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Digging Into the Arizona Behavioral Health Payment Reform Self-Help Toolkit Dale Jarvis, CPA www.djconsult.net
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The Arizona Toolkit 2 http://azpaymentreform.weebly.com/
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Two Discussion Topics The Arizona AHCCCS Value-Based Purchasing Design Organizing for Payment Reform within Your Organization 4
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5 30% Waste
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“Shocking News” Medicare Payment Reform is Working – 54 Medicare ACOs: $254 Million Savings in FIRST YEAR – 23 Pioneer ACOs: $147 Million Savings in FIRST YEAR – Physician Group Practice Demonstration: $108 Million Savings over the 5 Year Program 6
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“More Shocking News” January 2015 Announcement – Moving 50% of all Fee for Service Medicare Payments into Alternative Payment Models (not Fee for Service) by 2018 – Moving 90% of all Fee for Service Medicare Payments into APMs or Fee for Services Plus Pay for Performance by 2018 7
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Arizona is on the Heels of CMS Arizona AHCCCS: Medicaid Contractors must implement Value Based Purchasing for the year beginning 10/1/2015 – 15% of Long Term Care System Elderly and Physical Disability Program Payments – 20% of Children’s Rehabilitative Services – 20% of Acute Care Services – 5%(20%)(?%) of RBHA-Behavioral Health Services With a plan to increase the percentages each year. 8
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The Arizona AHCCCS Value- Based Purchasing Design 9
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Value-Based Purchasing Defined Payors hold Providers Accountable for both the Cost and Quality of Care Using Strategies to Reward Providers for: – Reducing Inappropriate Care and – Providing High Value Care that is Patient Centered, Clinically Effective, and Cost Effective – That can result in Bending the Cost Curve And sometimes using Strategies to put Providers at Risk if the above isn’t accomplished 10
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High Value Care Defined 11 Achieves individual and systemwide outcomes Costs less than alternatives with comparable outcomes Accessible care provided by staff that communicate well..
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What to Measure? Survey of 7 Federal Quality Programs 250 Quality Measures relevant to individuals with BH Disorders 12
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AHCCCS Acute Care P4P Measures 13
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AHCCCS Acute Care P4P Measures 14
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AZ VBP At-A-Glance 15
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Deconstructing the AZ VBP Menu 16
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Deconstructing AZ VBP – Blue Boxes Most of the Payment will not be value-based – (typically some version of Fee for Service) Plus a Pay for Performance (P4P)(Bonus) Layer if the provider meets certain quality and/or cost targets – Primary Care Incentives for Primary Care Providers – Performance-Based Contracts for Other Providers 17
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Deconstructing AZ VBP – Green Boxes Dump Fee for Service and Block Payment Replace with a Case Rate – Payment of a flat fee per patient for a predefined episode at a specific level of care – Regardless of how many services and how much money was spent – May involve service providers from multiple organizations Should also include a P4P Layer 18
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Deconstructing AZ VBP – Red Boxes Capitation Definition: – An agreed upon payment from the Health Plan to a Provider Organization, including Accountable Care Organizations – Paid in the form of a Per Member Per Month (PMPM) for each enrollee who is assigned to the Provider Organization/ACO – In return for the PMPM, the Provider/ACO will assure timely access to a predefined set of health benefits and quality agreements, – And the payment flows regardless of whether an individual uses services or not 19
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Deconstructing AZ VBP – Red Boxes Capitation Definition + Performance-Based Contracts: AHCCCS says you can’t pay Capitation without a P4P Layer Shared Savings: Use of a tracking system to determine whether your care reduced costs; if so, you get a share Shared Risk: You get to share in the Savings and any Losses. 20
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One Size Does Not Fit All 21
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Organizing for Payment Reform within Your Organization 22
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One Plan, Two Levels of Work 26
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National BH Performance Measurement Individual Outcomes System Outcomes 28
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Individual Outcomes University of Washington AIMS Center 29
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Treatment to Target 30
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Portland Oregon’s T2T Project 31
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Value-Based Purchasing Design 32
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Two Value-Based Purchasing Elements 33
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One Size Does NOT Fit All 38
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Pay for Performance 39
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What’s Next Give us Feedback! 45
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What’s Next RBHA Value-Based Purchasing Plans coming soon. Additions to the Toolkit based on the VBP Plans. RBHA-Specific VBP Provider Success Checklists RBHA-Specific VBP Provider Success Content A set of webinars on the above material 46
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What Else? 47
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