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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

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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

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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