven medical science is emerging that will better understand a person’s environmental context and its relationship with disease. It’s precision medicine, but more, using sensors and networks to better predict and prevent as well as treat the root causes of disease. No vision of the future of medicine can be complete or even competent if it doesn’t recognize these new sources of information and the power of patient engagement.
2. Open source and open knowledge – Open source, open APIs, open data, and open knowledge (such as wikis) will become central to defining a common architecture to support this new science. These are modern versions of peer review.
3. Nonclinical determinants of outcomes – To improve care and reduce costs with this new science, we must focus on what drives 80 percent of outcomes, the nonclinical factors, which include social, economic, and psychological determinants of health.
4. Cross-disciplinary collaboration – Cross-disciplinary collaboration and sharing of research data will be a requirement to accelerate new discoveries.
5. Evidence-Based understanding of what works – This new science will arrive at an evidence-based understanding of what works through a great wealth of shared longitudinal health data captured through mobile devices, sensors, and health records. It must be mindful of the concept of transforming data to information, knowledge, and wisdom.
6. Understanding the personome – The new medical science will focus on understanding the personome. “The influence of the unique circumstances of the person—the personome—is just as powerful as the impact of that individual’s genome, proteome, pharmacogenome, metabolome, and epigenome.”152
Openness Drives Effective Action
7. Individual choice – Individuals have the right to make choices and control their health destiny with the best information available.
8. Open access to information – Open access to information that will enable individuals to make the best decisions and become well-informed individuals, particularly when curated and contextualized by clinicians.
9. Openness and privacy are not in conflict – Openness and privacy are not in conflict with the right kinds of identity, consent, and data control mechanisms in place.
10.A required culture change – This openness will come with a required culture change. We must release information in order to ensure high-quality information and code. In software, Linus’ Law states, “Given enough eyeballs, all bugs are shallow.” Keeping information sealed until it is perfect will mean we miss opportunities to improve the data and fix the system.
Economics and Transparency
11.Information asymmetries – Information asymmetries lead to inefficient systems and suboptimal outcomes. Access to life-saving, taxpayer-supported research must be open.
12.Social determinants of health – Health and wealth are tightly linked. Eventually, poor financial health will negatively impact overall health.
13.Cost as comorbidity – The cost of care can be a comorbidity. By ignoring costs in clinical decisions, conditions can worsen as financial stress may drive individuals to choose not to follow a plan of care because it is too expensive.
14.Individual’s right to know the cost of care – Individuals have the right to know how much care will cost before receiving care, both out of pocket and covered. When there is unpredictable complexity (not caused by medical error, which shouldn’t be charged for at all), individuals should be informed of the most likely ranges.
15.Personal responsibility – Individuals have personal responsibility to manage their lives along with their care.
Relationships and Peer to Peer Networks Will Become Central
16.Communication as medical instrument – The most important “medical instrument” is communication. Communications drive actions, build relationships, and create trust.
17.Data liquidity for improving health – Exchange of personal health data will become enabled via decentralized Peer to Peer (P2P) networks and “HIEs of 1.” These P2P exchanges will improve health literacy, healthy action, and a functioning health economy.
18.P2P networked conversations – P2P networked conversations will empower new ways of organizing better health, allowing individuals to “organize without organizations” (h/t Clay Shirky) for better care.
19.Individuals and health research – Verifiable, but deidentified, opt-in health data will become part of a unified view of health care for research and risk assessment. Individuals will have the choice to contribute.
New Intelligence
20.Cognification – To “Cognify” (h/t Kevin Kelly) is to instill intelligence into something. Medical knowledge will increasingly be “cognified” into the IoT and much of the world around us is made “smart” and data-aware. This is good, and will free people to care for themselves where they want to receive care.
21.Feedback – All feedback has utility. Whether the news is good or bad, opinions become known and become a source for improvement and competitiveness.
Community-driven Health
22.Stewarding social and economic factors – True health system leadership comes from not just being stewards of hospitals and clinics but stewarding social and economic factors and the physical environment of a community, which account for half of outcomes.
23.Partnering for community health – Assessing community health needs and adopting strategies to address those needs will provide hospitals with a valuable opportunity to partner with community partners to identify strategies for improving health, quality of life, and the community’s vitality.
24.Building health literacy and community – Health care organizations that aggressively promote health literacy will build community capacity in addressing health issues. This may mean enabling and curating others in the community to reach all facets of the community.
25.Health and financial literacy – Start by teaching medicine and psychological self-awareness and resilience to kids. Starting in schools, health education needs to include the “medicine” we consume every day. Insurance/benefits literacy should be included in schools’ financial literacy courses.
26.School lunches – School lunches are an access point of great power: they reinforce or remove the unhealthy products we consume.
27.“Let food be thy medicine” – Hippocrates said, “Let food be thy medicine and medicine be thy food.” Individuals are “poisoning” themselves by the food they eat, largely without knowing it.
28.“Walking is man’s best medicine.” – Hippocrates also said, “Walking is man’s best medicine.” Communities and workplaces that make it easy to walk and be active can gain an advantage over the status quo.
29.Health care waste: A bandit stealing from our future – Health care waste is like a bandit stealing from our future. Health care is breaking U.S. schools. Money once directed to education is getting gobbled up by health care’s hyperinflation. This piles onto the problem that kids don’t learn enough about health, nutrition, finance, or any of the things that lead to healthy, long lives.
New Choices for Individuals and Care Teams
30.Health isn’t limited to the clinic – Health is not the limited time individuals spend in clinics. What happens in the other 99+ percent of their life has the greater impact on an individual’s overall well-being.
31.Better choices through motivation – We will learn how to rapidly enable better choices through motivation, tools, and access to better choices and lifestyles. Each individual will respond differently, requiring a whole new level of personalization.
32.Understanding motivations and habit change – People are complicated with both innate drives and ingrained habits that work against long-term h
ealth. The psychology of understanding these motivations and habit change is critical to success in achieving better health.
33.Wisdom of the individual – Still, people will make incredibly smart decisions when they understand the true risks and choices.
34.Mental health – Mental health is an equal component of a person’s overall health. Mental health directly impacts our physical health and our ability to recover from disease or medical interventions. Therefore, mental health needs to be deliberately and systematically integrated into the general health care system.
35.Nutritional and environmental causes of disease – Open information and research are needed to understand the nutritional and environmental causes of disease.
36.Unhealthy food – Foods that are void of nutrition are the tobacco of this generation.
37.Optimizing health – We have defined sick care very well: what happens when things go wrong and how to correct them. We have very little understanding of how to keep things going right, how to get people back on track when they go off the rails, nor how to continually optimize health. Innovations in research are changing this; new entrants will figure out how to enable it.
38.Preventing the need for care – Systems will be designed so individuals can stay healthy and take as few drugs, have as few procedures, and avoid the system as much as possible by engaging in self-care.
39.Embracing the “flat world” of care – The emergence of a flat world opens up new avenues to innovation about what has worked in other cultures. The US has the opportunity to learn to be open to ways of health care that originate outside our borders, particularly those that are more appropriate to the underserved.
Individuals and Engagement
40.Inclusivity with individuals and caregivers – Individuals and their caregivers are the greatest untapped sources of information, knowledge, and motivation. Optimizing care means partnering with individuals and caregivers to empower them.
41.Experience had a “Triple Aim” too – The effectiveness of engagement is tightly aligned with how convenient it is; how easily it integrates with where we live, work and play; how culturally relevant it is; and cost-effectiveness it is.