1. Vermont Mental Health Payment Reform

2. 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

3. 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

4. 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

5. 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

6. Why are we meeting? Communication is important!

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

8. 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

9. 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

10. 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

11. 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

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

13. 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.

14. 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

15. 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.