1. Population Health Management and Value Based Payment Models
The Virginia CHC Leadership Institute
February 10, 2016 Session
Population Health Management and Value Based Payment Models
The Virginia CHC Leadership Institute
February 10, 2016
Population Health Management and Value Based Payment Models

2. Disclosures
We have no actual or potential conflict of interest in relation to this program/presentation.

3. Introduction

4. The CHC Value Challenge
Virginia community health centers (CHCs) are being challenged to demonstrate their value to multiple audiences, including patients, partners, plans, purchasers, and policymakers.

5. The Virginia CHC Value Model
The Virginia Community Healthcare Association created the Virginia CHC Value Model to help CHCs define and communicate their value to key stakeholders. Virginia CHCs deliver value by:
Addressing Local Health Needs;
Providing Access to Vital Services;
Keeping Patients and Families First;
Delivering High Quality Health Care;
Controlling Health Care Costs;
Supporting Community and Economic Development; and
Innovating for Excellence.

6. An Emerging Value Strategy
Health care purchasers are adopting value-based payment models to reward population health management.
Virginia CHCs can prepare by strengthening their capabilities to:
Implement practical models of population health management for specific populations.
Demonstrate results to optimize value based payment.

7. Learning Objective
The primary learning objective of this session is to help participants understand the implications of population health management and value-based payment models for patient care, clinical leadership, and organizational strategy.

8. Format for this Session
Two Segments:
Population Health Management
Value-Based Payment Models
Format for Each Segment
Overview Presentation
Panelist Insights
Audience Questions and Insights

9. Presenters & Panelists
The Virginia CHC Leadership Institute
February 10, 2016 Session
Presenters & Panelists
Presenters:
Caitlin Feller and Stephen Horan, Community Health Solutions
Panelists
Dr. Torino Jennings, Medical Director, Capital Area Health Network
Sheryl Garland, Director, VCU Office of Health Innovation
Tony Herbert, Vice President, Managed Care Virginia, Bon Secours Health System
Population Health Management and Value Based Payment Models

10. Part 1 Population Health Management

11. Background
‘Population health management’ is receiving increasing attention as a clinical strategy in response to purchaser demands for value.
Medicare
Medicaid
Veterans Health
Employer Plans
Exchange Plans
Health Grantmakers
Providers need a practical model of population health management they can apply for defined populations.

12. The Practical PHM Model
Practical PHM is a framework for designing population health management programs.
Can be applied for any population.
Can be used to design a new initiative or strengthen an existing program.
More evolutionary than revolutionary:
Aligned with PCMH and other popular models.
Distinctive for its emphasis on total care for defined populations.

13. The Practical PHM Model
Defining population health management
The field has not adopted a single, standard definition of population health management.
In the Practical PHM Model: Population health management can be defined as the daily practice of improving health and health care relative to cost for defined populations.

14. The Practical PHM Model
Practical PHM provides a seven step model for optimizing health and health care relative to cost for defined populations.
Identify the Population
Assess Health Risks
Define Care Needs
Optimize the Care Model
Collaborate for Impact
Assure Quality
Demonstrate Value

15. Step 1. Identify the Population
Who is the defined population we want to serve?
What are the population characteristics in terms of payer as well as relevant demographic and health indicators?
Can we identify population members we are already serving?
How can we identify the next population member who comes to us for care?

16. Step 2. Assess Health Risks
What do we know about the health risks of the population we want to serve? Think broadly in terms of:
Health status
Health behaviors
Health knowledge, motivation, and skills
Social supports
Financial capacity
Access to health services
Access to supportive community services
Other environmental factors (home safety, transportation, etc.)

17. Step 3. Define Care Needs
What health goals do we want to help our population achieve?
Think about access, quality, experience, utilization, self- management, outcomes and costs.
What services and supports do our population members need to help them achieve their health goals?
Clinical care?
Community supports?
Care coordination?
Other?
Don’t leave anything out at this stage of discussion!

18. Step 4. Optimize the Care Model
What essential services and supports do our population members receive right now?
What are the assets or strengths we can build on?
What are the gaps in services and supports that really need to be addressed?
How do these services match up with the strategic direction for our organization?
What do we know about ‘what works’ from our own experience and from promising programs in other places?
How could we optimize the care model if we had the right partners?
Document the optimal care model.
Identify potential partners who are not already at the table.

19. Step 5. Collaborate for Impact
The key to collaboration is that everyone involved has to win in some fashion.
Who are the partners?
What is the value proposition for each partner?
What are the responsibilities of each partner?
What are the key performance indicators for each partner and the project overall?
What is the working structure and process for the partnership?
How can everyone win including population members and partners?

20. Step 6. Assure Quality
One challenge in population health management is that quality has to be assured for the defined population across service settings.
What are the quality objectives for each partner and the project overall?
What are the essential quality measures and how will they be produced and reported?
How will any observed quality deficits be addressed?

21. Step 7. Demonstrate Value
How will we define and demonstrate value?
The definition of value may vary across key stakeholders (patients, partners, payers, purchasers, funders).
A starting point:
Are we demonstrating better health and health care relative to cost for the defined population?
Can we customize this conceptual definition of “value” for particular stakeholders?

22. Discussion
What are the implications of population health management for:
Patient care?
Clinical leadership?
Organizational strategy?

23. Part 2 Value-Based Payment Models

24. Defining Value Based Payment
Value-Based Payment (VBP) is a strategy used by purchasers to promote quality and value of health care services. (Health Care Incentives Institute)
The goal is to improve health and health care while reducing costs of care.
The strategy is to shift from pure volume-based payment to payments that are more closely related to outcomes.
The tactics are to:
Structure payments in ways that incentivize desired results.
Use data to measure and reward (or penalize) performance.

25. Testing Value-Based Payment
Most purchasers and payers are now exploring or testing value-based payment.
Medicare
Medicaid
Veterans Health
Employer Plans
Exchange Plans
Health Grantmakers
Explore the Catalyst for Payment Reform website for an in-depth look at VBP evolution (not completely accurate but illustrates the scope)

26. What Purchasers Want Data on defined populations showing:
Timely clinical preventive services
Evidence-based care management
Good clinical quality measures
Low rates of ED utilization
Low rates of preventable hospitalization
Low rates of readmission
Low rates of medication error
Low rates of questionable services (Choosing Wisely)
Evidence of positive patient experience
Lower costs relative to trend for the population

27. Models of Value Based Payment
A Growing Array of Models
Bonus Payment
Bundled Payment
Capitation (full, partial, condition-specific)
Episode-Based Payment
Fee for Service with Performance Reporting
Prospective Payment
Pay for Performance
Shared Savings
Blended Payment (some combination of above)
Learn more from Catalyst for Payment Reform

28. Using PHM to Optimize VBP
Who are our patient populations in VBP models?
What are the value expectations of the VBP model?
What is the payment structure of the VBP model?
How can we optimize our PHM model to meet the value expectations?

29. Discussion
What are the implications of population health management and value-based payment for:
Patient care?
Clinical leadership?
Organizational strategy?

30. A Summary Framework for Action
Help defined groups of patients improve their health and health care relative to cost…
By applying practical PHM…
In response to VBP models from…
Optimize their health
Obtain need services
Avoid hospitalization
Avoid medical errors
Avoid unnecessary services
Have a positive care experience
1. Identify the Population
2. Assess Health Risks
3. Define Care Needs
4. Optimize the Care Model
5. Collaborate for Impact
6. Assure Quality
7. Demonstrate Value
Medicaid
Medicare
Veterans Health
Employer Plans
Exchange Plans
Uninsured Programs

31. Presenter Contacts Stephen Horan, PhD Caitlin Feller, MPP, PCMH CCE
President, Community Health Solutions
Caitlin Feller, MPP, PCMH CCE
Principal, Community Health Solutions