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value based care

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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

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

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

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

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