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Organizational Preparedness: Moving Towards Value-Based Paym ent - - PowerPoint PPT Presentation
Organizational Preparedness: Moving Towards Value-Based Paym ent - - PowerPoint PPT Presentation
Organizational Preparedness: Moving Towards Value-Based Paym ent Karen Batia, Ph. D December 10, 2018 CBHA Conference 1 FEE FOR SERVICE (FFS) TO VALUE-BASED PAYMENT (VBP) Moving from a volume driven system to one that is value-based
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FEE FOR SERVICE (FFS) TO VALUE-BASED PAYMENT (VBP)
- Moving from a volume driven system to one that is value-based comes in all sizes
and shapes + Organizations build systems based on what has traditionally been paid for + Must balance continued requirements of the FFS world with VBP readiness + Key ingredients = committed leadership + change management focus
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For Public Release
The framework situates existing and potential APMs into a series of categories.
APM Framework At-A-Glance
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Va Value-Based ed R Reimbursem emen ent t Conti tinuum
FFS Care Coordination Fee P4P Shared Savings (up only) Shared Savings (up and down) Partial Capitation Global Capitation
Accountability, financial
- pportunity, and Incentive
alignment supported by clinical integration, infrastructure and data analytics
FFS Outpatient Capitated Rate BH Capitated Rate Capitated Rate with Guardrails Accountability Financial risk/reward
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Practice T Transformation F Financial M Model
P4P Shared savings Partial Capitation
Fee-for- service
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VALUE-BASED PAYMENT ORGANIZATIONAL READINESS
- Quality and Performance Management
- Access and Capacity
- Care Management
- System of Care
Behavioral Health + Primary Care Social Determinants of Health
- Data Analytics and Health Information Technology
- Financial and Operational Capacity
Revenue and Cash Flow Models Cash and Positive Margin Cost Management
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HIGH-IMPACT ACTIONS
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QUALITY AND PERFORMANCE MEASUREMENT
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ACCESS AND CAPACITY
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CARE MANAGEMENT/CARE PLANNING
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HEALTH INFORMATION TECHNOLOGY READINESS
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HEALTH INFORMATION TECHNOLOGY READINESS – DATA AND ANALYTICS
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VALUE-BASED PAYMENT ASSESSMENT TOOLS
- Numerous tools available to assess organizational readiness
- HMA
Primary Care Organization VBP Assessment Tool Behavioral Health Organization VBP Assessment Tool IPA VBP Assessment Tool
- Other tools
Health plans National Council
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IPA VALUE-BASED PAYMENT TOOL
The tool is broken into six sections: + Value-Based Payment (VBP) Experience + Quality Measurement + Access and Capacity + Care Management/Care Planning + Health Information Technology Readiness + IPA/Accountable Care Organization (ACO) Experience
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CONTACT ME KAREN BATIA, PH.D.
180 N. LaSalle, Suite 2305 Chicago, IL, 60601
312.641.5007 | kbatia@healthmanagement.com www.healthmanagement.com