Practice leaders face more decisions than ever as the District of Columbia works to build an integrated health system that delivers whole person care. This learning series is designed to help organizational decision makers better manage change within a dynamic health system. Part 1 will introduce ways that leadership can transform ingrained policies and practices using new information, data points, and approaches to improve care access and outcomes. The session will also preview exciting next steps for the learning series moving into 2024.
In the dynamic landscape of healthcare, crafting a compelling value proposition involves a strategic blend of audience understanding, innovation, and responsiveness to the needs of payers, community partners and other stakeholders. This short take describes the steps to creating a strong value proposition.
The transition to Value-Based Payment (VBP) represents a multifaceted process, encompassing significant system-level adjustments in healthcare delivery and reimbursement. Effectively implementing these changes requires a methodical and developmental approach. To facilitate this transition, a comprehensive toolkit has been designed, empowering healthcare providers to evaluate their existing readiness and access resources essential for enhancing their capabilities to operate within a value-based payment framework. In this webinar, we will introduce providers to this invaluable toolkit and guide them on how to navigate it seamlessly.
Transitioning to payment models that support value-based care means doing business differently. Many District healthcare providers are requesting assistance preparing for and implementing this important change. This virtual learning collaborative focused on legal agreements, contracting, and financial topics, including revenue cycle management and assessing risk. Presenters shared scenarios, assessments, and tools to advance capacity and understanding.
This short take video will outline the elements of shared savings contract and where the “share” fits in. It will outline some of the key considerations to think about when trying to negotiate your share of savings with a payer for a value-based contract (including downside risk v. upside potential, contract structure, and other value-based care funding), as well as touch on internal considerations for providers when negotiating a share of savings (i.e. is the share enough to cover the provider’s investment to perform in the contract).
Value-Based Payment (VBP) arrangements with MCOs are generally described in a separate exhibit to a provider's managed care contract. This session will help participants assess the opportunities and risks of participating in VBP arrangements by evaluating legal terms associated with pay-for-performance programs, total cost of care programs, and capitation payment arrangements. Finally, the session will offer participants practice pointers for evaluating contract terms and examples of favorable and unfavorable VBP contract terms.
This tool helps FQHCs understand all of the various VBC elements that are encompassed in a model or program and can impact performance and hence are important consideration in the contract analysis. It provides the considerations, but also guidance on how to approach them and what may be favorable or unfavorable terms within a contract, depending on the scenario and LAN category.
VBP comes with lots of new vocabulary (and a deluge of new acronyms - including "VBP"). Come learn some of the key words, concepts, and constructs with which to understand VBP.
Different states (and the Health Care Payment Learning and Action Network) define different types of value-based contracts in different ways. Gain an understanding of the different types of VBPs and the path to them.
Studies have shown that $1 invested in integrating primary and behavioral healthcare will yield $4.50 in savings…and clients and providers both like integrated care better. Learn about the promises and pitfalls of primary and behavioral health integration.
CMS has signaled its intent to move from strict fee-for-service reimbursement to value-based payment for Medicaid as it has been actively doing for Medicare over the past decade. A few FQHCs are pursuing advanced alternative payment models on their own but most are choosing to clinically integrate with others, especially other FQHCs. This session will share national experiences from these initiatives and provide a framework for evaluating strategic options for DC FQHCs to progress in their pursuit of advanced alternative payment models.
Description: 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. Download the Tool
Description: 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...
Description: 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...
Description: 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...
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.
Description: 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...
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 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.
Description: 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...
Description: 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...
Medicare, state Medicaid agencies, managed care organizations, and commercial insurers are increasingly adopting value-based payment (VBP) models. Community Health Centers (CHCs) are uniquely positioned to deliver on that high expectation by offering enhanced access to high quality primary care, coordinating the care delivered by specialists, hospitals and other institutions and care managing the most complex individuals. This requires CHCs to transform their care delivery to efficiently deliver optimal patient- and population-level health outcomes and successfully manage costs. Many CHCs are forming clinically integrated Networks to create contracting leverage, make joint investments in data analytics and collaborate to develop complex care management and clinical models of care.
https://www.integratedcaredc.com/wp-content/uploads/2023/09/Managing-Expectations-Related-to-Behavioral-Health-Carve-In.mp4 Description: Basic overview of legal requirements for DC’s Medicaid MCOs and how these requirements intersect with behavioral...
https://www.integratedcaredc.com/wp-content/uploads/2023/09/RAG-Tool-for-Quality-Measures-and-Contracts.mp4 Description: RAG is a tool designed to assess the viability of expectations related to quality metrics and reporting requirements providers may encounter...
https://www.integratedcaredc.com/wp-content/uploads/2023/09/Clinical-and-Programmatic-Implications-of-VBP-.mp4 Description: Value-based payment reimbursement links payment to the quality and effectiveness of care we deliver. This webinar considers the clinical...
High-need, high-cost (HNHC) patients often face multiple challenges including high disease burden, behavioral health comorbidity, functional limitations and social barriers to treatment plan compliance. They typically make up just 5 percent of the population, but account for 50 percent of health care costs. This webinar will discuss taking a tailored approach to care in order to improve their outcomes.
One of the greatest threats to success for clinically integrated networks is an uneven commitment from disparate providers to improve patient outcomes and reduce avoidable, low-value healthcare costs. Success depends on providers investing time and other resources to achieve performance targets. Although the distribution of value-based payments should certainly take into consideration the number of patients either attributed or served, it must also recognize the contribution each entity made to generate the incentive payments. This webinar will explore principles and examples of distribution methodologies aimed at fairly allocating those dollars.
https://www.integratedcaredc.com/wp-content/uploads/2023/09/Getting-to-an-Advanced-APM-as-a-BH-Provider-–-Behavioral-Health-VBP-Part-3.mp4 Description: What does VBP really mean for BH providers (beyond P4P). How do you get to an advanced APM as a BH provider?...
https://www.integratedcaredc.com/wp-content/uploads/2023/09/Risk-Mitigation-and-Risk-Reserves.mp4 Description: Once health care providers have demonstrated the ability to reach quality performance targets and generate surplus in a shared savings pool, they may...
Review of DC's Medicaid MCO contract requirements related to equity and value-based purchasing and tips on how to use these requirements to your clinic or organization's advantage.
Advances in digital technologies and data analytics have created unparalleled opportunities to assess health data accelerating the ability of science to understand and contribute to improved health behavior and health outcomes. Additionally, behavioral health in the United States is being challenged to address persistent health inequities while improving the quality and value of the care delivered. As regulators, payors, and policies push behavioral health toward data-driven performance, the pressure for behavioral health providers to measure and monitor outcomes increases. This training will introduce providers to the key facets of using data to drive performance including metric selection, diagnosing performance issues and acting on data, driving innovation, and making data analytics a central part of the behavioral health quality strategy.
This session will provide an orientation to quality initiatives implemented by MCOs in their managed care contracts. The session will explain the importance of these quality initiatives, the associated performance measurement reporting, and the contract terms that implement those quality initiatives. In addition, participants will be introduced to the VBP pathway so that regardless of current state of readiness, participants can understand the expectations of quality and be prepared to meaningfully assess these expectations in a VBP contract.
https://www.integratedcaredc.com/wp-content/uploads/2023/08/Measurement-Based-Care-for-VBP-–-Behavioral-Health-VBP-Part-2.mp4 Description: The use of measurement-based care (MBC) centers on the use of regular patient-reported outcome measures throughout their...
A basic overview of the structure and function of Accountable Care Organizations (ACO) as well as an exploration of their challenges and opportunities in advancing value based care contracts with the government and private payers.
This webinar will focus on the “why” of transitioning from fee-for-service to capitation to pay for community health center direct services. Dr. Jones will discuss how fee-for-service reimbursement limits patient access to care and hampers efforts to improve patient self-management and accountability for their own health. He will share examples of how innovators are using lessons learned from other service industries to disrupt the health care market. Participants will learn how moving away from the fee-for-service system can preserve revenue streams but also support new models of care, and how payment reform can help to address primary care workforce shortages.
Managed care contracts, like many legal contracts, are challenging to understand. This session will provide a roadmap to key terms commonly found in managed care contracts. The session will explain what these terms mean in plain language and offer examples of favorable and unfavorable terms. In addition, the session will offer pointers for evaluating the favorability of contract terms and describe potential changes to standard terms that participants may wish to address during negotiations.
This is a self-assessment tool intended to help health care providers plan for negotiations around proposed managed care contracts. The tool can be used for internal conversations to analyze key terms, develop strategic direction, and set priorities for approaching negotiations. This tool can help providers determine if they are ready to contract, what level of risk they can tolerate, and what areas to focus on in negotiations.
Value is a function of impact and cost. BH providers provide a very high-impact, relatively low-cost service. As such, payment methodologies that reward value should be an opportunity for them to increase their revenue. But that's a theory that only plays out in practice sometimes. Come learn what BH providers need to do to be successful in a value-based environment.
CMS has signaled its intent to move from strict fee-for-service reimbursement to value-based payment for Medicaid as it has been actively doing for Medicare over the past decade. A few FQHCs are pursuing advanced alternative payment models on their own but most are choosing to clinically integrate with others, especially other FQHCs. This session will share national experiences from these initiatives and provide a framework for evaluating strategic options for DC FQHCs to progress in their pursuit of advanced alternative payment models.
This is a self-assessment tool intended to help healthcare providers plan for negotiations around proposed managed care contracts. The tool can be used for internal conversations to analyze key terms, develop strategic direction, and set priorities for approaching negotiations. This tool can help providers determine if they are ready to contract, what level of risk they can tolerate, and what areas to focus on in negotiations.
PCBH services not only facilitate change at the individual level but impact the family system. Conversely, family engagement in PCBH services can expedite the achievement and sustainability of an individual’s health goals. Strategies will be discussed that can help enhance family engagement within the PCBH model of care.
View materials from this event hosted by Department of Health Care Finance, DBH Training Institute, & Integrated Care DC on May 9, 2023. The in-person workshop was designed for behavioral health providers and other organizations seeking to prepare for the integration of behavioral health into the District’s Medicaid Managed Care Program. Presenters shared information and facilitated exercises to help leadership, clinical and operational staff, and other stakeholders develop the organizational competencies needed to succeed in managed care, including an understanding of managed care principles, how to communicate effectively with managed care partners, and how to effectively demonstrate the value of care through quality measurement and population health.
The diagnosis of a long-term health condition can be frightening and overwhelming for many people. Behavioral health professionals working in integrated care settings have the unique opportunity to intervene early to assist individuals with adjusting and adapting to the new demands for behavior change that accompany a new diagnosis.
Lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ+) individuals are frequently underserved and experience significant disparities in health outcomes and accessing preventive and ongoing healthcare. Sexual and gender minorities (SGM) often experience discrimination and bias in health care settings and may delay or avoid medical and preventive care.
Developing safe, culturally competent healthcare environments and practices for LGBTQ+ patients is critical and closely related to individuals’ willingness to openly share their sexual orientation and/or gender identity and expression (SOGIE). Capturing SOGIE data is critical as it allows providers to have a more comprehensive picture of key factors that influence care.
This session will start with a brief discussion of SOGIE terminology and a compilation of what is known about medical and behavioral health needs and disparities among the LGBTQ+ community. We will highlight the critical need for creating environments that improve patients’ psychological safety and increase their willingness to share SOGIE characteristics. We will share examples of how this data could be utilized to improve care and patient satisfaction, including capturing a patient’s preferred name and pronouns, and ways to engage in respectful conversations that could reveal key aspects of their medical history that could otherwise go unnoticed.
