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).
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.
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...
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...
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.
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.
We often think of the treatment plan as a document to complete. However, it can be a tool to engage and empower the person served in their own recovery process. In this interactive webinar we will learn the core components of the treatment planning process from a person-centered and engagement-focused lens.
Understanding, measuring, working to improve quality performance are critical to ensuring that patients have positive outcomes and providers are satisfied—they’re also critical to ensure your practice is meeting its regulatory requirements and maximizing payment opportunities. As the District of Columbia carves in behavioral health care to managed care arrangements and requires more providers to be in value-based care arrangements, it is even more imperative that quality measurement and improvement is understood and infused across your organization—from providers, to leaders, to auxiliary staff.
This two-part series will describe the quality measurement basics and why it matters, and then treatment planning for population health. In Part 1, we will explore why we need to infuse a culture of quality within healthcare organizations, including an understanding of what we value, who we serve, and who we are accountable to. Presenters will emphasize the importance of all staff understanding quality and its impact on our patients, staff and organization. We will review the basics of measurement and key measures in quality focused on integrated care.
In making the transition from practicing outpatient behavioral health to primary care behavioral health, clinicians often wonder, how can I do my work in 20 minutes, and is it really possible to make a meaningful difference in this amount of time? This training answers this question directly by simulating a 20 minute behavioral health consultation and discussing as a group each stage of the encounter, best practices, and the strengths and challenges that arise.
Evidence-based modalities developed to treat trauma are commonplace in outpatient behavioral health practices, but we often struggle to adapt these therapies to the integrated care setting where brief intervention is common. In this session, we will present Accelerated Resolution Therapy (ART) as a useful tool for treating trauma in an integrated setting. Accelerated Resolution Therapy has been shown to achieve benefits rapidly, usually within 1-5 sessions, and is effective in treating PTSD and complex trauma as well as other mental health problems such as anxiety, depression, phobias, grief, chronic pain, and relationship issues.
We will explore the basics of Accelerated Resolution Therapy, highlight examples of how it has been used effectively in the primary care setting, and discuss both benefits and barriers to implementing this modality. We will focus on the compatibility of this therapy as a brief intervention within the PCBH model and the particular benefit of sustainability as Accelerated Resolution Therapy reduces exposure to vicarious trauma – critical to clinician self-care and preservation in these trying times.
As healthcare centers around the country further embrace data and metrics, integrated primary care behavioral health programs must incorporate data to reflect the value of work being done. In this webinar, attendees will learn about primary data and metric points and the importance of ensuring that data tells a story and reflects the infinite values of health systems, rather than becoming finite goals.
During this webinar, presenters discussed how proactive approaches to value-based care, including the use of VBP models, can improve individual and population health outcomes while enhancing efficiencies and reducing total costs. We also featured AmeriHealth’s new care coordination dashboard focused on helping providers close care gaps and achieve better patient outcomes.
During this webinar, participants will be able to identify the foundations of value-based care and the Health Care Payment Learning & Action Network (HCPLAN or LAN) value-based payment (VBP) framework. The presentation will also include the Department of Health Care Finance’s VBP strategy.
The session will address the realities of health behavioral change and subsequent adherence in integrated, primary care settings, and key lifestyle interventions and recommendations that transcend many evidence-based guidelines for chronic conditions (e.g., diabetes, hypertension, etc.). The session will discuss the importance of filtering evidence-based medicine guidelines through the prism of contextual and compassionate healthcare to increase the probability of patients embracing and implementing such interventions.
A provider will demonstrate how it has decided to use the tools provided by AmeriHealth to start looking at integrated care outcomes. There will be time for audience questions and answers after a brief presentation.
We will talk with Dr. Yavar Moghimi, Chief Psychiatric Medical Officer of AmeriHealth Caritas about why integrated care is important and the ways AmeriHealth is working with providers to identify and ultimately achieve key physical and behavioral health outcomes. There will be time for audience questions and answers after a brief interview-style presentation.
Vice President of Human Resources at Mount Sinai Health System in NYC and Dr. Mary Awuonda Associate Professor of Howard University and Dean Mashonda Smith of UDC will be share lessons learned in the district and other large health systems. The aim of the conversation is to talk and learn from one another to develop solutions grounded in the realities of the Washington DC policy, regulatory and health care environment.
What’s the link between pay for performance and healthy eating on a budget? What about the link between quality metrics and understanding nutrition labels? These are all related topics that providers and practices address every day! Care teams work 1:1 with patients to better manage their chronic diseases while at the same time, measuring and reporting outcomes that are related to payments and incentives. During this webinar, we will make the connection between patient engagement strategies and meeting quality metrics. This webinar is designed for ALL AUDIENCES as everyone has a role in providing high-quality care- from the exam room to the boardroom.
Prior to the webinar, we invite you to view this short video “Bites on a Budget” created by HMA Senior Associate, Brandin Bowden, MSc., as he attempts to build a healthy dinner for under $5. In this #HealthyDinnerChallenge, Brandin puts on his nutrition educator hat to share healthful tips to help your patients and clients navigate the grocery store, increase nutrient intake and promote comfort in the kitchen.
The Primary Care Behavioral Health Consultation model (PCBH) is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care. This webinar overs the framework of the PCBH model, the behavioral health consultant role, and a day-in-the-life look at integrated care using this model.
Because many women and persons of childbearing age pregnant with SUD may not readily share information with providers and because pregnancy is a period where the motivation for change is extremely high, positioning providers to identify and care for this population has great potential for establishing a recovery path and changing lives. This webinar will review the risks and effects of SUD among women of childbearing age, pregnant and parenting persons and their affected infants, including screening and treatment considerations, breastfeeding decisions and ideal mechanisms for engagement and support of women and other pregnant persons on their recovery journey. We will also cover the short and long-term effects of SUD exposure on the infants, including non-pharmacologic alternative interventions and follow-up considerations.
Valuable Revenue Cycle Tip of the Week #6 is one of the FREE resources provided by Rev-Up DC, sponsored by the Department of Health Care Finance (DHCF). to help DC Medicaid Behavioral Health providers transition to participating in the Managed Care contracts.
A 2017 RAND study found that 60 percent of American adults now live with at least one chronic condition; 42 percent have more than one. They account for hundreds of billions of dollars in health care spending every year. Individuals with serious mental illness are disproportionately impacted by our siloed physical and behavioral health systems with mortality rates 2–3 times higher than those of the general population. This disparity translates to life expectancies shortened by 10–28.5 years. It is critical that behavioral health providers understand the fundamentals of the physical health conditions that are major drivers of this early mortality so that basic health behavior interventions can be integrated into behavioral health services. Part 2 of this webinar series covers tobacco use disorder and infectious diseases. Attendees will learn how to use the 5 As model to assess need and promote lifesaving behavior changes.
Valuable Revenue Cycle Tip of the Week #4 is one of the FREE resources provided by Rev-Up DC, sponsored by the Department of Health Care Finance (DHCF). to help DC Medicaid Behavioral Health providers transition to participating in the Managed Care contracts.
Valuable Revenue Cycle Tip of the Week #3 is one of the FREE resources provided by Rev-Up DC, sponsored by the Department of Health Care Finance (DHCF). to help DC Medicaid Behavioral Health providers transition to participating in the Managed Care contracts.
During this brief presentation, Kristan McIntosh, LMSW, shares an overview of what a Certified Community Behavioral Health Clinic (CCBHC) is, discusses why it is an important opportunity to build behavioral health system capacity, and talks about some upcoming opportunities to become (or partner with) a CCBHC.
This short take covers the basic concept of the Screening, Brief Intervention, Referral to Treatment (SBIRT) model. It reviews the reasons for why this approach is important, where SBIRT is delivered. Finally, each component of the model is briefly described.
Valuable Revenue Cycle Tip of the Week #2 is one of the FREE resources provided by Rev-Up DC, sponsored by the Department of Health Care Finance (DHCF). to help DC Medicaid Behavioral Health providers transition to participating in the Managed Care contracts.
Valuable Revenue Cycle Tip of the Week #1 is one of the FREE resources provided by Rev-Up DC, sponsored by the Department of Health Care Finance (DHCF). to help DC Medicaid Behavioral Health providers transition to participating in the Managed Care contracts.
This hour-long presentation will discuss the Value-Based Payment framework and where the Medicare bundled payment available to Opioid Treatment Programs (OTPs) fits. It will also include information about how to appropriately bill the bundled payment in various situations, and when to bill separately for additional services.