2019 Greater Value Portfolio Awards

Donaghue has recently made four new awards in its fifth cycle of the Greater Value Portfolio. This brings the total awards to 19 with $9.5 million invested in research demonstrating new approaches to improved healthcare value. Each study is a partnership between a research team and a healthcare services organization, and the research question reflects strategic goals of that organization. Because the research will be closely aligned with the functions of a healthcare system, the timeline for GVP awards project is for no more than two years. The maximum allowable award for this year’s cycle was $440,000, which included a 10% indirect rate.

Laura F. Garabedian, PhD, MPH
Harvard Pilgrim Health Care Institute
“Impact of an Innovative Payer-Provider Joint Venture on Health Care Value”

Partner Organization – Benevera Health This study will evaluate the impact of an innovative insurer and delivery system collaboration on healthcare value. Benevera Health is a novel payer-provider joint venture initiated in 2016 between Harvard Pilgrim Health Care, a non-profit health insurance organization with 1.25 million members in four New England states, and four delivery systems in New Hampshire that aims to improve quality of care and reduce costs. The Benevera Health model includes data sharing between the insurer and providers, population health management tools, care management, and value-based provider payment. This study will examine the short and longer-term (i.e., 5-year impact) of Benevera Health on healthcare utilization, quality and costs using robust quasi-experimental research designs. This will be the first study to evaluate the impact of a payer-provider joint venture, a model which is being implemented in various forms across the United States, and it will provide actionable information for the partnering organizations. The research findings, combined with recommendations from the stakeholder group that will be convened for this project, will allow Benevera Health to make evidence-based strategic decisions regarding whether to continue, refine, expand, or cease this payer-provider model. Our research will also provide important evidence for payers and providers across the country who are currently involved in or developing a joint venture in efforts to improve healthcare value.

Malini Nijagal, MD, MPH and Courtney Lyles, PhD
University of California San Francisco Medical School
“The Use of Telemedicine to Achieve Higher Value Pregnancy Care for Low‐income, Urban Women”
Partner Organization – San Francisco Health Network

Inability to access care is a fundamental barrier to achieving optimal health outcomes and disproportionately affects low income communities and minorities. Telemedicine, a low cost modality that can decrease barriers to care, therefore holds significant promise to improve healthcare value, particularly for safety‐net systems serving the most vulnerable patients, by improving access. Through collaboration with the partnering safety‐net healthcare institution, the San Francisco Health Network, the project will implement and evaluate home‐telemedicine as an alternative option to in‐person visits for publicly‐insured, urban pregnant patients. Using an effectiveness‐implementation hybrid design, the study’s aims include 1) assessing effectiveness by determining whether offering home‐telemedicine as an alternative to in-person visits improves access to care and 2) assessing implementation by evaluating the uptake, experience and feasibility of home telemedicine using an implementation science framework. By engaging diverse institutional stakeholders throughout the implementation process and systematically evaluating facilitators and barriers to adoption, the study findings will provide specific guidance to other institutions and policymakers interested in achieving higher value care for low‐income populations.

Scott E. Regenbogen, MD, MPH
University of Michigan
“Hospital Strategies for Success in Episode-based Hospital Reimbursement”
Partner Organization – Michigan Value Collaborative

Early evaluations of federal bundled payment programs suggest that hospitals can successfully reduce unwarranted spending, mainly through savings in post-acute care. Following this lead, commercial insurers are increasingly introducing bundled payments but with far less scrutiny. To date, little is known about what specific, generalizable strategies hospitals can employ for successful episode-based reimbursement in commercial markets. Within a statewide hospital collaborative supported by the state’s largest commercial payer, this project capitalizes on a natural experiment created by a novel episode-based reimbursement incentive and has two critical aims: 1) identify, define, and understand reproducible hospital strategies for high-value savings in episode-based incentive programs and 2) design and test customizable intervention strategies for savings around hospitalization. Using the Michigan Value Collaborative’s established process for hospital engagement and Michigan’s network of Collaborative Quality Initiatives (CQIs), strategies will be tested at scale in participating hospitals. The partnering institution is a founding Accountable Care Organization and coordinator for 18 statewide CQIs, with demonstrated investment and engagement in value improvement initiatives. The work plan is focused on a commercial bundled payment program and use of a mixed-methods design among a diverse set of hospitals participating in a statewide collaborative. The insights into hospitals’ responsiveness to shared savings will directly influence reimbursement design in Michigan. The customizable strategies can be disseminated nationally through multi-payer collaborations and national value-based and bundled payment consortia.

Mary E. Tinetti. MD
Yale School of Medicine
“Reducing Unwanted Care and Improving Outcomes by Aligning Care with the Health Priorities of Older Adults with Multiple Chronic Conditions”
Partner Organization – Cleveland Clinic Center for Geriatric Medicine

Healthcare for older adults with multiple chronic conditions is burdensome and of uncertain benefit, resulting in unwanted and unhelpful care. Patient Priorities Care aligns care with patients’ health priorities, that is, the health outcomes most desired given the healthcare each is willing and able to receive. Patient Priorities Care offers the opportunity to increase value by improving both desired health outcomes and healthcare preferences for these major users of healthcare. Compared to patients receiving usual care in a recent study, those receiving Patient Priorities Care reported greater decrease in treatment burden (a major concern for older adults with multiple chronic conditions), had more medications stopped, and fewer self-management tasks and diagnostic tests ordered. To determine the value of Patient Priorities Care, comparable primary care sites within the Cleveland Clinic Shared Savings Accountable Care Organization will be assigned to Patient Priorities Care or usual care. Clinicians and staff at the Patient Priorities Care sites will be trained to identify and align decision-making with the health priorities of older adults with multiple chronic conditions. Value at the patient, healthcare provider, and payer levels will be compared using patient and provider-reported outcomes, healthcare utilization, and costs at Patient Priorities Care and usual care sites. If proven effective and supported by Cleveland Clinic leadership, practice change strategies and incentives that are tied to ACO shared savings will be deployed to scale the Patient Priorities Care model. Proof of the value of Patient Priorities Care at Cleveland Clinic should foster policy changes such as patient priorities-centric quality and performance measures and payment models.