Ann Christian, MSW Washington Council for Behavioral Health

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

2. P-TCPi Behavioral Health ChampionsJanuary 18, 2019 Ann Christian, MSWWashington Council for Behavioral Health

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

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

22. 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. MILESTONE #8: Coordination with Primary Care

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

24. Milestones Showing Most Improvement Throughout Project

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? • Yourvalue 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) 628-4608, ext. 14 achristian@thewashingtoncouncil.org