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Updating Value-Based Payments Basics and New Developments

Value-based payments continue to progress and we are excited to see even more developments in 2022

THE VBP Blog

Happy New Year! We hope that 2022 will be a happy, healthy, and successful year for you and yours. To start the New Year, it’s time to get back to the fundamentals. For us, that means going back to the beginning and taking a deep dive into the basics of value-based payments and the recent developments that we have seen.

There are many promising signs for value-based payments, including increasing acceptance and implementation of VPB Models for LTSS, BH, and IDD. Florida, Texas, and Arizona are among some of the leaders in this arena and we will dive into the details of those programs later on.

What Are Value-Based Payments – A Quick Review

One positive thing to see is that there has been increasing acceptance and implementation of VBP models in the long-term services and supports (LTSS), behavioral health (BH), and Intellectual and Developmental Disabilities (IDD) arena.

Florida stands out as a state that is leading the way in regard to value-based payment programs for LTSS. As we covered in a recent blog, Florida’s Medicaid program has shifted over time and the state has made great strides. In 2013, Florida launched the Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC), which was designed as a nursing home diversion program. In 2018, they awarded contracts to MCOs to provide MMA and LTC to participants in the state, with an increased prioritization on home and community-based services (HCBS).

Recently in June 2021, top healthcare leaders in the state gathered at the 2021 Florida State of Reform Health Policy Conference to lay out a path forward for value-based care systems in the state. One of the participants, in addressing the move to value-based care, stressed the importance of incentivizing the incorporation of social determinants of health into payment models to improve long-term population health.

Texas’s Value-Based Payment Roadmap Highlights Importance of Behavioral Health

Texas is another state that is doing great things in the VBP arena, especially in regards to behavioral health. In March 2021, the Texas Health and Human Services Commission released its Value-Based Payment Roadmap. Among others, one of the broad goals of the plan is promoting effective practices for people with chronic, complex, and serious conditions to improve people’s quality of life and independence. Another goal revolves around attracting and retaining high-performing Medicaid providers, including medical, behavioral health, and long-term services and supports providers.

Where Texas truly stands out though, are recent gains in the behavioral health space. According to the National Committee for Quality Assurance (NCQA), evidence shows that quality measurement for behavioral healthcare lags behind physical health measures and shows less improvement over time. Texas saw this as an opportunity to improve and implement the Certified Community Behavioral Health Clinic (CCBHC) model. 

The state participated in the Substance Abuse and Mental Health Services Administration Certified Community Behavioral Health Clinic (SAMHSA CCBHC) planning grant in October 2015. This allowed Texas to partner with MCOs, providers, and other key stakeholders to certify clinics and develop a unique and integrated service delivery framework. While the state was not selected as a national demonstration site in phase 2 of SAMHSA’s CCBHC initiative, that did not deter Texas. 

Identified as a goal in the HHS Business Plan: Blueprint for a Healthy Texas, in Fiscal Year 2020, HHS began increasing the number of CCBHCs statewide to expand capacity for community-based behavioral health services and enhance behavioral health care outcomes.

Arizona Sets an Example with Value-Based Payments for the IDD Community

For the IDD community, Arizona sets a good example. The Arizona Long Term Care System (ALTCS) provides LTSS to eligible individuals at little or no cost, to financially and medically eligible Arizona residents who are aged, blind, disabled, or have a developmental disability.

Through ALTCS, those eligible can receive services including behavioral health, day treatment, home health aide, home health nurse, home modifications, homemaker, therapy, and non-emergency transportation among others. Of note, is that Arizona’s developmental disabilities service system focuses very strongly on HCBS to keep individuals living independently. According to the Medicaid Long Term Services and Supports Annual Expenditures Report released in 2021, over 75% of all Medicaid LTSS dollars were delivered in Home and Community-Based Settings. This ranks Arizona 4th highest in the country behind Oregon, Minnesota, and New Mexico. 

Advocates Perspective

At XtraGlobex, we believe in value-based payments and the benefits that they can provide consumers if implemented properly. It is clear through the programs in Florida, Texas, and Arizona that strides have been made when it comes to implementing VBP programs for LTSS, BH, and IDD to ensure that quality and low-cost care are available to all. We want VBP trends to continue as long as they support consumers’ access to services and improve the quality of those services.  Whole person care is critical and we will monitor the trends towards integrated care carefully, to assure consumer access and protection. Stay tuned for more updates on recent developments in the value-based payments arena.

Onward!

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About the Author

Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).

His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.

mandy sahhar

About the Co-Author

Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.