We take a look at Arkansas’ provider-led network as a groundbreaking new model for Medicaid consumers. Their whole-person approach is a true example of what value-based care can offer consumers and providers.
As of July 1st, North Caroline shifted to a Medicaid Managed Care Program. Almost 1.6 million beneficiaries are now receiving the same care in a new way through Medicaid Managed Care health plans.
Wisconsin’s long-tenured Family Care MLTSS Program continues to find success with major goals including increased ability to keep consumers at home, lowered costs and reduced inefficiencies. They continue to raise the bar for national MLTSS programs.
Tennessee has built a strong structure for their Medicaid-managed long-term services and supports community with a program they launched in 2010 called CHOICES. Their program has been revered for its flexibility, high quality, and consumer-first approach.
Iowa’s IA Health Link launch left both providers and consumers frustrated by putting their budget before the quality of care. We analyze the missteps they took after setting unrealistic timelines for the work that needed to be done. Their MLTSS program continues to serve as a learning tool for other state’s roll outs.
First up in our review of value-based purchasing in managed care MLTSS programs is Arizona. The program has gone through a variety of upgrades and changes.
Value-Based Payments Growth Trends…Are You Ready? THE VBP Blog We are exploring value-based growth trends this week. Current data shows Medicaid managed care programs using value-based payments programs have experienced steady growth over the past few years, 67% of Medicaid’s 74 million consumers are enrolled in some type of health plan and 55% of Medicaid budgets are going to health plan payments. Of all Medicaid MCO respondents, 93% utilized a… Read More »Value-Based Payments Growth Trends…. Are You Ready?
Four Pillars to Build On in a VBP Environment THE VBP Blog [1/14/2021] In 2020, we took on the monumental task of evaluating all ten states that offered managed care programs for the Intellectual and Developmental Disabilities (I/DD) population. In our final blog of that series, we broke down our findings into four main pillars. These frameworks provided structure across the many different approaches over the ten states. At the… Read More »The Four Pillars to Build On in a VBP Environment
Commitments for 2021 – Onward! THE VBP Blog Looking back at 2020 would be what most of us do this time of year, however, we are always looking forward and Onward! So, there are commitments we making to drive our planning for 2021, we hope these help you to make your own commitments and resolutions for the upcoming year. Photo by Hide Obara on Unsplash Our Commitments for 2021 1.… Read More »Commitments for 2021 – Onward!
The Primary Care First VBP Model Explained THE VBP Blog [12/17/20] The Primary Care First (PCF) model was established by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. It offers a regionally-based, multi-payer approach to primary delivery and payment. By design, PCF allows for increased flexibility and freedom for practitioners to be innovative in their approach to increase quality and reduce costs. PCF will be offered in 26… Read More »The Primary Care First Model Explained
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
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
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
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
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
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
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 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
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 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 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!
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
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
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
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
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
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
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
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
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
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
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
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
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
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?
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
CMS proposed a rule to expand the Home Health Value-Based Purchasing Model nationwide to accelerate the shift to value-based care.
CMS is offering $20 million in grants to states in order to update their state-based exchanges. Each awardee can receive approximately $1.3 million
June is Pride Month and the Centers for Medicare & Medicaid Services (CMS) is focusing on LGBTQ+ persons and recognize their unique health needs