Organizational Preparedness: Moving Towards Value-Based Paym ent - PowerPoint PPT Presentation

Organizational Preparedness: Moving Towards Value-Based Paym ent Karen Batia, Ph. D December 10, 2018 CBHA Conference 1

FEE FOR SERVICE (FFS) TO VALUE-BASED PAYMENT (VBP)  Moving from a volume driven system to one that is value-based comes in all sizes and shapes + Organizations build systems based on what has traditionally been paid for + Must balance continued requirements of the FFS world with VBP readiness + Key ingredients = committed leadership + change management focus 3

5 APM Framework At-A-Glance The framework situates existing and potential APMs into a series of categories. For Public Release

Va Value-Based ed R Reimbursem emen ent t Conti tinuum Accountability Accountability, financial opportunity, and Incentive alignment supported by clinical integration, infrastructure and data analytics Financial risk/reward FFS Care Coordination P4P Shared Savings Shared Savings Partial Global Fee (up only) (up and down) Capitation Capitation FFS Outpatient Capitated Rate BH Capitated Capitated Rate Rate with Guardrails 6

Practice T Transformation F Financial M Model P4P Shared savings Partial Capitation Fee-for- service 7

VALUE-BASED PAYMENT ORGANIZATIONAL READINESS  Quality and Performance Management  Access and Capacity  Care Management  System of Care  Behavioral Health + Primary Care  Social Determinants of Health  Data Analytics and Health Information Technology  Financial and Operational Capacity  Revenue and Cash Flow Models  Cash and Positive Margin  Cost Management 8

HIGH-IMPACT ACTIONS 10

QUALITY AND PERFORMANCE MEASUREMENT 12

ACCESS AND CAPACITY 14

CARE MANAGEMENT/CARE PLANNING 15

HEALTH INFORMATION TECHNOLOGY READINESS 16

HEALTH INFORMATION TECHNOLOGY READINESS – DATA AND ANALYTICS 17

VALUE-BASED PAYMENT ASSESSMENT TOOLS  Numerous tools available to assess organizational readiness  HMA  Primary Care Organization VBP Assessment Tool  Behavioral Health Organization VBP Assessment Tool  IPA VBP Assessment Tool  Other tools  Health plans  National Council 18

IPA VALUE-BASED PAYMENT TOOL The tool is broken into six sections: + Value-Based Payment (VBP) Experience + Quality Measurement + Access and Capacity + Care Management/Care Planning + Health Information Technology Readiness + IPA/Accountable Care Organization (ACO) Experience 19

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CONTACT ME KAREN BATIA, PH.D. 180 N. LaSalle, Suite 2305 Chicago, IL, 60601 312.641.5007 | kbatia@healthmanagement.com www.healthmanagement.com