stark law

CMS’ Overhaul Could Mean VBP is Working for Consumers

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CMS’ Overhaul Could Mean VBP is Working for Consumers The Stark Law has been modernized: Here’s what you need to know THE VBP Blog [11/24/20] This week, CMS announced they were modernizing and updating the Physician Self-Referral Law (i.e. “Stark Law”) to steer it towards a value-based payment (VBP) structure. The core of the law, to protect patients from unnecessary, low quality, and expensive services, will stay in-tact. The new… Read More »CMS’ Overhaul Could Mean VBP is Working for Consumers

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Pay-for-Performance – Developing and Expanding Opportunities

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Pay-for-Performance Developing and Expanding Opportunities THE VBP Blog We are circling back to cover pay-for-performance, the second stop on the value-based payment continuum. The pay-for-performance (P4P) model gives providers bonuses for hitting quality and efficiency targets. As we continue to focus on whole-person care, the new normal of hybrid payments continues to shift.   According to Health Care Payment Learning & Action Network (LAN), in 2018, 25% of all fee-for-service… Read More »Pay-for-Performance – Developing and Expanding Opportunities

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Exploring Bundled Payments

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Exploring Bundled Payments THE VBP Blog When we started the VBP Blog back in 2018, we broke down the building blocks in the continuum for Value-Based Payments. In the last blog, we revisited Alternative Payments and what had changed since our original analysis. In this one, we will be covering Bundled Payments and what they mean to Value-Based Payments. Bundled Payments Refresher As a refresher, bundled payments – also known… Read More »Exploring Bundled Payments

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Alternative Payments Making a Splash

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Alternative Payments Making a Splash​ Examining the ever-changing Value-Based Payments landscape​ THE VBP Blog Value-Based Payments are a complex topic that is evolving very quickly. Back when we first started this blog in 2018, we began at the very beginning. We feel it’s important to double back on those foundational pieces of VBP as it continues to change. With that in mind, we are starting with Alternative Payment Models. This… Read More »Alternative Payments Making a Splash

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Full State Managed Care Review: All 10 Current Programs 2020

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Full State Managed Care Review: All 10 Current Programs Is Provider-Led Care the Future of Managed Care Programs? THE VBP Blog [July 30, 2020] Across several months and multiple blogs, we have covered all ten states that feature managed care programs for the Intellectual and Developmental Disabilities population. We saw a wide range of successes, types of programs, and different phases of rollout. With each, we broke down the state’s… Read More »Full State Managed Care Review: All 10 Current Programs 2020

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A Fresh Approach to Managed Care in NC and NY

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Fresh Approach to Managed Care in NY and NC THE VBP Blog We’ve navigated you through 8 of the ten states with a managed care I/DD program and in this blog, we will cover the final two. We have learned a lot about the different approaches, the successful and not as successful programs, and the work that is still left to do. In our next blog, we will recap everything… Read More »A Fresh Approach to Managed Care in NC and NY

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Local Engagement in IDD Managed Care with AZ and MI

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Local Engagement in IDD Managed Care in Arizona and Michigan THE VBP Blog [5/26/2020] – As promised, this blog will examine the last 4 states that offer I/DD managed care programs to their consumers. This week, we take a look at Arizona and Michigan. Arizona built a completely different structure than we have seen before with a state-run Division of Developmental Disabilities as the managing entity. Michigan’s managed care program… Read More »Local Engagement in IDD Managed Care with AZ and MI

Let’s Jump Back in to Managed Care in I/DD

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Let’s Jump Back in to Managed Care in I/DD THE VBP Blog [5/14/2020] – For the past 8 months, we have touched on managed care in the individuals with intellectual and developmental disabilities (I/DD) population. While the world has been coping with COVID-19, this expansion of managed care has not slowed down. With the estimated 1.5 million Medicaid consumers with an I/DD, over 358,500 consumers with I/DD were enrolled in… Read More »Let’s Jump Back in to Managed Care in I/DD

Is Telehealth the TSA of COVID-19?

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Break Through Value-Based Payments Is Telehealth the TSA of COVID-19? THE VBP Blog For those of you who know me personally, you know that being an optimist is my downfall. In times of crisis, the ability to look forward to the forthcoming changes can be challenging.  Mandy, my co-author brings her creativity and technology-savvy perspective to our discussions. Together, we look ahead to the elements we want learn from.  Our… Read More »Is Telehealth the TSA of COVID-19?

Onward Means Consumer Protections

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Onward Means Consumer Protections THE VBP Blog Over the last few decades, advocates and regulators have worked tirelessly to build in significant protections in the way services are delivered. We’ve been fighting for things such as independent living in the community, smaller group homes, privacy in each room, and community integration. In the current COVID-19 crisis, we see many of these regulations being waived, in the name of emergency flexibility… Read More »Onward Means Consumer Protections

Onward Takes on New Meaning!

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ONWARD Takes On A New Meaning THE VBP Blog Our blog has focused on the quality of services and how you can leverage measuring performance to continuously improve satisfaction, support our consumers, and keep you ahead of the game.  Today, the challenges you face are monumental, so we will focus on supporting you and live by our mantra, ONWARD! With hourly updates on the COVID-19 situation, having resources you can… Read More »Onward Takes on New Meaning!

Pay for Performance – An Opportunity for Self-Direction in HCBS

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Break Through Value-Based Payments Pay for Performance – An Opportunity for Self-Direction in HCBS THE VBP Blog Roughly a year ago we did a blog on Payment for Performance that took a look at the second step in the Value-Based Continuum. Pay for Performance (P4P) is the model that sets metrics to incentivize providers to achieve, advance, and exceed through their quality of care. We talked about the pros –… Read More »Pay for Performance – An Opportunity for Self-Direction in HCBS

Looking at States’ Managed Care Programs: Kansas and Texas

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Break Through Value Based Payments Looking at States’ Managed Care Programs: Kansas and Texas THE VBP Blog Happy New Year! Let’s start 2020 where we left off in our last blog. We will review two of the ten states that currently are supporting the I/DD population with managed care programs. Using the Ancor 2018 White Paper, combined with our own research, we opted to break down Texas and Kansas. Both… Read More »Looking at States’ Managed Care Programs: Kansas and Texas

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Looking at States’ Managed Care Programs: Iowa and Tennessee

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Break Through Value Based Payments THE VBP Blog Looking at States’ Managed Care Programs: Iowa and Tennessee Managed care has been a slow mover for the I/DD population in multiple states. As of 2019, there are 229,817 Medicaid consumers with an intellectual/developmental disability (I/DD) enrolled in Medicaid managed long-term services and supports (MLTSS) programs. In fact, only ten states have adopted a policy for populations with special needs at all.… Read More »Looking at States’ Managed Care Programs: Iowa and Tennessee

Quality Measures for the I/DD and MLTSS Communities

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Break Through Value Based Payments Quality Measures for the I/DD and MLTSS Communities THE VBP Blog In our last blog we anticipated breaking down the current state models for I/DD communities. However, we attended the Rehabilitation and Community Providers Association (RCPA) conference and presented to the MAX Group, where we learned that many providers aren’t as attuned to the quality measures available in this area. So, acting on the counsel… Read More »Quality Measures for the I/DD and MLTSS Communities

Lower Risk and Reward with Sub-Capitation

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THE VBP Blog One of the greatest areas of concern when we discuss capitation, is that it is “all or nothing.” However, that is not the case. In the development of Value Based Payments, there are ample opportunities to incorporate partial capitation, for specific services, events/episodes, and even treatments. As value-based options continue to take on more risk, we find ourselves looking at every alternative option. Capitation, as we covered… Read More »Lower Risk and Reward with Sub-Capitation

VBP Risk Capitation Pros and Cons

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Break Through Value Based Payments Part 10: Risk Capitation Pros and Cons THE VBP Blog Welcome back to THE VBP Blog Series. Continuing our drill-down into risk-sharing in Value Based Payments, in today’s blog we look at the capitation model. As the ever-challenging task of lowering healthcare costs continues to come to the forefront, organizations may look to capitation, which requires that providers take on the full financial risk for the care of… Read More »VBP Risk Capitation Pros and Cons

VBP Risk Sharing

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Break Through Value Based Payments Risk Sharing in Value Based Payments The VBP Blog Welcome back to THE VBP Blog Series. As many of you have asked for continuing the global view of Value Based Payments, in today’s blog we look at how contracting entities take part in risk sharing arrangements. This is usually an option for mature VBP organizations, with proven stable data tracks and clear quality-controlled processes. Risk sharing involves… Read More »VBP Risk Sharing

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Shared Savings in VBP

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Break Through Value Based Payments Risk Capitation Pros and Cons The VBP Blog So, in preparing for our 8th installment of our blog series, it’s become evident that there’s a whole lot more than 10 portions of the topic to cover.  The progress through the Value Based Payments journey has many more steps and stepping stones than the initial view most of us have.  In the past two weeks, I… Read More »Shared Savings in VBP

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Succeeding with Payment for Outcomes

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Break Through Value Based Payments Succeeding with Payment for Outcomes The VBP Blog Value Based Payments are leading us to focus on the outcomes we can deliver and to have providers share in the savings.  However, the real success of payment for outcomes is in better health outcomes, longer periods without a need for higher-level care, and better quality of life for consumers.   The Advocate’s Perspective in this blog focuses… Read More »Succeeding with Payment for Outcomes

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VBP Bundled Payments

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Break Through Value Based Payments Bundled Payments THE VBP Blog As we move Onward! Along the continuum of Value Based Payments, we examine Bundled Payments in this installment of our series. We have noted that some of these topics require more depth, so you may see our series expand to 12 or more…. This gives us the opportunity to share and advocate even more. Look for our Advocate Perspective below!… Read More »VBP Bundled Payments

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VBP Payment for Performance

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Break Through Value Based Payments Payment for Performance THE VBP Blog We have received very positive response to this series and we continue to see the path of Value Based Payments as a progression, a journey from knowing what you do, how you do it and how well you do it, to capitalizing on the quality of what you share in the value of what you are delivering.  Our Advocate’s Perspective is… Read More »VBP Payment for Performance

VBP Payment for Process and Alternative Payments

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Break Through Value Based Payments Payment for Process & Alternative Payments THE VBP Blog Welcome back.  Our blog rolls on as we start to dive in the Value Based Payment (VBP) Continuum. The first steps on the continuum are Payment for Process & Alternative Payments. As we monitor changes in healthcare and move closer to the integrated VBP model, this first step is crucial for organizations as they prepare for the future. Look… Read More »VBP Payment for Process and Alternative Payments

Value Based Payments

VBP Payment for Value, Quality, and Outcomes

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Break Through Value Based Payments Payment for Value, Quality, and Outcomes THE VBP Blog Happy New Year! We hope 2019 is healthy and successful for you and yours. This is the third blog in our series. We want to continue to share the facts with you and encourage you to consider our Advocate’s Perspective…. And to share it with your colleagues. The transition from the Pay-For-Volume to the Pay-For-Value model marks… Read More »VBP Payment for Value, Quality, and Outcomes

Value based Payments

Value Based Payments… What does it really mean?

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Break Through Value Based Payments Value Based Payments…What does it really mean? THE VBP Blog The adoption of value-based care is expected to account for 59% of all healthcare payments by 2020. Read that again. Now one more time. Let’s break down how we got here. We are proud to include an advocate’s perspective as part of this blog… Read On. Traditionally, payment for health services has run on a model called… Read More »Value Based Payments… What does it really mean?

Value Based Payments

Break Through Value Based Payments

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Break Through Value Based Payments A 10-Part Series of Blogs Focusing on VBP Blog 1: An Introduction and Path Onward Value Based Payments (VBPs) are coming: are you ready? We are launching a series of blogs diving into this hot topic to help you understand what it is, why it works, and how it can work for you. We will pepper each blog with relevant facts and finish each with a… Read More »Break Through Value Based Payments