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.
The FTC’s recent ruling to eliminate non-compete agreements promises significant shifts in the healthcare industry. This blog explores the potential benefits and challenges this change could bring to healthcare professionals and patients alike.
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.
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.
Explore how Artificial Intelligence is transforming behavioral health, enhancing patient care through addressing mental health and social determinants of health.
Explore how Artificial Intelligence and AI-enabled technologies are transforming behavioral health and being used to enhance patient care through addressing mental health and SUDS.
Explore how Artificial Intelligence can improve quality of care in home health and home care through various applications.
Explore how Artificial Intelligence is transforming home health and home care through predictive analytics, personalized care plans, and operational efficiencies.
Explore the key challenges of implementing AI in healthcare, including data privacy, the balance between technology and human interaction, regulation, and more. This blog delves into the practical, ethical, and financial implications of AI integration in healthcare to ensure it is beneficial and equitable.
Dive into the potential of Artificial Intelligence (AI) in the healthcare industry, exploring how AI enhances care through predictive analytics, personalized plans, and operational efficiency.
Delve into an analysis of the factors driving up home health and home care costs, from increased demand to inflation, and discover how value-based payments could offer a beacon of hope for consumers facing financial pressures.
Explore how Florida’s innovative Medicaid Managed Care pilot program aims to reshape healthcare for individuals with Intellectual and Developmental Disabilities IDD, offering insights into the potential benefits and challenges of this transformative approach.
Explore how the CMS’s Innovation in Behavioral Health (IBH) Model is setting new standards in integrated care, focusing on value-based approaches, health equity, and addressing social determinants of health.
Explore how New York’s recent Section 1115 waiver amendment aims to revolutionize Medicaid by integrating healthcare with essential social services, focusing on health equity and patient-centered care.
Explore the key trends shaping the home health and home care industry in 2024, focusing on the impact of inflation, the shift towards larger providers, and the rise in M&A activities.
Discover the key trends shaping the home health and home care industry in 2024, focusing on the diversification of services and the growth of community partnerships and Hospital at Home models.
Continue exploring the anticipated trends for 2024 in the home health and home care industry, including the rise of cultural competency and the significant impact of the immigrant workforce in meeting diverse patient needs.
Continue exploring the anticipated trends for 2024 in the home health and home care industry, including sector growth, labor shortages, and the rising importance of cultural competency.
Dive into the anticipated trends of 2024 for the home health and home care industry, focusing on the significant growth of the sector and the empowering rise of consumer involvement in at-home care.
Explore the top trends set to reshape the home health and home care industry in 2024, from
the continued growth of services to the integration of technology and the emphasis on whole-person
care.
Uncover the challenges and opportunities in reducing healthcare disparities for minorities in home health care, focusing on value-based payments and health equity strategies.
Delve into the world of value-based payments (VBP) in healthcare, examining its growth, the challenges faced, and the potential for future improvements. Explore how VBP is reshaping healthcare delivery and reimbursement.
Uncover how state-specific Medicaid policies impact the access to and outcomes of Long-Term Services and Supports (LTSS) policies.
Uncover how states vary when it comes to their Long-Term Services and Supports (LTSS) landscape, affecting quality, access, and innovation in home care services.
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.
Dive into California’s innovative CalAIM initiative, exploring its transformative approach to behavioral health, and uncover the early lessons guiding its forward trajectory.
Explore the transformative impact of Value-Based Payment in Managed Long-Term Services and Supports, with a special focus on New York’s pioneering efforts.
In this blog, part of our Home Health Series, we will dive into the intricacies of the home health and home care industry’s workforce challenge, exploring its root causes and examining the approaches states and organizations are adopting to address it.
Explore the innovative strides ACOs are making by integrating behavioral health into traditional healthcare models, promising improved patient outcomes and comprehensive well-being.
Dive deep into the CMS’s AHEAD Model, exploring its foundations, potential benefits, and the challenges it faces as it aims to reshape the American healthcare landscape.
Hospital at home programs have the potential to transform the healthcare landscape, but there are challenges to widespread implementation. Read on to discover the challenges these programs face
Dive into the transformative world of hospital at home programs. Discover their benefits, success stories, and what key players are getting involved in reshaping the future of healthcare.
Explore the challenges states face integrating behavioral health services into Medicaid managed care, from administrative burdens to workforce shortages, and learn about innovative solutions being implemented
Explore the evolving role of payviders in the home health industry, understand the unique advantages they bring, and assess the potential pitfalls of this emerging model.
As UnitedHealth, Humana, and other big players are shifting to the payvider model for home health services, we explore how the shift is reshaping the home health industry.
Dive deep into the transformative potential of managed care in addressing behavioral health concerns and learn about various state-led initiatives in this realm.
This blog post delves into the intricacies of the Home Health Value-Based Purchasing (HHVBP) Model, its results, the current state of the expanded HHVBP model, and potential for the future of home healthcare.
A detailed exploration of the Making Care Primary Model, an innovative value-based initiative by CMS aimed at transforming primary care.
A detailed exploration of the Making Care Primary Model, an innovative value-based initiative by CMS aimed at transforming primary care.
Oklahoma Health Care Authority (OHCA) awarded managed care contracts to Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma and Oklahoma Complete Health, a subsidiary of Centene Corporation.
An in-depth look at PACE (Program of All-Inclusive Care for the Elderly), its benefits, and its expanding footprint in the United States.
This blog delves into Alabama and Arkansas’ strategies towards Medicaid expansion. Understand the implications of adopting ‘private option’ models and their impacts on improving healthcare access.
Explore what the extension of the Medicare Advantage Value-Based Insurance Design Model through 2030 means for patient outcomes and healthcare innovation.
An exploration of the emerging intersection of home care and value-based payments, with a spotlight on the Expanded Home Health VBP Model and its impact on health outcomes and the industry.
Category: value-based payment models
Value-based payment models have the potential to revolutionize the healthcare industry. In this blog post, we’ll delve into key strategies for successful VBP implementation in the years to come
Value-based payment models have the potential to revolutionize the healthcare industry, improving patient outcomes while reducing costs. In this blog post, we’ll delve into VBP models and the challenges that we are facing when striving to drive future implementation of value-based payments.
As the federal Public Health Emergency comes to an end, home health and homecare agencies must adapt to the changing landscape. Learn about the potential impacts on reimbursement rates, telehealth, and regulatory compliance.
Dive into how states can utilize managed care to address health-related social needs and social determinants of health, promoting health equity and community well-being.
You likely hear a lot about Medicare, Medicaid, and Medicare Advantage, but do you know what the difference between the programs is?
Ohio’s Next Generation Managed Care program is officially off the ground and running. We take a look at the ins and outs of the program and determine if we think it has the foundation to be successful.
The Commonwealth Fund study indicates that while the U.S. excels in certain aspects of healthcare, there is still much work to be done in terms of access, efficiency, and equity. Value-based payments are a potential solution to reducing healthcare costs and improving health outcomes for consumers.
As home care costs increase and the industry faces staffing shortages that may affect quality of care, is the home care industry the next frontier for value-based payments?
The Expanded Home Health VBP model is meant to transform the home health industry. But who does the model actually provide coverage for? Keep reading to learn more about the limits of the HHVBP model and the challenges that the home health care industry is facing.
We are in Performance Year 1 of the Expanded Home Health VBP model, which is meant to transform the home health industry. Will we see an improvement in care and reduction in healthcare costs as CMS predicts?
Value-based payments are becoming increasingly popular, but should we be focusing on the money? In reality, value-based payments are keeping the focus on quality of care, by incentivizing providers.
IDD Managed Care plans are constantly changing, growing and expanding. We take a look at what is working and who had to go back to the drawing board. Additionally, we dive into Oklahoma’s new program.
We are launching 2023 off by taking a look at what our readers loved in 2022. Check out the top 3 blogs from 2022 as well as what we have in store for 2023!
As we wrap up 2022, the VBP Blog is walking down memory lane and recapping the CalAIM blog series. Whether you missed them the first time, or want a refresher, keep reading for more!
Physical health problems significantly increase our risk of developing behavioral health problems and vice versa. That is why integrated care plans that provide whole-person care are necessary to achieve optimal health outcomes.
All across America, the Child and Adolescent Needs and Strengths (CANS) assessment is gaining major traction. As the CANS becomes increasingly popular at a rapid pace, it’s important to reflect upon how the implementation is impacting communities and the prospects it may serve for Value-Based Purchasing (VPB).
In this blog, we are looking at lessons learned from CalAIM, specifically how shared savings/shared risk models can improve the quality of care and lower healthcare costs by providing the right incentives
CalAIM fully integrates physical health, behavioral health, and oral health under one contracted managed care plan. How can this be replicated and beneficial to other states?
The Iowa HHS issued a notice of intent to award Medicaid MCO contracts to Molina Healthcare and Amerigroup Iowa Inc. for managed care services for Medicaid members in Iowa. But what makes round two of Iowa’s MCO rollout any different than its failed first attempt?
This new optional Medicaid health home benefit helps state Medicaid programs provide Medicaid-eligible children who have medically complex conditions with person-centered care management, care coordination, and patient and family support
CalAIM launched in January 2022 and in this blog, we will take a look at the Community Supports offering, its impact to date, and best practices for enhancing the value to beneficiaries.
CalAIM launched in January 2022 and in this blog, we will take a look at the slow initial rollout of the Community Supports and how it is impacting individuals in need of service.
As part of Ohio Medicaid’s effort to launch the next generation of Medicaid, ODM has launched OhioRISE (Resilience through Integrated Systems and Excellence), a specialized managed care program for youth with complex behavioral health and multisystem needs.
CMS recently released the Fifth Annual Report evaluating the Home Health Value-Based
Purchasing (HHVBP) Model. Key findings show participating providers performed 7% better in 2020 than non-participating providers
The Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler said that a future requirement for participating in a value-based payment model will be to create a health equity plan
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.
MS announced a redesigned Accountable Care Organization (ACO) model that better reflects the agency’s vision of creating a health system that achieves equitable outcomes through high quality, affordable, person-centered care
In this blog, we will look at some of the recent partnerships that have sprung up in the healthcare world and how these partnerships are helping to improve health outcomes.
Social determinants of health impact health outcomes. In this blog, we will take a deeper look at how federal funds are being used to encourage incorporation of social determinants of health into care plans.
Social determinants of health have a large impact on health outcomes. In this blog, we will take a deeper look at recent advancements and how states are shifting their thought processes to include social determinants of health
The California Department of Health Care Services (DHCS) released Request for Proposal, for the Medi-Cal Managed Care Plans (MCP) procurement, but some deals have already been worked out.
CalAIM focuses on whole-person care and integrating social services through Enhanced Care Management and Community Supports
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.
What are value-based payments and what are the new VBP developments? Keep reading for an update on value-based payments to start the New Year
Throughout our Healthcare at Home blog series, we took a deep dive into the transformative healthcare industry shift of utilizing the home as a healthcare hub
As the healthcare at home industry grows, it gives the industry a unique opportunity to explore social determinants of health and incorporate them into care to improve services and patient outcomes
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
As healthcare at home and hospital at home programs ramp up, many companies are trying to get into the mix
Hospital at home programs that enable patients to receive acute care at home have proven effective in reducing complications while cutting the cost of care
Innovations in health care technology like remote monitoring, telecommunication, and care delivery technologies have been developed in recent years and make delivering healthcare at home possible.
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
The political landscape and CMS policies are shifting to support the transition of healthcare at home.
The political landscape and CMS policies are shifting to support the transition of healthcare at home.
Summers can be busy, so we put together a quick synopsis of the last 8 blogs for you to get fully updated
COVID-19 made home health for more than the elderly. The shift towards making the home a healthcare hub is supported by policies and improved health outcomes
An integrated approach to managed care in Delaware is creating true value-based care systems for the state’s LTSS communities
The ADA was the world’s first comprehensive declaration of equality for people with disabilities. However, in the wake of COVID-19, the evidence shows there is still work to be done.
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.
The Tennessee advocates worked with consumers, families, peers, and legislators to create an increase for direct care workers.
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.
New Blog Series Launch: Looking at 25 states’ MLTSS managed care programs from an advocate-centered point of view
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?
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
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!
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
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
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
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
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
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
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
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 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
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?
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 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!
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
Deep dives into six states’ working managed care programs found some that achieved great success and others that stumbled right out of the gate.
This week’s blog will break down the Arkansas and Wisconsin I/DD managed care programs.
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
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
Continuing the conversation about the measures used in the evaluation of I/DD Services in a managed care environment
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
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
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
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
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
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
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
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
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
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
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?
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
A legal battle unfolds in Florida as ImagineCare LLC sues to prevent the state’s health agency from advancing with new Medicaid managed-care contracts, citing potential harm to enrollees and ongoing bid protests.
A recent survey shows increasing acceptance among Americans for hospital-at-home care, highlighting its perceived effectiveness, safety, and the willingness of individuals to undertake caregiving tasks.
Explore the latest insights from a report detailing how states leverage Section 1115 Medicaid demonstration projects to improve health outcomes for pregnant women, postpartum individuals, and young children by addressing crucial social needs.
In a significant financial boost, CalOptima Health in Orange, California, has announced a $526 million rate increase for its healthcare providers, enhancing service accessibility and economic stability across its network.
Explore why at-home care costs for the elderly have soared to new heights, driven by increased labor costs and a growing elderly population, and what this means for families and the healthcare system.
In a policy shift, the New Mexico Human Services Department is increasing requirements on managed care organizations to address gaps in behavioral health care access, setting more rigorous standards for service provision.