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Before we begin, reminders for todays webinar Audio Connection: - - PowerPoint PPT Presentation

Jul 08, 2023 207 likes •728 views

Before we begin, reminders for todays webinar Audio Connection: 415-655-0002 Audio Code: 926 554 775 To ensure everyone is able to hear todays presentation, we ask that all webinar participants please: Do NOT place your phone line on hold

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Getting Ready for VBP March 28, 2018

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Before we begin, reminders for today’s webinar

Audio Connection: 415-655-0002 Audio Code: 926 554 775

To ensure everyone is able to hear today’s presentation, we ask that all webinar participants please:

  • Do NOT place your phone line on hold during the webinar
  • Ensure your web cam is turned OFF
  • Use the CHAT function to ask your questions
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Getting Ready for Value Based Payment:

STRATEGY AND INFORMATION MANAGEMENT

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Today’s Presenters

Meaghan Baier

LMSW Assistant Director Strategic Operations McSilver Institute for Poverty Policy and Research

Boris Vilgorin, MPA

Healthcare Strategy Officer McSilver Institute for Poverty Policy and Research

Margot Hughes- Lopez, MPH

Assistant Vice-President OneCity Health Services New York City Health + Hospitals

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Disclosures

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The presenters have no actual or potential conflict of interest in relation to this presentation. The members of the Planning Committee have no actual or potential conflict of interest in relation to this presentation.

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  • The Landscape of Value Based Payment
  • Overview of tools and methods to assess VBP readiness to inform planning

strategies

  • Strategy development and execution, including creating and managing

effective work flows for deliverables and goals

  • Introduction to data analytics; relevance to the partner and the network

Agenda

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The McSilver Institute for Poverty Policy and Research at New York University Silver School of Social Work is committed to creating new knowledge about the root causes of poverty, developing evidence-based interventions to address its consequences, and rapidly translating research findings into action through policy and practice.

About the McSilver Institute

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In order to ensure our work is culturally and contextually appropriate for the populations we serve, the McSilver Institute employs a collaborative model via partnerships with policymakers, service

  • rganizations, community

stakeholders, and consumers.

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In New York, McSilver directs the state-funded Community Technical Assistance Center (CTAC) and Managed Care Technical Assistance Center (MCTAC), which provide a range of trainings, tools, and intensive support to help New York’s behavioral health safety net stay afloat.

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The Landscape of Value Based Payment (VBP)

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  • DSRIP allows the state to implement payment reform
  • Encourages DSRIP to promote and implement Value Based Approaches
  • By year 5, all Managed Care Organizations must reward value over

volume and implement Value Based Payment.

  • Ensure that the new system is sustainable.

NYS VBP Roadmap

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There will not be one path towards Value Based

  • Payments. Rather, there will be a menu of options

that MCOs and Providers can jointly choose from.

Path Toward Value Based

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Contextualizing Key Foundational Concepts

  • f Value Based

Purchasing (VBP)

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  • Triple Aim
  • Improve Member Experience
  • Improve Quality of Care
  • Decrease Cost
  • Value not Volume
  • Aligned Incentives
  • Change in Focus

VBP Key Concepts

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  • Providers get paid based on value/quality rather then volume
  • Providers will be held accountable for both quality and cost of care
  • Performance Measures: Not just outcomes
  • Efficiency and Effectiveness
  • Aligning incentives

Change In Focus

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Incentive Alignment

Agency Program Supervisor Payer Network Staff

Consumer /Client

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Performance Standards

Standards Will Vary Based On Payer Needs Change Overtime Based On State Measures

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VBP Contracting Models and Risk Sharing

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Level 0 VBP* Level 1 VBP Level 2 VBP Level 3 VBP (feasible after experience with Level 2; requires mature contractors) FFS with bonus and/or withhold based on quality scores FFS with upside-only shared savings available when

  • utcome scores aresufficient

(For PCMH/IPC, FFS may be complemented with PMPM subsidy) FFS with risk sharing (upside availablewhen

  • utcome scores are

sufficient) Prospective capitation PMPM

  • r Bundle (with outcome-

based component) FFS Payments FFS Payments FFS Payments Prospective total budget payments No Risk Sharing Upside Risk Only Upside & Downside Risk Upside & Downside Risk

*Level 0 is not considered to be a sufficient move away from traditional fee-for-service incentives to be counted as value based payment in the terms of the NYS VBPRoadmap. Source: VBP Bootcamp#137

MCOs and Contractors can choose different levels of Value Based Payments

In addition to choosing which integrated services to focus on, the MCOs and contractors can choose different levels of Value Based Payments

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  • Payment Continues to be FFS
  • Shared Savings Potential
  • If savings and quality is achieved
  • No Downside Financial Risk
  • Lower Shared Savings Compared to Level 2 and 3

Shared Savings Level 1 – FFS w/Upside Risk Only

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  • Payment continues to be FFS
  • Shared savings potential
  • If savings and quality is achieved
  • Downside financial risk if shared savings in not achieved
  • Higher shared savings compared to level 1

Shared Savings Level 2 – FFS w/Upside and Downside Risk

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  • Capitation payment: based on per member per month
  • No FFS payment
  • Shared savings potential
  • If savings and quality is achieved
  • Downside financial risk if shared savings in not achieved
  • Higher shared savings compared to level 1 and 2

Shared Savings Level 3

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Value Base Payment Contract Types

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Types of VBP Arrangements

Source: VBP Bootcamp #2 Types Total Care for General Population (TCGP) Integrated Primary Care (IPC) Care Bundles Special Need Populations Definition Party(ies) contracted with the MCO assumes responsibility for the total care of its attributed population Patient Centered Medical Home or Advanced Primary Care, includes:

  • Care management
  • Practice transformation
  • Savings from

downstream costs

  • Chronic Bundle

(includes 14 chronic conditions related to physical and behavioral health related) Episodes in which all costs related to the episode across the care continuum are measured

  • Maternity Bundle

Total Care for the Total Sub-Pop

  • HIV/AIDS
  • MLTC
  • HARP

Contracting Parties IPA/ACO, Large Health Systems, FQHCs, and Physician Groups IPA/ACO, Large Health Systems, FQHCs, and Physician Groups IPA/ACO, FQHCs, Physician Groups and Hospitals IPA/ACO, FQHCs, and Physician Groups

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  • General Population
  • Special Need Population
  • HIV/AIDS
  • MLTC
  • HARP
  • Includes All Services (Inpatient and Outpatient)
  • Members can only be enrolled in on population

Total Care

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  • Focuses on Chronic Conditions
  • Consists of Three Components
  • Preventative
  • Chronic Conditions (14 identified conditions)
  • Sick Care

– Upper Respiratory Infection – Allergic Rhinitis/Chronic Sinusitis Episode – Routine Sick Care Episode

Integrated Primary Care Episode of Care

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Source: DOH VBP Fact Sheet IPC Arrangement

Integrated Primary Care (IPC) Arrangement

IPC Arrangement

Preventive Care Component Includes Care activities such as wellness visits, checkups, immunizations, screening laboratory tests. Chronic Condition Component Includes disease management and secondary prevention activities to 14 chronic conditions identified as priority by the state. Sick Care Component Includes care for symptoms such as headache or abdominal pain and minor acute conditions and procedures.

  • Preventive Care Episode
  • Arrhythmia/Heart Block/ Conduction Disorders Episodes
  • Asthma Episode
  • Bipolar Disorder Episode
  • COPD Episode
  • Coronary Artery Disease Episode
  • Depression & Anxiety Episode
  • Diabetes Episode
  • GERD Episode
  • Heart Failure Episode
  • Hypertension Episode
  • Low Back pain Episode
  • Ostooarthritis Episode
  • Substance Use Disorder Episode
  • Trauma & Stressors Disorders Episode
  • Chronic Sinusitis/Rhinitis Episode
  • URI Episode
  • Routine Sick Care Episode
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  • Medicaid MCO members are only included in the IPC Arrangement once they

have triggered one of the episodes within the three components of care.

  • The IPC Arrangement only addresses a subset of services provided to

members based on the services addressed through the three components of care.

  • Only those services and associated costs captured by the episodes triggered

will be included in the Arrangement.

Member and Episode Eligibility

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  • For example, a member who has an established diagnosis of Rheumatoid

Arthritis (with no comorbid diagnoses identified) can be included in the Arrangement through the Preventive Care or Sick Care components of the Arrangement.

  • In this example, only those services and costs associated with the Preventive

Care and/or Sick Care component episodes triggered by the member will be included in the Arrangement.

  • The services and associated costs provided to fully manage the member´s

Rheumatoid Arthritis diagnosis will not be included in the Arrangement.

Member and Episode Eligibility Continued

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Consists of three components

  • Prenatal Care (services delivered up to 270 days prior to delivery the

Pregnancy Episode)

  • Delivery and Postpartum (care provided to the mother from inpatient

admission for delivery through 60 days after discharge the Delivery Episode)

  • New Born Care (care provided to the newborn from birth to 30 days after

discharge the Newborn Episode).

Source: DOH Fact Sheet

Maternity Care

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VBP contractor is the entity that contracts for VBP arrangement with the MCO. This can be:

  • Accountable Care Organization (ACO)
  • Independent Physician Association (IPA)
  • Individual provider (either assuming all responsibility and upside/downside risk
  • r subcontracting with other providers)
  • Individual providers brought together by an MCO to create a VBP arrangement

through individual contracts with these providers Note: A PPS is not a legal entity and therefore cannot be a VBP contractor. However, a PPS can form one of the entities above to be considered a VBP contractor.

Contracting Overview

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Overview of Tools and Methods to Assess VBP Readiness

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  • Information Technology
  • Finance and Budgeting
  • Operations and Programs
  • Human Resources (HR)
  • Training and Support
  • Quality Improvement
  • Executive/Senior Leadership and Board Support

Areas of Readiness

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  • Do you have an EHR? (both billing and medical record)
  • Is your EHR interoperable? Can connect and share information with other

systems like RHIO

  • Do you have IT infrastructure support?
  • Is your EHR/IT flexible and mobile?

Information Technology

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  • Does your finance department understand value based payment?
  • Do you have Revenue Cycle Management team?
  • Do you know your cost per service/unit?
  • How often do you get financial statements?

Finance and Budget

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  • How often do you review your policies and procedures (P&P) to make sure

they are up to date and align with current needs

  • Are your policies and procedure member/client focused
  • Do you staff know and understand your P&P
  • How welcoming and flexible are you with clients

Operations and Program

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Do your job descriptions align with current needs

  • Skills: Computer and data driven staff
  • Staff responsibilities such as off site work

Staff quality standards

  • Not just productivity, meeting quality standards

Incentives and disciplinary actions

  • Providing staff incentives
  • Disciplinary actions for not meeting quality

Human Resources (HR)

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  • Do you have a training program?
  • Do staff have to go through training before they start working with clients
  • Do staff have customer servicer training
  • Is there ongoing training
  • Are staff encouraged to learn and implement best practices
  • Do staff get sufficient supervision/support

Training and Support

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Do you have a quality improvement program?

  • Provides tracking and analytics of measures
  • Develops and implements continues quality improvement initiatives
  • Oversees compliance

Quality Improvement

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  • Do you have a strategic plan
  • Has the leadership included VBP in its strategic plan?
  • Do board of directors understand and support VBP vision
  • Does your organizational structure support VBP

Leadership

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Strategy, Development & Execution: Creating and Managing Effective Work Flows for Deliverables and Goals

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Develop A Team That Will:

  • Develop Strategic Plan
  • Develop Value Proposition
  • Be Accountable
  • Provide Management Oversight
  • Develop Workflows
  • Execute Contracts

Agency Strategy

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Introduction to Data Analytics: Relevance to the Partner and the Network

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  • Is data useful and relevant to your organization and partners?
  • Can you afford to collect, store and measure data?
  • Do you have the resources that can analyze and determine efficiency and

effectiveness based on data?

  • Build (individual vs. network) vs. Buy

Data, Data and Data

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  • Population served by:
  • Payer
  • Diagnosis
  • Demographics
  • Cost of care (total vs. network vs. agency)
  • Volume of services by type of service
  • Know your super utilizers
  • Based on contract needs

What You Should Be Measuring

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Remember the Basics

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  • Be collaborative
  • Listen
  • Understand payer needs
  • Meet timelines and reporting needs
  • Develop infrastructure

Basics

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New York State DOH https://www.health.ny.gov/health_care/medicaid/redesign/dsrip

VBP Arrangement Fact Sheet

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/index.htm

Additional Resources

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Questions

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Before We End …

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Thank you for your participation!

Questions or Suggestions?: Email: OCHWorkforceTeam@nychhc.org

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