Value Based Payment: A Guide for Managers in Behavioral HealthMCTAC+ 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‣ Overview of Types of VBP Arrangements‣ Using the Team Approach‣ Using Data to Improve Quality‣ Designing Staff Roles‣ Engagement‣ Group Exercise
Value Based Payment: Brief Overview
What Is Value-Based Payment?‣ An approach to Medicaid reimbursement that rewards value (improved
health) over volume (number of billable services)‣ 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‣ A component of DSRIP that is key to the sustainability of the program
What’s the Goal?‣ To improve population and individual
health outcomes by creating a sustainable system through integrated models of care & coordination, and rewarding high value, results based 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
Transition From Volume to Value
CapitationShared RiskShared Savings
Bundled & Episodic
Payments
Performance Based
ContractingFee for Service
Full Financial AccountabilityModerate Financial Accountability
No Financial Accountability
Large % of Financial RiskModerate % of Financial RiskSmall % of Financial Risk
Talbot, Wells, & Foulke,“The Fundamental Differences In the Business Models & Required Competencies for Fee For Service and Capitation Payment
Types of VBP Arrangements
Level 1
• FFS with upside only
shared savings available
only when outcome scores
are sufficient
• FFS payments
• Upside only
Level 2
• FFS wth risk sharing
(upside available when
outcome scores are
sufficient)
• FFS Payments
• Upside and Downside risk
Level 3
• Prospective capitation
PMPM or bundle (with
outcome based component)
• Prospective total budget
payments
• Upside and Downside risk
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_u/docs/vbp_levels_narrative.pdf
Clinical Models
FFS-Deliver services within the framework of what is approved per contract-Primary focus is the services being provided, less emphasis on linkage to a continuum of services
Value Based -Ensure that all covered members get what they need-no more, no less-Strong focus on interventions to prevent higher levels of care-Step-down from inpatient-Prevention/wellness-Strong linkages between programs
From Talbot, Wells, & Foulke, 2/16/18 Open Minds Performance Institute workshop titled “The Fundamental Differences In the Business Models & Required Competencies for Fee For Service and Capitation Payment
Who Benefits From VBP?‣ Individuals‣ Providers‣ Payors
Value Based Care‣ The “value” in value-based healthcare is derived from
measuring health outcomes against the cost of delivering those outcomes.
https://catalyst.nejm.org/what-is-value-based-healthcare/
Potential Benefits of Value Based Care‣ It costs less money to achieve better health‣ Providers achieve efficiencies and greater client satisfaction‣ Payers control cost and reduce risk‣ Providers align price with cost of services designed to achieve specific
and measurable client outcomes‣ Society becomes healthier while reducing overall healthcare spending
Your Organization’s Role‣ Lead VBP Contractor• Typically larger provider systems/networks, experienced and capable of
contracting with an MCO‣ Behavioral Health or Primary Care Provider Partner• Typically smaller or downstream providers that will contract with Lead VBP
Contractors.•May fill gaps in care•Strengthen the network’s ability to provide high quality care‣ Community Based Organization•Support the network by addressing social determinants of health that improve
population health
Using A Team Approach to VBP
Prioritize Team Communication‣ Meet weekly‣ Include key players•Physicians•PAs•Nurse Practitioners• Leadership•Professional and Non-Professional Staff‣ Incorporate skills and expertise• Think about what each person brings to the table
Why a Team Approach?‣ Share information‣ Prevent duplication of effort‣ Communicate within the organization‣ Communicate with other stakeholders in the contract•Hospital•MCO•Support & Supervision
Using Data to Improve Quality
Data Reporting
FFS-Any clinical/reporting data as specified in the contract-Internal QI/QA data-RCM data-Marketing/referrals data
Value Based -Service and cost utilization data-By level of care-By cohort (population specific)-By network provider-Medical Loss Ratio/Admin Cost-Performance and quality measures as specified in the contract-Client satisfaction data-If Medicaid, additional compliance and other reporting-Ad hoc data as required-The proper IT system is essential
From Talbot, Wells, & Foulke, 2/16/18 Open Minds Performance Institute workshop titled “The Fundamental Differences In the Business Models & Required Competencies for Fee For Service and Capitation Payment
Data to Improve CareConsider how your organization uses data•How do you currently use data to improve care?•What data do you collect?•How do you use it?•What quality improvement projects are you involved
in? PDSA cycles?
Data to Improve Care ‣ Consider investing in IT infrastructure‣ How do you use an electronic health
record to collect and manipulate data?‣ Who is in charge of this task? Is this
their primary role?‣ Is the data collection and review
process a sustainable one? If not, what are the barriers?
Using Data to Measure AccessInformation you need to know: What needs to change to improve access to services?‣ Time to first appointment‣ Time from 1st to 2nd appointment‣ Time to 1st prescriber visit‣ Response time for unscheduled, same day “crisis” visits‣ Rate of missed appointments‣ Rate of people who drop out of care‣ Characteristics of people who drop out of care‣ Surveys and feedback
Selecting an IT Partner‣ Move beyond analytics…‣ If you’re selecting an IT Partner, take into account their depth of
knowledge in clinical and administrative processes related to:•Care models•Contracting•Care coordination
What Data Does Your Team Need To Navigate This Change?
The New Value
Assessment
Routine services and transactions “easy and cheap”
Great personal service-customer
service and customer
engagement
Cutting edge expertise –
condition-specific advice on emerging
approaches
Contract-specific performance
measures
From Monica Oss, 2018 Open Minds Performance Management Institute Workshop Titled “Keeping Your Competitive Advantage While the Market is Redefining Value-The Performance Challenge in Health and Human Services
Designing Roles That Empower the Team
Human Talent Needs in a Value Based World
• From Productivity to Outcomes Focus
• From Do More Make More to Do Better Make More
Data needs are changing
Data analysis changes: Productivity to Quality
Metrics
• New Skill-sets at all levels –C Suite to Non-professional staff
• New ways to recruit and train staff
• What new knowledge does our existing staff need?
How these changes affect the human talent we need: How to find it
and how to keep it!
New Work Flows –how does outcome focus
change what our staff do and how they do it?
Stewart, Rutherford, Young Lott, 2018 Open Minds Performance Management Institute Workshop Titled “Building the Human Talent You Need to Succeed with Value Based Reimbursement
Designing Staff Roles‣ Team model is essential for VBP‣ Create a strong team and empower them to address the needs of the
people you serve‣ Who is on your team?‣ Consider these roles:•Supervisor•Direct care staff including a mix of professional and non-professional staff•Peers•Prescribers?
Supervision‣ Supportive: Acknowledge the pressures and emotional impact of the job (e.g.
Compassion Fatigue, Secondary Traumatic Stress)‣ Be sensitive to how trauma in the histories of persons served impacts providers‣ Address signs of Compassion Fatigue and STS (aka “burnout”)‣ Encourage self-care‣ Support opportunities for professional growth‣ Don’t focus entirely on productivity‣ Encourage peer support (especially with new recruits)‣ Establish and lead forums for mutual learning and professional development‣ Provide frequent feedback…no surprises on performance evaluations‣ Praise often
Engagement
Individual Engagement‣ Periodic “Check-in” / Communicate often to ensure a positive experience‣ Every interaction has impact•Website •Community connections•Scheduling•Physical environment•Reception• Language •Workforce competencies• Initial meeting
http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii
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
Website & Social Media‣ Easy to navigate?‣ Language relatable and empowering?‣ Tone hopeful and recovery oriented? ‣ 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?‣ Are you reaching out to the places people go?‣ Are you reaching out to the “voices” people listen to
and trust?
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 afford personal boundary space?‣ Does it reflect tolerance, openness, and hopefulness?‣ Does it reflect the community and culture of persons
served?‣ 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? Eye contact? Respectful?‣ 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? ‣ Is there time to connect, person-to-person?‣ Are mutual expectations shared? Clear?‣ Will the person leave with a predictable sense of what to expect the
next time they come? ‣ Does the person feel rushed?‣ Are all essential questions and concerns addressed?‣ Screening for trauma?‣ “Giving Voice”: Have you asked the person about their experience
so far? Has is met with their expectations?
http://www.ctacny.org/training/value-based-care-one-providers-journey-part-iii
Staff Competencies for Maximizing Engagement:‣ Recovery principles and practice‣ Trauma- and gender-informed and responsive‣ Culturally sensitivity and competent‣ Comfort with and informed about at-risk populations, e.g. female
veterans, LGBTQ, justice-involved, young adults.‣ Health literate (Diabetes, CVD, Hypertension, HIV, Asthma)‣ Motivational Interviewing‣ Person-Centered Care‣ Concurrent Documentation
Group Exercise
Key Points‣ VBP is an approach to Medicaid reimbursement that rewards value over volume.
It incentivizes providers through shared financial savings and risk.‣ Use a team approach and prioritize communication.‣ Consider how you currently collect and use data to drive quality services and
show your impact. Is this a sustainable process?‣ Clearly define staff roles‣ Engagement is key!• Access• Website• Community connections• Scheduling• Physical environment• Staff training & competency
Please email additional questions [email protected] 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‣ https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_u/docs/vbp_levels_narrative.pdf‣ What is value based healthcare? https://catalyst.nejm.org/what-is-value-based-healthcare/‣ From Talbot, Wells, & Foulke,“The Fundamental Differences In the Business Models & Required
Competencies for Fee For Service and Capitation Payment‣ From Monica Oss,“Keeping Your Competitive Advantage While the Market is Redefining Value-The
Performance Challenge in Health and Human Services‣ Stewart, Rutherford, Young, Lott, “Building the Human Talent You Need to Succeed with Value Based
Reimbursement‣ 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