Value Based Payment: A Guide for Direct Care Practitioners

MCTAC+ Training PartnersMay 2018

Introduction and HousekeepingHousekeeping:

• Slides are posted at MCTAC.org

• Questions not addressed today will be: • Reviewed and incorporated into future trainings and presentations

• Added to Q&A resources when possible

Reminder: Information and timelines are current as of the date of the presentation

Agenda‣ The basics of VBP‣ How healthcare reform aligns with the behavioral

healthcare community‣ Volume to value: shifting the paradigm‣ Integrated care: rethinking your role‣ Group Exercise

Value Based Payment: The Basics

What Is Value-Based Payment?‣An approach to Medicaid reimbursement that

rewards value (improved health) over volume (amount billed)‣An approach to incentivize providers through

shared financial savings and risk‣A method to directly tie revenue to providers

with quality of care and health outcomes

Reshaping Healthcare‣ VBP rewards providers for caring for and improving

the health and lives of the people they serve‣ Current FFS rewards volume (including admissions

and readmissions) more than value (and the delivery of quality healthcare)‣ In VBP the focus is on quality, preventive, and primary

care and to coordinate care with other providers

What’s the Goal?‣ To improve health outcomes by creating a sustainable

system through integrated care coordination and rewarding high value care delivery‣ By DSRIP year 5 (2020), all MCOs must employ VBP

systems that reward value over volume for at least 80-90% of their provider payments

Who benefits from VBP?‣ Individuals‣ Providers‣ Payors

The old FFS system

ClinicsPharmaciesHospitalsDoctors

Providers were previously organized separately and paid based on the services they provide. The more they deliver, the more they receive, regardless of positive outcomes

Value Based Care‣ The “value” in value-based healthcare is derived from

measuring health outcomes against the cost of delivering the outcomes.

https://catalyst.nejm.org/what-is-value-based-healthcare/

Potential Benefits of Value Based Care‣ Less money is spent to achieve better health‣ Providers achieve efficiencies and greater client

satisfaction‣ Payers control cost and reduce risk‣ Society becomes healthier while reducing overall

healthcare spending

In Other Words…

The Triple Aim of Healthcare Transformation‣ Improve the experience of care‣ Improve the health of populations‣ Reduce the cost of care

Value Through the Lens of the Triple Aim‣ Improve the experience of care•How do your services engage individuals in care that

results in the adoption of healthy behaviors?‣ Improve population health•How does your service philosophy and practice positively

impact the health of high risk populations?‣ Reduce the cost of care•How do your services keep people in community based

care and divert them from ERs and hospitals?

How Healthcare Reform Aligns with the Behavioral

Healthcare Community

Recovery‣ Behavioral health challenges exist and recovery is

possible‣ What does recovery mean?•A safe place to live•Meaningful work activities• Friends/family•Satisfaction with life

Why Health?‣Because housing, employment and peer

support are social determinants of health.‣ If you provide these or similar non-medical

behavioral health services, you are in the healthcare business!

Whole Health‣How do the services of behavioral health providers contribute to whole health outcomes?

Volume to Value: Shifting the Paradigm

Bigger Is Not Always Better‣ It’s better to tackle a condition while it’s small

(outpatient) than to let it get bigger (hospital treatment)‣ It’s even better to prevent it altogether.‣ The person receiving services is the focus!

Coordination Benefits Everyone‣ Value based payment encourages providers to work

together•Create networks of care‣ Providers are paid based on the value and the quality

of the health care they provide•Rewarded for keeping people healthy‣ Providers will share in savings created from

developing high value care

Client At The Center of The System‣ VBP puts the individual

receiving services at the center of the health care system•Providers work together to help

make sure that people receive the care they need, when they need it, from the provider best suited to provide it

Individual

HHCM

HARP CM

PeerSupport

Social Worker/CASAC

Psychiatrist

PCP

Volume to Value‣ High volume = limited availability, difficulty accessing

care, assembly line approach to treatment‣ This approach can be intolerable for people with

behavioral health disorders‣ Social determinants of health often take priority over,

and interfere with, the management of pressing health issues.

Changing the Paradigm‣ People with behavioral health concerns don’t fit into

traditional, high volume medical models so they seek alternative care in ERs‣ Providers have the key to changing this paradigm•Getting payers and medical providers to understand your

value in promoting positive health outcomes. •What is your value?

Your Role in Healthcare‣ Fill the gap between behavioral and physical

healthcare‣ Understanding the need of primary care and physical

health care providers‣ Approach stakeholders as healthcare providers, not as

community based organizations, that produce positive health interventions‣ What is your value proposition?

Discussion About Your Role‣ What practices do you employ that work to fill the gap

between behavioral and physical healthcare?‣ What kind of person centered, recovery oriented

services do you provide and how do they address overall healthcare?‣ How do you know what you do works?‣ What outcomes do you measure?‣ Communication: Who is part of the team?

Your Supports‣ What supports do you need from your supervisor to

help you achieve success in this new work environment?‣ How do you see healthcare integration affect change

for the people you work with?

Considerations

August 29, 2019

Access Is Important‣ Access is the 1st step to expressing value‣ Engagement is key!•What makes people come back?•Why do people recommend your services?

http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii

Every Interaction Has Impact‣ Website‣ Community connections‣ Scheduling‣ Physical environment‣ Reception‣ Initial meeting

http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii

Website & Social Media‣ Easy to navigate?‣ Contact information easy to find?‣ Outcomes or stories? How do people learn about your

organization’s impact?‣ Connect with millennials?

http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii

Community Connections‣ Be a part of the community?‣ What cultures are in the community where you provide

services?

http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii

Scheduling‣ How easy is it to get in the door?‣ Can you speak with a live person?‣ Is there a simple intake process?‣ Are same day appointments available?‣ Is immediate crisis intervention available? “Face time?”‣ Tech enabled appointment reminders? Text Messaging?

http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii

Physical Environment‣ Is the building accessible? ‣ Is the space clean and welcoming?‣ Does it feel safe?‣ Does it promote recovery?

http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii

Reception‣ Who is the first point of access?‣ Is there a friendly face?‣ Would you come back for a second appointment?

http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii

1st Meeting with a Provider‣ Is the process long and complicated?‣ Are assessments cumbersome?‣ Does the person feel rushed?‣ Are all questions and concerns addressed?‣ Screening for trauma?

http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii

Using Data to Measure Access‣ Time to first appointment‣ Time from 1st to 2nd appointment‣ Time to 1st prescriber visit‣ Rate of missed appointments‣ Rate of people who drop out of care‣ Surveys and feedback

Integrated Care: Rethinking Your Role

Integration‣ BH providers can address risk factors that interfere

with primary care‣ BH providers see individuals more often than their

PCPs‣ Address healthy eating, smoking cessation, physical

activity (all of the things that contribute to improving health)‣ Health literacy•Basic knowledge of chronic disease management

(Diabetes, Hypertension, Cardiovascular Disease, HIV, Asthma)

The Role of Person Centered Care‣ How does someone’s diabetes interfere with their goal

of employment?‣ What person centered practices do you employ that

address whole health?

Group Exercise

You Are An Important Piece of

The Puzzle!

Key Points To Take With You‣ VBP is an approach to Medicaid reimbursement that

rewards value (improve health) over volume (amount billed)‣ VBP ties revenue to providers with quality of care and

health outcomes‣ The goal is to improve population and individual health

outcomes through integrated care coordination‣ Everyone has the potential to benefit from VBP• Shared savings for providers and people get better!‣ VBP puts the individual at the center of the health care

system and providers work together to ensure that people get the care they need, when they need it from the provider that is best suited to provide it

Please email additional questions tomctacplusinfo@nyu.edu and register for future

events athttp://www.ctacny.org under “Upcoming Events”

Resources‣ NYS DOH website with links to videos, resource library and other

tools for VBP https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform.htm

‣ What is value based healthcare? https://catalyst.nejm.org/what-is-value-based-healthcare/

‣ Value Based Care: One Provider’s Journey• Part 1 http://www.ctacny.org/training/value-based-care-one-providers-

journey-part-i• Part 2: http://www.ctacny.org/training/value-based-care-one-providers-

journey-part-ii• Part 3: http://www.ctacny.org/training/value-based-care-one-providers-

journey-part-iii• Part 4: http://www.ctacny.org/training/value-based-care-one-providers-

journey-part-iv