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 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‣ 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