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The VBP Blog 2024 Recap

In 2024, managed care and value-based payment models reshaped healthcare by improving care coordination, enhancing outcomes, and addressing diverse population needs in behavioral health, I/DD care, and home health.

New York Section 1115 Waiver

VBP Update – The Benefits of VBP for Consumers and Providers

Value-based payments (VBP) prioritize quality care over the volume of services, benefiting consumers with better outcomes and providers with financial incentives. Learn how VBP models promote preventive care, reduce costs, and create a more patient-centered healthcare system.

VBP Update – What are Value-Based Payments?

Learn about value-based payments and how this model shifts healthcare towards improved patient outcomes, reduced costs, and more efficient care delivery. We explore the different types of models, early successes, and challenges in implementation.

Navigating the Impact of the 80-20 provision on Home-Based Care

The new 80-20 provision mandates significant wage increases for caregivers but brings challenges for smaller providers. This blog explores the rule’s implications, including the potential for provider closures and the effect on consumer choice in the home-based care sector.

Wrapping Up the AI Revolution Series

Used correctly, AI can revolutionize the healthcare industry. From improving quality of care and access to care in home care and home health industry, to addressing behavioral health issues and health-related social needs, AI is primed to accelerate the industry.

Navigating the Impact of CMS’s Home Health Payment Rule

Explore the detailed implications of the CMS’s 2024 home health payment rule and its effects on home health agencies and patient care. Understand the critical role of home health care in ensuring patient independence and health outcomes.

health equity

Health Equity is Shifting to the Forefront

Health inequities result from race, ethnicity, disability, sexual orientation, socioeconomic status, geography, and other factors. In this blog, we will take a deeper dive into health equity, what it is and how it has come to the forefront of the industry.

CalAIM and Whole Person Care – All right here

CMS approved a five-year extension of its Medicaid managed care section 1915(b) waiver, which was renamed California Advancing and Innovating Medi-Cal (CalAIM). The program focuses more on whole-person care and integrating social services.

Senior father in wheelchair and young son on a walk. SoDH

Healthcare at Home Blog Series Exploring Social Determinants of Health

Social determinants of health are being taken more seriously when it comes to healthcare and health outcomes. There is no better time for this focus than now when healthcare is shifting into the home as it provides a more in-depth look the lifestyles and behaviors that impact consumers’ health

Florida Focuses on Choice

The sunshine state has a comprehensive LTSS program that still has some work to do on value-based care and is focusing on Managed Care

Wisconsin’s Deliberate MLTSS Approach Means Success

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’s Strong MLTSS Program

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 Health Link Drops the Ball

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.

doctor using a marker to draw a heart beat wave growth trends

Value-Based Payments Growth Trends…. Are You Ready?

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 value-based purchasing (VBP) or alternative payment model (APM), according to a survey done in 2020 by Medicaid Innovation. That is an increase of 14% since 2017.  The survey covered 2019 data taken from Medicaid managed care organizations (MCOs), and the trend continues Enrollment Growth Trends Enrollment also continues to climb,… Read More »Value-Based Payments Growth Trends…. Are You Ready?

building pillars on the front of a building

The Four Pillars to Build On in a VBP Environment

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 end of 2020, we offered our commitments as a company and in this blog we take a look at how those cross over. 4 Pillars of Reviewing Value-Based Care in I/DD Managed Care Time Matters: more than almost any other factor, the states that gave themselves time for a methodical… Read More »The Four Pillars to Build On in a VBP Environment

onward

Commitments for 2021 – Onward!

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. Stay True to Our Mission to be Advocates First We say that every time we introduce ourselves to new clients. We find that having a mission helps guide our decisions, our approach, and recommendations we make. When you think about your own organization: Revisit and update your mission to make… Read More »Commitments for 2021 – Onward!

primary care

The Primary Care First Model Explained

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 regions in 2021, including many that were covered in our I/DD Managed Care Review blogs.  In those blogs, we covered the ten current programs being offered. Out of those ten, five (New York, Tennessee, Kansas, Arkansas, and Michigan) also have a PCF option.  This leaves us hopeful that PCF programs… Read More »The Primary Care First Model Explained

stark law

CMS’ Overhaul Could Mean VBP is Working for Consumers

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 adjustments support the CMS “Patients over Paperwork” initiative of reducing unnecessary regulatory burdens on physicians. Photo by Tingey Injury Law Firm on Unsplash The Stark Law History In 1989, when healthcare was paid for primarily on a fee-for-service (FFS) structure, the Stark Law was put into place to protect patients… Read More »CMS’ Overhaul Could Mean VBP is Working for Consumers

black woman and her nurse

Pay-for-Performance – Developing and Expanding Opportunities

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 payments had a link to quality or value, including pay-for-performance models. To understand more of the basics, you can check out our first blog covering P4P.  Pay-for-performance is a payment model that attaches financial incentives to provider performance. Incentives can range from small bonuses to large payments, depending on the… Read More »Pay-for-Performance – Developing and Expanding Opportunities

older woman with flowers bundled payments

Exploring Bundled Payments

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 as episode-based payments (EPMs) – are an alternative payment method (APM) in which services are grouped together and a target price is calculated. This target price is the total allowable expenditure throughout an entire episode of care. A bundled price can be set and adjusted based on risk factors, age,… Read More »Exploring Bundled Payments

Elderly couple sitting by ocean

Alternative Payments Making a Splash

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 will be a two-part blog, starting with the national pieces and then working to a regional level. Fee-For-Service Models Traditionally, payment for health services has run on a model called fee-for service (FFS). This simple model means that physicians and healthcare providers delivered in units. This has little to do… Read More »Alternative Payments Making a Splash

elderly senior being brought meal by a nurse

Full State Managed Care Review: All 10 Current Programs 2020

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 managing entity, how many consumers were affected, the role of case management, the rollout approach, and more. To make things a bit easier to compare, we also compiled a chart and a presentation [Full State Review Managed Care IDD ] for you to reference. Iowa & Tennessee Kansas & Texas… Read More »Full State Managed Care Review: All 10 Current Programs 2020

managedcare1

A Fresh Approach to Managed Care in NC and NY

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 we have learned and what it means moving forward. North Carolina has been working with a form of managed care since 2005, but in 2015 committed to move towards a whole-person managed care approach. Their shift towards a new program has been halted due to legislation struggles and COVID-19, but… Read More »A Fresh Approach to Managed Care in NC and NY

older couple hugging

Local Engagement in IDD Managed Care with AZ and MI

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 is similar to that of North Carolina, focusing on county-based programs. These two contrasting styles have both found success and both have created unique solutions to manage the I/DD and MLTSS population. Arizona’s Managed Care Program Arizona’s Long-Term Care System (ALTCS) was established in 1998 for the management of Long-Term… Read More »Local Engagement in IDD Managed Care with AZ and MI

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

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 a managed long-term services and supports (MLTSS) program over 10 states as of May of 2020. This means approximately 2.1% of the total Medicaid population and 25.4% of I/DD consumers enrolled in a Medicaid program. This population has 45% with three or more chronic conditions and 35% always have a… Read More »Let’s Jump Back in to Managed Care in I/DD

Is Telehealth the TSA of COVID-19?

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 starting point for this blog was the major change that came out of 9/11.  We jointly concluded that technology changed significantly because of that crisis. We also saw the TSA in our airports as one of the manifestations of the change.  So, could telehealth be the TSA of the COVID-19… Read More »Is Telehealth the TSA of COVID-19?

elderly man in a wheelchair with a dog in his lap

Onward Means Consumer Protections

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 and the ability to provide services efficiently.  We’re also seeing individuals with disabilities being pushed to the back of the line in some states. We see three ways to look at this abrupt change. One, there are a number of burdensome regulations we should reconsider. The pandemic is just exposing… Read More »Onward Means Consumer Protections

Onward Takes on New Meaning!

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 rely on is paramount. We want to make sure that you have resources for not only your consumers, but your staff and your business to ensure you make informed decisions. With that in mind, we have compiled both news articles and resources for you to reference. Here are a few… Read More »Onward Takes on New Meaning!

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

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 – sustainable metrics can lead to higher quality care – and the cons – lower social-economic status areas will have inevitable bad outcomes and thus receive less funding. The P4P model is undoubtedly the longest standing and fastest growing[2] above its counterparts in shared savings, bundling, and shared risk models.  In… Read More »Pay for Performance – An Opportunity for Self-Direction in HCBS

Looking at States’ Managed Care Programs: Kansas and Texas

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 contract with Multi-state Commercial MCOs to administer their programs. Kansas’ fully capitated, MCO-based, state-wide program is called KanCare, started in 2013 with the I/DD enrollment portion starting in 2014. As of the end of 2017 there were 8954 people on the KanCare I/DD Waiver program. The initial goals for KanCare… Read More »Looking at States’ Managed Care Programs: Kansas and Texas

Hipster son walking with disabled father in wheelchair at park.

Looking at States’ Managed Care Programs: Iowa and Tennessee

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. As stated in our last blog, managed care for the I/DD population is the largest challenge to date.  The need for lifelong care, high levels or care, and the Managed Care Organization’s (MCO’s) lack of experience with this community has made transitions difficult. In this blog, we are going to… Read More »Looking at States’ Managed Care Programs: Iowa and Tennessee

Quality Measures for the I/DD and MLTSS Communities

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 from many of you, we adjusted course, flexed a little and decided to spend a little time sharing the state of measures of quality being developed and used in this area. Once we have covered this fully, we’ll return to our discussion of state models. Our Advocate’s Perspective may surprise… Read More »Quality Measures for the I/DD and MLTSS Communities

Lower Risk and Reward with Sub-Capitation

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 in the last blog, has many potential positives for the consumer, physician, and managed care organizations (MCO). Full capitation can be a hard sell for some doctors as they want some flexibility as they create innovative ways to treat patients. That lands us squarely on sub capitation (aka partial capitation)… Read More »Lower Risk and Reward with Sub-Capitation

VBP Risk Capitation Pros and Cons

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 their consumers.   Do keep reading! It’s already shown success in California, where the state’s Regional Health Care Cost & Quality Atlas reveals the capitated-integrated model delivers on all the major VBP scores:  9% lower total cost of care, 14 points higher in quality, and $4,450 less in total cost of care… Read More »VBP Risk Capitation Pros and Cons

VBP Risk Sharing

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 actually foregoing revenues if goals are not accomplished. It should not be approached lightly. Caption for Photo Risk Sharing and Reward A shared risk value-based model representing possibly the best of both of those worlds. Thought of as the “next-level” of value payment methods, risk-sharing is the ultimate opportunity for… Read More »VBP Risk Sharing

elderly man thumbs up

Shared Savings in VBP

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 had the opportunity to talk with a number of providers about an alternative payment structure and I found myself breaking down the process from alternative payments to shared savings into potentially 15 or more steps.  As you read on…. Consider our Advocate’s Perspective and join us in making sure that our consumers’… Read More »Shared Savings in VBP

nurse and patient in a wheelchair

Succeeding with Payment for Outcomes

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 on the latter part of this statement. Focusing on Patient Outcomes 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… Read More »Succeeding with Payment for Outcomes

medical billing

VBP Bundled Payments

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! Bundled payments are forecasted to account for 17% of payments by 2021, according to McKesson and ORC International. In the past two blogs, we have covered payment for process, alternative payment models, and payment for performance. All three of those set up building blocks for larger value-based payment changes. Bundled payments in… Read More »VBP Bundled Payments

Older couple sitting by water

VBP Payment for Performance

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 at the end of this blog… Make sure to check it out! The second step in the Value Based Continuum is Payment for Performance (P4P). Payment for performance takes the fee-for-service model and nudges it towards a value-based model. This is done by having metrics set and providers achieving, advancing, or exceeding… Read More »VBP Payment for Performance

VBP Payment for Process and Alternative Payments

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 for our Advocate’s Perspective at the close of this blog. Those of you who participated in our presentation heard us urge you to practice measurement, develop tracking and know what you do and how much it costs.  This skill set is one that is foundational to the ability  to demonstrate… Read More »VBP Payment for Process and Alternative Payments

Value Based Payments

VBP Payment for Value, Quality, and Outcomes

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 a major shift in healthcare policy. This is by no means a “light switch” that can be done with small modifications. Healthcare providers will be expected to offer value over volume, quality over quantity, and outcomes versus activity. Let’s take a look at some examples of each. Value vs. Volume… Read More »VBP Payment for Value, Quality, and Outcomes

Value based Payments

Value Based Payments… What does it really mean?

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 fee-for service (FFS). This simple model means that physicians and healthcare providers delivered in units. This has little to do with results or outcomes of those services. In 2017, the estimated cost of care for an insured family of four reached nearly $27,000 considering health insurance, payroll deductions, and out of pocket… Read More »Value Based Payments… What does it really mean?

Value Based Payments

Break Through Value Based Payments

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 specific example from one of our clients. Each blog should expand your knowledge of VBPs, as well as set you up for success within your own company. What you can expect over the course of the VBP blog series: What are VBPs? How did we get here? This blog will… Read More »Break Through Value Based Payments