Health value is defined as the combination of a “community health index” measuring a range of population health outcomes and “total cost”. Teams would compete to show improvements in the health of their assigned community while also highlighting improvements generated in the total cost of care. The rules require improvements in both outcomes and costs for an entry to qualify. The focus on community-level results encourages teams to continually find new ways to improve the health of a significant number of people Outcomes should lead to innovations improving individual engagement in programs as well as a sharper focus on achieving outcomes for participants. Teams must make a difference by engaging individuals, including the creation of an “individual vitality score” that helps an individual understand their health status and the impact of specific health choices/ programs on their health.
Five finalists will be selected to compete in five separate 10,000 person community or employer-based test group during the three year trial. Each finalist would implement their comprehensive system with mechanisms to engage, coordinate, advise, evaluate, and influence individuals and care providers in their test group. Their outcomes and financial results would be compared to a control group in a similar or adjacent community, allowing for the real-world demonstration of the impact of their system. The competition and all results would be audited by an independent panel of judges and trusted third parties.
The initial prize design for the Healthcare X PRIZE differs significantly from other health reform efforts in the following ways:
- Focus on health outcomes and value at a community level: The Community Health Index creates a comprehensive picture of health across a community and the combination of Total Cost enables apples to apples comparisons of different approaches over a wide range of health conditions
- Consumer engagement: Consumers must opt-in to any programs the teams offer. The assignment of people to a team makes high rates of participation a requirement for success.
- Payment incentives: Teams may create payment innovations to improve incentives for consumer, providers, or vendors who demonstrate desirable outcomes. This allows for a team the flexibility to appropriately reward providers that create value.
- Comprehensive and proactive outlook: Teams are responsible for an individual’s health across all care settings for a multi-year period of time. This creates an increased focus and investment opportunity in proactive, longer-horizon health improvement programs. This also allows for the development of a relationship across multiple types of care and coordination across multiple care programs and treatments.
- Local partnerships: Teams must develop relationships with local health care providers/employers/community organizations in order to deploy local solutions. The ability to work outside of established facilities should enhance the scalability of solutions.