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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.
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.
