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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

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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

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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

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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

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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

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

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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