Solving the Healthcare Value Puzzle: The Board Game

Move over SimCity, Dungeons & Dragons and Monopoly – there’s a new game in town.

Attendees of the Hub’s in-person conference know that we take great pride in our opening night healthcare value-themed gameshow that gets everyone “warmed up” for the substantive discussions ahead. Because 2019’s meeting was virtual, we decided to continue our tradition with the first-ever, health policy board game.

Below, we included fun questions from our board game so you can play too! Click on the questions to revesl the answer and a link to additional resources. Share your experience with us by tagging @HealthValueHub on Twitter and using the hashtag #HubBoardGame.

Question 1:
Approximately how many healthcare quality measures are in use today: 100, 500, 750 or more than 1,000?

Question 2:
Air ambulance services are often billed out-of-network, resulting in very high bills for patients. Which state proposed to enroll all residents in a Medicaid benefit program that covers this service in order to make it widely available and reimbursed at pre-set rates: Wyoming, South Dakota, Alaska or Montana?

Question 3:
Comparative effectiveness research (CER) compares different clinical interventions to understand which are most effective and under what circumstances. TRUE or FALSE: As of 2009, the majority of clinical decisions were not based on CER.

Question 4:
Which is the ONLY state that pays hospitals using an ALL PAYER, global budget system?

Question 5:
TRUE or FALSE: Expanding Medicaid to ALL adults up to 138% of the Federal Poverty Level has resulted in state budget savings and has had a positive effect on state economic growth.

Question 6:
What is the term that refers to taxes designed to discourage unhealthy behaviors such as smoking, consuming sugary beverages and drinking excessive alcohol?

Question 7:
Under the Affordable Care Act, qualified health plans sold to individuals must spend a minimum amount of the premiums collected on medical care. What is that percentage?

Question 8:
TRUE or FALSE: Patient Shared Decision-making improves quality of care.

Question 9:
State “Certificate of Need” requirements can help ensure that capital spending is aligned with public need. Is evidence of effectiveness strong, weak or mixed?

Question 10:
Which state was the first in the nation to cap the price of insulin?

Question 11:
TRUE or FALSE: Aging of the population is an important driver of growth in health spending per person.

Question 12:
In 2019, which state began a demonstration project that implements global budgets for rural hospitals?

Question 13:
Which entity does NOT face a federal requirement to conduct periodic Community Health Needs Assessments: a nonprofit hospital, federally-qualified health center, public health department or emergency services?

Question 14:
A 2018 Federal audit of Medicare Advantage plans’ Provider Directories revealed that WHAT PERCENT of directories contained at least one mistake (e.g., wrong location, wrong phone #, wrongly listed as accepting new patients): 20%, 25%, 35% or 50% ?

Question 15:
TRUE or FALSE: Pharmacy benefit managers - the entities that design and administer drug coverage - have a fiduciary responsibility to keep drug costs as low as possible for payers.

Question 16:
What is the name for a structured ALLIANCE of healthcare, public health and other organizations that seeks to improve population health and health equity for all residents of a particular geographic area?

Question 17:
TRUE or FALSE: Increasing price transparency in rural areas will leverage competition to help lower healthcare prices.

Question 18:
According to the Centers for Medicaid and Medicare Services, which ONE of the following states has an EFFECTIVE rate review program: Texas, Oklahoma, Missouri or Wyoming?

Question 19:
Which state was the first, and only, state to give its attorney general the authority to investigate price gouging by generic drug companies? (Note: the law is under legal challenge.)

Question 20:
Only one state requires non-profit behavioral health providers, retirement communities and nursing homes to conduct Community Health Needs Assessments. Is it: Massachusetts, Connecticut, New Hampshire or Vermont?

Question 21:
Which state was the first to introduce quality benchmarks to compliment its statewide health spending target: Oregon, Idaho, Utah or Delaware?

Question 22:
What institute, created by the Affordable Care Act, funds comparative effectiveness research studies and engages patients and other stakeholders throughout the research process?

Question 23:
TRUE or FALSE: Reimbursement policies, broadband availability and state licensing laws are barriers to the use of telehealth in rural areas.

Question 24:
Which state has the most Accountable Care Organizations (ACOs) in the country: California, Connecticut, Colorado or Texas?

Question 25:
According to the Health Care Cost Institute, in what state are patients most likely to get a Surprise Medical Bill?

Question 26:
TRUE or FALSE: Antitrust laws effectively preserve healthcare competition.

Question 27:
According to the former Institute of Medicine, approximately what percentage of national healthcare spending is spent on unnecessary or inefficient services: 14%, 19%, 25% or 33%?

Question 28:
TRUE or FALSE: A growing number of state legislatures (as well as the federal government) have passed bills to outlaw “gag clauses” that prevent pharmacists from telling consumers when there are cheaper prescription drug alternatives available.

Question 29:
What are the two states that received an “A” for PRICE transparency on Altarum & Catalyst for Payment Reform’s 2017 Price Transparency & Physician Quality Report Card?

Question 30:
Surprise medical bills (SMBs) can occur when patients are unexpectedly treated by an out-of-network provider. TRUE OR FALSE: A study found that SMBs occur in roughly one-in-five ER visits that resulted in an inpatient admission.

Question 31:
According to the Commonwealth Fund, what percent of provider markets (hospitals, specialist physicians and primary care physicians) are either highly or “super” concentrated: 25%, 50%, 75% or 90%?

Question 32:
Name the ONLY state that uses clinical effectiveness to decide what Medicaid should pay for.

Question 33:
Accountable Care Organizations (ACOs) are groups of doctors, hospitals and other providers who collectively agree to be held financially accountable for costs, quality and outcomes for a defined patient population. What state is known for its innovative, ALL-PAYER ACO model: Massachusetts, Maine, New York or Vermont?

Question 34:
The National Quality Forum defines “never events” as patient safety events that result in death, permanent harm, or severe temporary harm. TRUE or FALSE: In 2017 the most common “never event” was “unintended retention of a foreign object” during surgery.

Question 35:
According to the Health Care Cost Institute, which service line had the greatest growth in total spending per person between 2013-2017: inpatient services, outpatient services, prescription drugs OR professional services?

Question 36:
What are the two types of Federal WAIVERS that states can apply for to make changes to their healthcare programs? (Hint: Both waivers are identified by the NUMERICAL SECTION of their respective laws.)

Question 37:
TRUE or FALSE: Value-based insurance design reduces cost-sharing for procedures or medications when there is strong evidence that doing so will improve health outcomes. The approach may also increase cost-sharing for services or medications with no clinical benefit.

Question 38:
Just one state funds an Office of the Consumer Advocate that helps ALL consumers find and understand their health plans, resolve coverage disputes and serves as the official voice of the consumer in front of the state legislature. Is it: New Mexico, Tenessee, Wisconsin or Connecticut?

Question 39:
As of July 2019, how many states have NO protections from surprise medical bills?

Question 40:
TRUE or FALSE: A flu shot, prenatal care and eye screening for diabetics are examples of high-value care.

Question 41:
A seminal report, known at the Heckler Report, documenting the existence and extent of health disparities among minorities, was released in what year: 1985, 1995, 2005 or 2015?

Question 42:
Which two states created Drug Affordability Review Boards in 2019: Colorado and Washington; Texas and Pennsylvania; New York and Florida; or Maryland and Maine?

Question 43:
TRUE or FALSE: Wasted spending on low-value care services far EXCEEDS wasted spending associated with failure to provide high-value care.

Question 44:
What are the two states that received an “A” for QUALITY transparency on Altarum & Catalyst for Payment Reform’s 2017 Price Transparency & Physician Quality Report Card?

Question 45:
TRUE or FALSE: Reference pricing aims to contain healthcare costs by establishing a “reference price” that a payer will contribute towards the cost of a certain procedure and requiring patients to pay expenses in excess of the established amount.

Question 46:
According to a study of claims data, which service most frequently appears as a surprise out-of-network charge: lab, anesthesiology or emergency medicine?

Question 47:
What state launched an Office of Health Strategy in 2018 to implement comprehensive, data-driven strategies that promote equal access to high quality healthcare, control costs and ensure better health for state residents?

Question 48:
Generally speaking, are the unit prices of healthcare services in the U.S. less expensive or more expensive compared to other countries?

Question 49:
TRUE or FALSE: Measures of healthcare “waste” includes spending that was incurred due to the failure to provide high-value, preventive services.

Question 50:
What state is a pioneer in terms of factoring affordability criteria into its insurance rate review process: Wisconsin, Rhode Island, Minnesota or Michigan?

Question 51:
What is the federal agency that grants waivers for state health system transformation activities?

Question 52:
TRUE or FALSE: Studies show that the price of brand name drugs declines to nearly half their original cost after two generics enter the market.

Question 53:
How many states have COMPREHENSIVE protections from surprise medical bills as of 2019: 6, 13, 25 or 35?

Question 54:
TRUE or FALSE: Price transparency drives smarter spending by consumers.

Question 55:
TRUE or FALSE: The Centers for Medicare & Medicaid Services are introducing new billing codes for select social determinants of health in 2020.

Question 56:
In 2019, which state created an “Office of Saving People Money on Healthcare:” Oregon, California, Massachusetts or Colorado?

Question 57:
According to just about every survey, what is consumers’ top healthcare-related concern?

Question 58:
TRUE or FALSE: Surprise medical bills include any medical bill for which a health insurer paid less than the patient expected.

Question 59:
Private and public payers are exploring new ways of paying healthcare providers to incentivize the provision of higher quality, cost-efficient care. Name one alternative payment approach that differs from the traditional fee-for-service model.

Question 60:
What state had the highest percentage of hospitals receiving an “A” rating on Leapfrog’s Spring 2019 Hospital Safety Grade report: Oregon, Tennessee, West Virginia or Washington?

Question 61:
TRUE or FALSE: Hospital mergers increase the price of a hospital stay.

Question 62:
What state is implementing a first-in-the-nation Medicaid policy where the state only compensates drug companies the full price for their medications if they work as advertised: Delaware, Oklahoma, Massachusetts or Vermont?

Question 63:
Name two PERSONAL determinants of health (as opposed to SOCIAL determinants of health).

Question 64:
TRUE or FALSE: Alaska, Delaware, North Dakota, and Wyoming had the HIGHEST percentages of hospitals receiving an “A” rating on Leapfrog’s Spring 2019 Hospital Safety Grade report.

Question 65:
Which state passed a 2019 law that creates a council focused on improving health outcomes for members of the state’s 29 tribes: Alaska, Oklahoma, Washington or North Carolina?

Question 66:
TRUE or FALSE: In a single year, more than 600,000 patients in Washington state received healthcare services they didn’t need, at an estimated cost of $282 million.

Question 67:
Which strategies help alleviate provider shortages in rural areas: A) telemedicine, B) expanding scope of practice for para-professionals, C) medical school pipeline programs or D) all of the above?

Question 68:
A few states have implemented oversight commissions, with varying degrees of authority, to study state-wide healthcare spending trends and make recommendations. Name one state that has an oversight commission.

Question 69:
TRUE or FALSE: Black patients are more likely to undergo major surgery at low-quality hospitals than white patients, even when they live closer to a high-quality hospital than their white counterparts.

Question 70:
Approximately what portion of spending for healthcare services is considered “shoppable:” 13, 33, 53 or 63 percent?

Question 71:
Name TWO states that have expanded Medicaid as of 2019. (Note: States that have adopted but not implemented Medicaid expansion don’t count.)

Question 72:
Name the TWO major components of healthcare “value:” A) quality, B) cost, C) accountability

Question 73:
If other prices had grown as quickly as medical costs since 2060, today a gallon of milk would cost: A) $16, B) $40, C) $78, D) $105

Question 74:
TRUE or FALSE: National healthcare expenditures could be greatly reduced by eliminating health disparities.

Question 75:
Which of the following is NOT a type of medical harm: hospital-acquired infections; medication errors; diagnostic errors; OR lack of diet soda in hospital cafeteria?

Question 76:
Name three SOCIAL determinants of health.

Question 77:
TRUE or FALSE: High-deductible health plans incentivize smarter shopping among consumers by increasing their “skin in the game.”

Question 78:
According to a 2019 Kaiser Family Foundation Health Tracking Poll, what percent of insured adults report having difficulty paying their deductible? A) 10%, B) 25% or C) 34%

Question 79:
TRUE or FALSE: Fee-for-service is appropriate for some types of healthcare services.

Question 80:
According to a 2019 GAO report, what percent of air ambulance bills result in an out-of-network charge to privately insured patients? A) 29%, B) 42% or C) 69%

Question 81:
Which 3 states on this list BLOCKED consumer copayments higher than the full cost of a drug in 2019: Louisiana, Maine, Missouri, Minnesota?

Question 82:
TRUE or FALSE: A growing body of research indicates that workplace wellness programs produce meaningful healthcare savings as a result of employee health gains.

Question 83:
Consumer healthcare affordability burdens include which of the following: A) inability to afford premiums, B) inability to afford medical care, C) difficulty paying medical bills after receiving care or D) all of the above?

Question 84:
TRUE or FALSE: Research supports the integration of Community Health Workers into interdisciplinary care teams by documenting their ability to connect people to needed services, improve health outcomes and establish trusted relationships in the communities they serve.

Question 85:
A 2019 study found that comprehensive, state-level prescription drug monitoring programs (PDMPs) were associated with reduced opioid prescribing, lower opioid-related hospitalization rate and lower opioid-related ED visit rate among Medicaid enrollees. As of 2019, which is the ONLY state in the nation that does not have a PDMP?

Question 86:
TRUE or FALSE: Despite a 20 percent reduction in families reporting problems paying medical bills from 2013-2017, one in six children (approximately 13 million) still lived in a family struggling to pay medical bills in 2017.

Question 87:
A 2019 Health Care Cost Institute study revealed that nearly three-quarters of U.S. metropolitan areas had highly concentrated hospital markets in 2016. What state on this list did NOT have a highly concentrated market: Missouri, Illinois, Florida or New York?

Question 88:
TRUE or FALSE: The policy debate about healthcare affordability is hampered by a lack of consensus about what cost thresholds are “affordable.”

Question 89:
The ACA requires qualified health plans to pay rebates to customers if the premiums collected end up far exceeding what the insurer paid in medical claims (this is known as the Medical Loss Ratio [MLR] requirement). In what state will insurers pay the highest total rebates in 2019?

Question 90:
TRUE or FALSE: A 2019 Boston University study found that white Medicare patients were more likely to be transported to the closest emergency department than their Black or Hispanic counterparts.

Question 91:
Accountable Care Organizations (ACOs) aim to address poor care coordination and service utilization. Is the evidence on ACOs: strong, weak or mixed?

Question 92:
TRUE or FALSE: ACA Medicaid expansion has reduced the uninsured rate and uncompensated care costs in expansion states, while increasing affordability, expanding access to care and producing state budget savings.

Question 93:
TRUE or FALSE: Social determinants of health SCREENING TOOLS help providers identify unmet health-related social needs in order to connect patients to community resources.

Question 94:
The U.S. spends more per person on healthcare than other developed countries. Do we get higher quality as a result?

Question 95:
TRUE or FALSE: An extensive review published by the National Academy of Medicine documents how Accountable Communities for Health (ACHs) have the potential to drive us toward population health and well-being.

Question 96:
The evidence that malpractice reform (a.k.a., tort reform) will lower spending and reduce unecessary services is: weak, mixed or strong?

Question 97:
TRUE or FALSE: Patient shared decision making is widely practiced and considered a standard of care.

Question 98:
Mid-level providers like Physician Assistants and Nurse Practitioners are trained to perform routine services that physicians typically provide. TRUE or FALSE: Cost-effectiveness studies show that, in some cases, non-physician providers can provide an equivalent level of care at a lower cost than physicians.

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