Vermont Mental Health Payment Reform

VERMONT’S QUADRUPLE AIM Assure that all Vermonters have Access to and Coverage for High Quality Care Reduce Health Care Costs and Cost Growth Assure Greater Fairness and Equity in How We Pay for Health Care Improve the Health of Vermonters

HOW DOES HEALTH CARE REFORM TRY TO CONTROL COST AND IMPROVE CARE? Integrated Care Excellent Value Excellent Outcomes Shifting /Pooling Resources Payments Based on Outcomes Efficiency

WE HAVE BEEN PREPARING… WE HAVE BEEN PREPARING…. FOR HEALTH AND PAYMENT REFORM AND DATA DRIVEN DECISION MAKING DATA QUALITY DATA REPOSITORY VCP CENTERS OF EXCELLENCE ITERATIONS OF PAYMENT REFORM PLANNING NEW EHRS STANDARDIZATION

WE BELIEVE…AND WE CAN ALWAYS IMPROVE Agencies have high quality care Agencies are efficient Agencies are meeting the needs of the people they are serving Payment reform is happening around the country We, together with the VCP agencies, have a good relationship with DMH This is our first take at this new payment methodology and we will work together to improve it overtime

Why are we meeting? Communication is important!

What are we focused on today? The big picture of health and payment reform The goals of mental health payment reform

The BIG picture of Payment Reform All-Payer ACO Model AHS Payment Reform Integration Better Health Better Care Lower Costs The BIG picture of Payment Reform

Integrated Delivery System All Payer Model AHS Payment Reform Medicare Commercial Medicaid ~A&B-type services Medicaid ~non A&B-type services ACO Delivery Model TBD Delivery Model “By the end of Performance Year 3 [CY2020], AHS, in collaboration with the GMCB, shall submit to CMS a plan to coordinate the financing and delivery of Medicaid Behavioral Health Services and Medicaid Home and Community-based Services with the All-payer Financial Target Services.” Note- Medicare A and B services are Hospital and Physician services

Why Payment Reform? Today Future Eligibility criteria driving services Billable Hours Numbers of People Data on money and time Documentation for documentation’s sake Outcomes Services driven by need and goals Case rates- more aggregated Caseload counts- more aggregated Data on money and time Documenting Progress Outcomes

Scope of Payment Reform Payment reform is not about adding new money to the system; it is about reducing barriers and increasing flexibility to meet the needs of individuals and families. Current State Multiple discreet payments supported by varying programmatic requirements, indicators & outcomes. Future State One bundled payment supported by aligned programmatic requirements, indicators & outcomes. Payment A Payment B Payment C Payment D 1 Monthly Bundled Case Rate Payment

What Does Payment Reform Mean For…. Individuals & Families Providers Agency of Human Services ALIGNED GOALS SUPPORTED BY CLEAR AND CONSISTENT MESSAGES

Goals of Payment Reform: Individuals & Families This will enable individuals & families to: Access primary and secondary prevention, including early intervention to reduce risk factors; Decide on necessary services based on a person’s unique treatment and/or support plan needs and social determinants of health, including use of home-and community-based services; and Navigate service delivery across the care continuum.

Goals of Payment Reform: Providers Current Eligibility Future Respond to Needs Current Billing & Clinical Documentation Future Move to Outcomes This does not mean that we will ever fully move away from billing and clinical documentation

Goals of Payment Reform: Agency of Human Services Build on past experiences of Integrating Family Services and Medicaid Pathway projects; Include other AHS Departments over time; Align with alternative and value based payment approaches and the All-Payer Model; and Support providers to have the flexibility they need to implement effective service delivery approaches.