Business Transformation VBP Toolkit
The value-based payment (VBP) toolkit serves as a comprehensive resource for facilitating the transition from traditional fee-for-service healthcare payment models to value-based payment models. It offers valuable guidance in various critical areas, including assessing VBP readiness, providing education and training, enhancing comprehension of contracts, proficiently managing data collection and analysis, identifying key performance metrics, fostering collaborative agreements and alignment, promoting continuous quality improvement, benchmarking performance, and preparing the workforce for the demands of value-based care. This toolkit equips healthcare providers and organizations with the foundational tools and knowledge needed to navigate the evolving landscape of value-based payment.
This resource assists providers in understanding the transition from value-based arrangements, which were previously constructed solely on the achievement of quality metrics, to models now grounded in the total cost of care. It furnishes providers with a roadmap delineating the tools and sources of information at their disposal for gaining a deeper understanding of their entire population, including subpopulations, and discerning the factors influencing the total cost of care within their population.
This resource provides strategies for cultivating a strong relationship with a Managed Care Organization (MCO) when entering into a value-based purchasing agreement. It provides insights into what the payer values and pinpoints measurable outcomes that hold significance to the payer, thereby guiding the formulation of a value proposition. Understanding the payer’s requirements is imperative in the design of your program.
This resource provides contracting tools to support value-based payment arrangements, beginning with a description of the components of legally enforceable contracts and the legal terms generally found in such contracts. The materials describe key legal considerations for arrangements between providers, which will assist providers in identifying and navigating potential legal issues. Recommendations are offered on how to address legal risks through the purchase of insurance, managing contracts throughout the contracting lifecycle, and negotiating contracts with other organizations.
This resource outlines key considerations for demonstrating your VBP Plan through a presentation to a payer.
This resource covers the development of a value proposition, a compelling statement or proposition that outlines the unique benefits and value that a healthcare provider or organization offers to payers, service recipients, and other stakeholders. A well-crafted value proposition helps healthcare providers and organizations communicate their unique strengths and advantages to payers and patients, ultimately driving engagement, partnerships, and success in value-based payment models.
This resource introduces an initial approach for creating accountable and outcome-driven partnerships spanning the network of healthcare and community-based providers, all geared towards enabling comprehensive, whole-person care. The central focus is on the Care Compact as the primary tool, accompanied by a well-defined outline of its key elements.
This resource is designed to assist leaders in introducing and educating staff about value-based payment (VBP) and value-based care, with a strong emphasis on leadership’s unwavering commitment to the program’s success. Achieving success in VBP arrangements hinges on garnering the full commitment of your workforce and ensuring their continuous participation in VBP activities. The materials provided offer valuable techniques for actively engaging your workforce in the development, implementation, and diligent monitoring of the VBP program.
This resource serves as a comprehensive guide, offering a step-by-step process for the creation of an integrated and comprehensive quality strategy. The strategy’s core components are thoroughly examined, encompassing population health outcomes and clinical process optimization, while also delving into the crucial aspect of identifying and addressing social needs to support a holistic approach to healthcare, combating rising costs, and improving outcomes. Additionally, it emphasizes the importance of measuring and benchmarking outcomes, alongside other quality improvement practices, to foster a culture of quality and value-based care (VBC). The resource further encourages the promotion of innovative initiatives and highlights the essential elements that underpin an effective integrated & comprehensive quality strategy. It also provides frameworks to guide the development of a data-driven quality strategy and guidance on identifying the behavioral health measures most pertinent to your organization’s unique goals and needs.
This resource describes the competencies that providers must systematically master to thrive within each Health Care Payment Learning Action Network (LAN) category. At the very least, all alternative payment models (APMs) necessitate providers to achieve performance targets related to quality metrics. As providers advance to a LAN Category 3 APM, they must possess the capability to exert a positive influence across the entire care continuum, extending beyond their direct services. The progression to a LAN Category 4 signifies a significant paradigm shift, as revenue is no longer tied to fee-for-service reimbursement. Success now hinges on delivering the most timely and convenient access to services in the most cost-effective setting, facilitated by the most cost-effective member of the care team, regardless of their status as a “billable” provider.
This resource serves as a gap assessment for providers and a roadmap for the needed infrastructure to succeed in advanced value-based models. As providers transition from value-based payment models centered around quality performance to models with cost-of-care accountability, providers will need to have a new perspective on infrastructure and technology needs to be successful.
This resource emphasizes the importance of understanding a patient population for successful VBP and provides a foundational understanding of the key considerations in population assessment.
This resource provides organizations with a tool for tracking progress in twelve key milestones during the implementation of VBP: 1. Leadership and Board Engagement, 2. Staff Readiness, 3. Market Assessment, 4. Partnership Agreements, 5. Access and Capacity, 6. Quality Measurement and Data Monitoring, 7. Provider Alerts, Decision Support Tools, and Registries, 8. Care Management, 9. Providing Person-Centered Care, 10. Behavioral Health/Primary Care Integration of Services, 11. Financial and Operational Considerations and 12. Demonstration of Organizational Financial Strength. Beneath each milestone, recommended action steps are outlined. This tool can be adapted into a work plan for a VBP leadership team.
The Health Management Associates VBP Readiness Assessment for Behavioral Health is designed to gain an understanding of your organizational readiness to guide successful engagement in payment reform models. This 12-item survey posits critical elements for success in value-based models and provides a basic description of the components of what readiness might include. It is recommended that this readiness assessment be completed as a team to ensure multiple perspectives on organizational operations are captured. This tool is not designed to provide a comprehensive assessment of organizational readiness. The results from this assessment can be used to guide discussion on potential opportunities to strengthen your organizational position for engagement in value-based care.
This resource provides an alphabetically organized glossary, defining the numerous terms and acronyms relevant to the domain of value-based purchasing. It serves as a valuable resource for providers, aiding them in navigating and familiarizing themselves with this specialized lexicon. This list provides a foundational definition of terms. Additional research is recommended to gain a complete grasp of these concepts and their practical implications.
Additional Online Resources
- Health Care Payment Learning & Action Network
- Oregon Health Authority Transformation Center – Value-Based Payment Resource Library
- Werner, R. M., Emanuel, E. J., Pham, H. H., & Navathe, A. S. (2021). The future of value-based payment: A road map to 2030. http://resource.nlm.nih.gov/9918335062506676
- About Us – Health Care Payment Learning & Action Network (hcp-lan.org)
- Integrating to Improve Health: Partnership Models between Community-Based and Health Care Organizations
- A tool from Nonprofit Finance Fund: https://nff.org/fundamental/resources-community-based-organization-and-healthcare-partnerships