WRHAP and Payment Model 2: Encounter to Value June 25, 2017 Goals - - PowerPoint PPT Presentation

WRHAP and Payment Model 2: Encounter to Value

June 25, 2017

Goals and Evolving Strategy for Payment Reform

2

• Design and implement improvements in

payment and delivery for health care in Washington’s smallest and remote communities, where CAHs are at risk of closing.

• Identify patient-centered approaches that

improve the quality of care for clients

Goals of WRHAP Payment Reforms

3

Why is VBP a core business strategy

• f HCA?
• Current FFS system is unsustainable and

broken

• Market leverage as largest purchaser in WA
• Payment drive delivery system transformation
• Value-based purchasing legislative mandate
• National movement
• Early results are promising

4

HCA and Medicare’s VBP goals

2016 30%

In 2018, at least 50% 50% of Medicare payments are linked to quality and value through APMs In 2021, at least 90% 90% of state- financed health care payments and 50% 50% of commercial health care payments are linked to quality and value through APMs (Categories 2c-4b)

2018 50%

2021

90%

state-financed 2021 90% 50%

In 2016, at least 30% 30% of Medicare payments are linked to quality and value through APMs

50%

commercial

5

Alignment with CMS’ Alternative Payment Models Framework

6

HCA Value-based Roadmap

Medicaid PEBB 2016: 20% VBP

2021: 90% VBP

• Reward patient-centered, high quality care
• Reward health plan and system performance
• Align payment and reforms with CMS
• Improve outcomes
• Drive standardization
• Increase sustainability of state health programs
• Achieve Triple Aim

2019: 80% VBP

7

• Patient-centered

– Improvement on quality and patient experience

• Accountable for total cost of care

– Commitment to managing the total cost of care

• Transformative

– Changes in the way that care is delivered from a multi-payer perspective

• Broad-based

– Broad provider and payer participation

• Feasible to implement

– Assurances that model is administratively feasible

• Feasible to Evaluate

– Performance against a baseline

CMMI Guidance

8

• Promotion of ‘quality, efficiency, cost savings, and

health improvement, for Medicaid’ – Budget neutrality of the model

• Demonstration through analysis that the

model will not cost the state more in total appropriations – Alignment with value-based purchasing

• Reward for the delivery of high quality care

through implementing new payment models

Authorizing Environment Guidance

9

• Alignment with the desires expressed by CMMI

and our authorizing environment

• Alignment with national trends and current

HCA directionality

• Recognize the challenges faced by providers

and identify a workable model that helps to build long-term sustainability and move toward value-based purchasing

HCA Goals and Intents

10

• Minimum services included to start:

– Inpatient, Observation, Swing-bed, ED, Outpatient, Ancillary

• Basic construct:

– All-payer – Scalable to additional providers – Same basic structure for all participating providers with flexibility in performance and redesign efforts – Payment is linked to historical revenue, utilization, and/or costs in a budget neutral approach – Per-Resident payment:

• The budget is set to a per-resident amount for attributed members

for each participating payer

Basic Parameters of the Model

11

Tracking the Shift in Process

Comparative Element WRHAP Proposal Under Discussion HCA Desired Approach Scope of services included at start Leads with

• ED
• Primary care
• LTC

Leads with

• Inpatient
• Observation
• Swing-bed
• ED
• Outpatient
• Ancillary

Phasing Over time, expands to include:

• Inpatient and outpatient
• ther services

Over time, expands to include:

• Primary care
• LTC
• ther service

Defining the Budget Based on minimum requirements to sustain services according to agreed upon standards Based on historical revenues, utilization and/or costs

12

Tracking the Shift in Process

Comparative Element WRHAP Proposal Under Discussion HCA Desired Approach Key Payment constructs Options proposed include starting with:

• ED
• Per-visit and per-resident

payments with quality and utilization adjustments

• Primary care
• Per-resident for clinic

services

• Payment for enhanced

services

• Quality bonus
• Increased or minimum

payment to LTC

• Hospitals would receive a

predefined amount for the scope of services included

• Per-resident payment or

budget for attributed members

• Clients not attributed would

be reimbursed under current system

• Retrospective reconciliation of

billings current payment under current budget

13

Designing the Payment Model

Timeline

14

• Commitments to CMMI

– Development and delivery of a ‘term sheet’ to CMMI – Agreement in principle to explore this model with CMMI

• CMMI STCs

– 7/31/2017

• Implementation discussions held with

stakeholders – 1/31/2018

• Agreement in principle with CMS on final model,

including identification of required CMS authority and necessary timeline/process

CMMI Timeline and Commitments

15

• Additional model review and iteration
• Target a working session for rapid turnaround
• Engagement of payers
• Draft a term sheet
• Draft letter of intent

Upcoming Activities

16