1. Value Based Payments ARE in Your Future
October 2, 2018

2. RCPA - VBP ARE in Your Future
Agenda
What Brings Us Here
Who is XtraGlobex
What is the Value Based Payment Continuum
What is VBR in Pennsylvania – HeathChoices, Behavioral Health
Where is the Future – MLTSS, I/DD
How to Prepare
10/2/2018
RCPA - VBP ARE in Your Future

3. RCPA - VBP ARE in Your Future
Managed Care is established in over 23 states
Managed Care Implemented in Physical Health, Behavioral Health, LTSS and I/DD
PA Managed Care has Value Based Payments in Physical Health and Behavioral Health
PA MLTSS Roll Out is Underway
PA I/DD Managed Care Discussions Are On-Going
What Brings Us Here
10/2/2018
RCPA - VBP ARE in Your Future

4. Creating Your Exceptional and Sustainable Competitive Advantage
6/6/2017
Creating Your Exceptional and Sustainable Competitive Advantage
XtraGlobex is a consulting firm that provides strategy, analytics and communications services to organizations specializing in healthcare, community-based and professional organizations serving the Medicare and Medicaid populations and Long Term Services and Supports. We work with our clients to create exceptional and sustainable competitive advantage, turning existing challenges into positive solutions and future hurdles into launchpads for growth.
XtraGlobex is a certified WBE and DBE
1700 Market Street, Suite 1005, Philadelphia, PA 19103n n

5. What Are Value Based Payments
NOT Payment for Volume
Payment for Value
NOT Payment for Units / Quantity
Payment for Quality
NOT Payment for Activity
Payment for Outcomes
10/2/2018
RCPA - VBP ARE in Your Future

6. The Transition From Pay-For-Volume to Pay-For-Value
About 40% of commercial health plan reimbursements to provider organizations linked to value-oriented initiatives; compared to 11% in 2013
Encourages the use of new treatment technologies and tech-enabled platforms for service delivery
Fee-For-Service
Case Rates & Bundled Payments
Capitation & Population Payments
Pay-For-Performance (P4P)

7. Business Model Transition For Provider Organizations
6/6/2017
Business Model Transition For Provider Organizations
Payer Policy Pay-For-Cost/Volume
Payer Policy Pay-For-Value
Business Model: What is paid for is good for the consumer and is doing more
Business Model: Giving the consumer (and their payer) good outcomes at a low cost, conveniently
A Revolution In Performance Management Required
1 – Requires a focus on outcomes
2 - Requires focus on how to engage consumers in services to driver better satisfaction and outcomes
June 6, 2017
XtraGlobex Consumer Engagement

8. RCPA - VBP ARE in Your Future
The VBP Continuum
Payment for Process / Alternative Payment 01
Payment for Performance 02
Bundled Payments 03
Payment for Outcomes 04
Shared Risk 05
10/2/2018
RCPA - VBP ARE in Your Future

9. Pay For Process / Alternative Payments
Recognizing the Payer’s Most Desired Process
Processes as a way of providing the service
Processes as repetitive and predictable
Processes are trackable and reported
Processes can be monitored and improved
Payments for Uniquely Credentialed Staff / Organizations
Individuals / leadership
Organizations
10/2/2018
RCPA - VBP ARE in Your Future

10. Pay For Performance Performance Standards Desired By the Payer
Achievement of Process Measures – e.g. Time for Completing Activity / Frequency of Reporting
Consistency in Providing Services – Length of Time in Waiting Room / Shifts Filled
Quality of Communications
Indicators of Efficiency
Utilization vs Authorization Rates
Staff Turn over ratio
Accuracy of Billing
10/2/2018
RCPA - VBP ARE in Your Future

11. RCPA - VBP ARE in Your Future
Doctor Visit Example
Family Services in Behavioral Health
A combination of PAS and Skilled Nursing after ED Event
Traditionally – focused on episodic / sub-capitation
A collection of Related Services Delivered Together
Bundles within Single Provider Contracts
Bundles with Network of Providers
Usually based on Fee For Service Structure
Discrete and Trackable
Bundled Payments
10/2/2018
RCPA - VBP ARE in Your Future

12. Pay For Outcomes Results Focused – Payment Based on Payer Objectives
Usually structured as withhold / bonus payout
Involves a level of Risk
Outcomes have to be very specific and controllable!
Cannot get credit for what you do not do or control!
Involves a Level of Risk that should be based on data!
10/2/2018
RCPA - VBP ARE in Your Future

13. Shared Risk Models Payers WITHOLD A PORTION OF PAYMENT with an UPSIDE
Based on DELIVERY and COST!
Providers Share in the POTENTIAL SAVINGS!
Delayed Payments / Bonuses
Rigid Standards for Benefits
Detailed!
10/2/2018
RCPA - VBP ARE in Your Future

14. VBR in Pennsylvania / Well Established in Health Choices
Rolling Out in Behavioral Health Choices – Moving To Higher Levels of Risk Sharing – Network Management Opportunities
VBR / Alternative Payments USED by all 3 CHC MCO’s
Employment Services
Nursing Home Transition Services
Transportation
Service Coordination
Managed Care in I/DD
VBR in Pennsylvania
10/2/2018
RCPA - VBP ARE in Your Future

15. Community HealthChoices Update
Rolled out on January 1, 2018 in 14 SW PA Counties – 80,000+ Participants, 16,000+ Community
Scheduled on January 1, 2019 in 5 SE PA Counties – 130,000 Participants, 40,000 Community
Challenges:
Consumers Receiving Services – Minimal interruptions
Providers Getting Paid – Improving
Service Coordination Systems and Authorization
Changing Role of Service Coordinators
Ancillary Services and Transportation
10/2/2018
RCPA - VBP ARE in Your Future

16. Customer Satisfaction & Consumer Experience Monitoring
Focus:
Assess ability to obtain frequent consumer feedback through easy, non-obtrusive methods
Key Competencies for Success
Survey tools and processes for obtaining consumer feedback on the consumer experience including:
Access to care
Facilities
Interactions with staff
Effectiveness of treatment
Net promoter score (consumer willingness to refer other for treatment)
June 6, 2017
XtraGlobex Consumer Engagement

17. Clinical Outcomes Tracking – By Consumer Type & Provider Organizations
Focus:
Ability to track and analyze outcomes, identify options to improve services, and quickly change processes
Key Competencies for Success
Systems in place to measure clinical quality of care, patient experience and service cost measures
Transparent process to publicly report outcomes
Collaborative efforts to identify performance improvement initiatives
June 6, 2017
XtraGlobex Consumer Engagement

18. NQF National Core Indicators – Aging &Disabilities
❖ Community participation ❖ Choice and Decision Making ❖ Relationships ❖ Satisfaction ❖ Service Coordination ❖ Care Coordination ❖ Work ❖ Self-Direction ❖ Access Health Care ❖ Medications ❖ Wellness ❖ Rights and Respect ❖ Safety ❖ Everyday Living ❖ Affordability ❖ Future Planning ❖ Control

19. RCPA - VBP ARE in Your Future
Getting Ready for VBP
Understanding
Processes
Infrastructure
Costs
Quality Measurement and Improvement
Leadership
10/2/2018
RCPA - VBP ARE in Your Future

20. Understanding Your Processes
Define Key Processes in Your Operations 1
Process Mapping 2
Accountability 3
Process Streamlining 4
Process Improvement 5
October 2017
XtraGlobex VBP Readiness

21. Understanding Your Infrastructure
Physical Infrastructure 1
Technology Infrastructure 2
People Infrastructure 3
October 2017
XtraGlobex VBP Readiness

22. Understanding Your Costs
Beyond accounting
Aligning Processes and Costs
Structural Costs
Capital Costs
Operational Costs
Accountability for Costs
October 2017
XtraGlobex VBP Readiness

23. Getting Ready Know Know Your Market Know Your Consumer
Know Your Priorities / Strategic Direction
Know Your Operations / Measures
Know Your Quality / Measures
Know Your Costs / Financial Position / Measures
Know Your Leadership / Measures
Know Your People / Measures
10/2/2018
RCPA - VBP ARE in Your Future

24. RCPA - VBP ARE in Your Future
Onward!
1700 Market St, STE 1005, Philadelphia, PA 19103
(856)
10/2/2018
RCPA - VBP ARE in Your Future