1. The Value Transformation Assessment Are We on the Right Path to Value-Based Care and Payment?

2. Ann Christian, MSW Washington Council for Behavioral Health
P-TCPi Behavioral Health Champions January 18, 2019

4. To achieve the goals of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume.
APM Framework, HCP-LAN

5. Such alignment requires a fundamental change in how health care is organized and delivered, and requires the participation of the entire health care ecosystem.
APM Framework, HCP-LAN

6. We all know we need to transform, reform, redesign, innovate, and continuously improve.
But how do we know if
we’re on the right
path??

7. Today’s Objectives
Quickly refresh the basics of value-based care and payment (VBC/P)
Introduce you to the Value Transformation Assessment and how to use it
Point you to other resources to support internal VBC/P readiness

8. The Basics: Why all this Focus on VBC/P?
State and federal policy direction
Better care for patients via data-informed care
Demonstrate value to payers, community, legislators, staff, board, private donors, and funders

9. The Basics: Value-Based Care vs. Payment
Value-Based Care = the service delivery component of value-based payment
From a VBP Practice Transformation Academy participant:
Success would be achieved if, by the end of the project, agency staff understood the value-based model and how their care could positively impact revenue
We took the approach that understanding value-based care and imparting the idea that individual providers can impact improved patient care as well as improved reimbursement was far more important than the actual goal of the stretch project

10. The Basics: Value-Based Care vs. Payment
Need Charles to help copy National Council slide 4 here.

11. The Basics: Alternative Payment Models

12. Unique Value of Behavioral Health Agencies in VBP Arrangements
Population served by BHAs—people with serious mental health and/or addiction disorders—is a complex, high-risk, high-cost sub-population requiring specialty care
Americans with serious mental illnesses die 15 to 30 years earlier than those without; see The Largest Health Disparity We Don't Talk About
The 5/50 population (5% of the population with highest health costs responsible for ≈ 50% of total health costs)
The 1/20 population (1% of the population responsible for 20% of health expenditures)

13. Unique Value of Behavioral Health Agencies in VBP Arrangements
Medicare-Medicaid Duals Population: nearly 50% of dual eligible adults aged 18 to 64 were identified as having a mental illness or substance use disorder
Total spending per person for individuals with a behavioral health diagnosis is nearly four times higher than for those without
Small numbers but large impact on health care spend

14. One More Thing about Behavioral Health and VBP
When talking about value-based payment, there is frequent reference to a needed shift ‘from volume to value.’ For BH providers, the reality is more nuanced.
As we think about value-based payment in an integrated delivery system, if anything, we need more access to behavioral health care throughout the health care system.
In successful integrated care models—those that both improve health outcomes and reduce overall health costs—savings most often occur by reducing the need for frequent, expensive physical health ER visits and hospitalizations.

15. VBP Core Competencies

16. The Value Transformation Assessment (VTA): What is It?
A self-administered assessment of organizational preparedness for VBP arrangements
Evaluates progress through the five phases of transformation
A way to focus internal attention and readiness activities in a purchasing environment that still lacks clarity about VBP mechanisms
A platform from which the organization can respond to specifics as they emerge

17. The VTA: How it was Developed
Based on core competencies for VBP contracting
Hybrid of two existing assessment tools already vetted and in use in Washington
Specialty Practice Assessment Tool (PAT)
MeHAF
Milestones selected to emphasize VBP competencies
Crosswalk matrix demonstrates overlap

18. Competencies for Value-Based Payment Contracts PAT-Specialty Milestone
Competencies for Value-Based Payment Contracts
MeHAF Characteris tic
PAT-Specialty Milestone
Comments
Patient and Family-Centered Care Design
1.1 Patient & family engagement
I.5, I.6
4, 5
Consistency with Hub
1.2 Team-based relationships
II.2 6
PAT includes reference to outcomes & accountability
1.3 Population management
I.11 7
1.4 Practice as a community partner
I.9
9, 10
PAT measures written from perspective of BH provider
1.5 Coordinated care delivery
II.4, II.5
1.6 Organized, evidence-based care
I.4 11
1.7 Enhanced access
I.12 12
MeHAF measure (I.12) is primary-care focused
Continuous, Data-Driven Quality Improvement
2.1 Engaged and committed leadership 13
No MeHAF option
2.2 QI strategy supporting a culture of quality and safety
1, 14, 15
2.3 Transparent measurement and monitoring 16
2.4 Optimal use of HIT
II.6 17
Sustainable Business Operations
3.1 Strategic use of practice revenue
II.9 18
3.2 Staff vitality and joy in work 19
3.3 Capability to analyze and document value
20, 21
3.4 Efficiency of operation 22
Note: Items in red were selected for hybrid tool

19. The VTA: How We Used It
Administered three times over course of VBP Academy (approximately 10-month period)
Reviewed and shared results with learning community
Reflected significant progress over course of the Academy

20. Results: Overall VTA Movement

21. MILESTONE #6: Risk Stratification
Tracking of vulnerable patient groups that require additional monitoring and intervention

22. MILESTONE #8: Coordination with Primary Care
Practice works with the primary care practices in its medical neighborhood to develop criteria for referrals for episodic care, co-management, and transfer of care/return to primary care, processes for care transition, including communication with patients and family.

23. MILESTONE #18: VBP Readiness
Practice considers itself ready for migrating into an alternative based payment arrangement.

24. Milestones Showing Most Improvement Throughout Project
% Improvement from Baseline
Milestone
26.63%
Milestone 12 - Practice uses an organized approach (e.g. use of PDSAs, Model for Improvement, Lean, FMEA, Six Sigma) to identify and act on improvement opportunities.
26.54%
Milestone 11 - Practice has developed a vision and plan for transformation that includes specific clinical outcomes and utilization aims that are aligned with national TCPI aims and that are shared broadly with the practice.
22.31%
Milestone 18 - Practice considers itself ready for migrating into an alternative based payment arrangement.
20.72%
Milestone 10 - Practice has a system in place for patient to access their care team 24/7.

25. Using the VTA as an Internal Readiness Tool
Can be easily self-administered to establish baseline status
Repeat approximately quarterly
Use results to target internal training, technical assistance, and quality improvement

26. Other Resources to Support Value-Based Payment Readiness

27. Value-Based Payment Practice Transformation Planning Guide
A multi-year strategic planning guide to assist your organization in pacing the needed changes, gaining buy-in, and building needed infrastructure
Provides support in the areas of:
Mobilizing personnel needed to guide and support practice transformation;
Identifying key performance measures, establishing baselines, and collecting data to track progress over time; and
Creating a work plan to set aims, benchmark progress, sustain change, and demonstrate value to payers.
Developed by the National Council for Behavioral Health, the Washington Council & Qualis Health

28. VBP Preparation Workbook: Defining a Strategy for Value-Based Contracting
A hands-on tool with examples, resources, and exercises to support transformation
Created by Qualis Health in partnership with the National Council and Washington Council

29. An Organizational (or Program) Value Proposition
What is a Value Proposition?
A positioning statement that explains what benefit you provide, who benefits, and how you do it uniquely well
It describes your target buyer, the problem you solve and why you are distinctly better than the alternative
Should show relevancy, quantified value and unique differentiation

30. An Organizational (or Program) Value Proposition
How does this solve a problem for your payer?
Your value proposition should be in the language of your payer
Assess your payer’s pain points
Research instances where your target payer organization has implemented value-based contracts in the past
Consider policy context including fully integrated managed care, Healthier Washington Medicaid Transformation, and value-based payment goals

31. An Organizational (or Program) Value Proposition
Value Proposition Template
For (target customers)
Who are dissatisfied with (the current alternative)
Our service is a (new model)
That provides a (key problem-solving capability)
Unlike (the current alternatives)

32. Questions?

33. Contact Information
Ann Christian
Washington Council for Behavioral Health
(206) , ext. 14