How do you prepare for value-based reimbursement when you’re in a market with a payer mix that isn’t quite there yet? That was the focus of a great presentation Building A New Value Proposition: Strategy & Positioning For Sustainability, delivered by Kent Dunlap, Chief Executive Officer of Stars Behavioral Health Group at The 2018 OPEN MINDS Children’s Services Executive Summit this past August.
I thought that Mr. Dunlap’s prescription for preparing for VBR sustainability was focused on the key areas that every executive team should be looking at, regardless of their market. Mr. Dunlap explained that Stars has been in the VBR “prep mode” for a few years and their journey began by codifying the best practices needed for success in their 2016 five-year strategic plan. Their goal for the current time is developing a “culture of value.” His guardrails for preparation for a value-based environment? Better business analytics, strengthening outcome measures, and proactive selection of evidence-based practices.
The focus of their business analytics development is two-fold—systems for staff to use data to manage care at the program and individual consumers levels, and to improve performance using metrics to identify staff in need of performance development support. The Stars team developed a set of key performance indicators by tying together the data in their Ceridian (HRIS), myEvolve (EHR), and SAGE (financial) systems.
On the outcomes side of the equation, The Stars team is focusing on treat-to-target dashboards, expanding the use of collaborative documentation, and advocacy training for clients. Their approach is focused on benchmarking their clinical performance, which the Stars team is doing by comparing programs from different counties and looking at outcomes from different models. He noted that they have the ability to compare and contrast like programs from different counties, and to look at outcomes from those different models; explaining that the counties in California want to be able to differentiate between the provider organizations. This means that they have to go forward with their own approach to benchmarking that includes contextual information about when that benchmark is applicable.
The business analytics and outcomes benchmarking are key ingredients in selecting evidence-based practices. In California, Mr. Dunlap explained, there is an added challenge in that each county had a different approach that needed to be catalogued and evaluated. Stars has been evaluating 14 different EBPs—by costs, clinical staff reactions, and the outcomes for the programs.
But like most markets, the Stars executive team is struggling with the timing of the transition to value in the California behavioral health market. The current financing of public behavioral health services is largely cost-based reimbursement—and payers have a “use it or lose it” attitude toward savings and surpluses. And, looking ahead, the politics are uncertain. There are a myriad of outcome and performance measures—and the payers have little experience in value-based contracting.
Mr. Dunlap’s assessment of the California behavioral health market is not unlike other public mental health markets. Movement to value-based contracting is slow—by payers, by health plans, and by the dominant provider organizations. But I think of it as glacial. Glaciers move slowly, but they are massive forces that inexorably sculpt the face of every landscape they touch. For more, check out these resources in the OPEN MINDS Industry library:
- Preparing For Value-Based Reimbursement—Even Before The Contracts Are Signed
- Four Ps For Leading A VBR Evolution (Or Any Change)
- Pay For Value—The Glass Half Full, The Glass Half Empty?
- The Future Has Arrived For VBR
- VBR Jumping From Hospital-Centric ACOs To Community-Based Players
- Crawl, Walk, Run To VBR
- VBR & I/DD—The Wave Begins
- Value Comes To Pharmaceuticals, Devices & Digital Treatment
- The Hospital Perspective On ‘Owning’ Value-Based Reimbursement
- Building A Workforce For Value-Based Reimbursement = Advice From Four Executives
Elite members of the OPEN MINDS Circle can check out the OPEN MINDS web-based readiness self-assessment, Value-Based Reimbursement Readiness Assessment, focused on the organizational and technical competencies provider organizations need to be successful with value-based reimbursement.
And for more VBR preparedness, join us at The 2018 OPEN MINDS Technology & Innovation Institute on October 23 in Philadelphia for the session: “Mapping Performance To Manage Value: The Clinical Data You Need To Manage The Risk Of Value-Based Reimbursement”, featuring OPEN MINDS Senior Associate Joseph P. Naughton-Travers; Vinfen President & Chief Executive Officer, Bruce L. Bird, Ph.D.; and Project Transition Chief Executive Officer, Luke Crabtree, J.D., MBA.