Our Work
The Florida Alliance for Healthcare Value serves a unique role in identifying the most pressing healthcare needs facing Florida’s employers and healthcare purchasers, and then collaborating with healthcare stakeholders to drive meaningful change.
Our work currently focuses on achieving two primary goals:
- Driving Quality Improvement
- Leading Transformation to Value-based Delivery of Care and Payment Reform
DRIVING QUALITY IMPROVEMENT
From our organization’s beginning in 1984, we have been conducting ground-breaking quality improvement work. Data, transparency, standardization, and consistency form the foundation of our quality improvement programs and projects which currently include:
The Leapfrog Group is a national, nonprofit watchdog organization dedicated to advancing positive change in the quality and safety of health care throughout the United States.The Florida Alliance for Healthcare Value has served as Florida’s Regional Leader for The Leapfrog Group since 2002, driving increased participation by Florida’s hospitals in The Leapfrog Hospital Survey. We also analyze Leapfrog’s data to provide our employer members with customized action reports, equipping them with the information they need to press for improvement in the safety and quality of health care provided to their employees.
Analyzing Population Health and Healthcare Utilization: Big Data Analytics for Employer-Based Health Insurance Research
The Florida Alliance for Healthcare Value manages and utilizes an analytics platform with a normative dataset of Florida-based medical and pharmacy claims. Within this platform, we look at healthcare trends in markets and statewide. This data tool helps to identify areas of concern, inform our decision-making, and support our project work, benefiting our members in many ways.
This employer-led project directly addresses the significant differences that exist between what private health plans and Medicare pay for the same hospital services, measuring and publicly reporting the gaps. It empowers our employer members to ensure that their insurance carriers are effectively negotiating reasonable prices.
In partnership with the Patient Advocate Foundation (PAF), this Florida Alliance program is an innovative, employer-based benefit that connects employees and their spouses/dependents to trained advocates who guide the plan members through a cancer, complex chronic condition or rare disease diagnosis and treatment journey, providing support with benefits education, financial and emotional stress, and access and adherence to care.
LEADING TRANSFORMATION TO VALUE-BASED DELIVERY OF CARE AND PAYMENT REFORM
As the second largest purchaser of health care in the United States after the federal government, employers have the opportunity to align and transform health care from fee-for-service delivery and payment for care to value-based delivery and payment for care. Our current Transformation to Value-Based Delivery of Care and Payment Reform initiatives include the following:
Assessing Market Readiness for Change
We are active members of the Catalyst for Payment Reform (CPR), a national alliance of progressive employers and healthcare purchasers working to get better value for their healthcare dollar. Through this membership, we are involved in the following:
- Our employer members are able to participate in CPR’s Health Plan User Groups, tools, and webinars.
- The Catalyst for Payment Reform and the Florida Alliance for Healthcare Value partnered on a multi-methods study examining the dynamics underlying and shaping the Tampa-Orlando area’s healthcare marketplace and identifying which purchasing and payment reform strategies will have the best chance of success given the market’s characteristics. This effort will help the region move toward meaningful transformation of healthcare delivery and payment. The study was completed in April 2021. For more information, contact Karen van Caulil.
- Florida Alliance for Healthcare Value President and CEO Karen van Caulil serves on the Catalyst for Payment Reform-Peterson Advisory Council which works on joint efforts to strengthen the effectiveness of employers and other healthcare purchasers in their efforts to buy high-value care.
The Florida Alliance for Healthcare Value has been a national leader in the evolution and education of Alternative Payment Models (APM). Case rates, bundled payments, Centers of Excellence, and episodes of care all fall under the APM umbrella. Through this initiative, we:
- Advocate for the usage of uniform clinical definitions
- Encourage the use of quality metrics to measure outcomes
- Promote the use of standardized and consistent clinical definitions coupled with quality benchmarks to achieve better outcomes
- Work with employers, providers, health plans, and conveners to integrate APMs in employee health benefit design
As part of a national initiative driven by the National Alliance of Healthcare Purchaser Coalitions, the American Psychiatric Association (APA) and others, the Florida Alliance for Healthcare Value has been selected to lead efforts in Florida to address the public health crisis of mental health and substance use. This includes leveraging the influence of our employer members to work with providers and payers to improve availability, affordability, and access to early detection and appropriate treatment.
The United States spends more on health care than any other country, and it is estimated that more than $340 billion annually is spent on low-value care. This includes services that provide little or no benefit to patients, have the potential to cause harm, incur unnecessary cost to patients, or waste limited healthcare resources. With the need to reduce healthcare costs and improve quality, the Florida Alliance for Healthcare Value is working to identify and address the most prevalent low-value care issues in Florida.
