In the past two weeks, we’ve covered two initiatives sponsored by Blues plans to move behavioral health to some value-based arrangement.
Blue Cross and Blue Shield of North Carolina launched a new value-based purchasing (VBP) model, Blue Premier Behavioral Health, which allows behavioral health professionals who either meet or exceed quality benchmarks to earn higher reimbursement rates (see Blue Cross NC Launches New Value-Based Payment Model For Behavioral Health). In New York, BlueCross BlueShield of Western New York (BCBSWNY) announced that it entered into a value-based reimbursement (VBR) arrangement with Value Network (see BlueCross BlueShield & Value Network Partner To Start Behavioral Health Value-Based Payment In Western New York).
The agreement with Value Network involves a behavioral health care collaborative that includes over 100 New York-area provider organizations—including BestSelf Behavioral Health, Endeavor Health Services, Horizon Health Services, and Spectrum Health and Human Services. Currently, BCBS is the first local health plan that will follow this approach – rewarding provider organizations for providing quality mental health and addiction treatment services to consumers.
The Blues plans have rolled out several new initiatives in the past six months. Late last year, Blue Cross and Blue Shield of Minnesota launched a value-based model for cancer care through a five-year collaboration with Minnesota Oncology (see Blue Cross & Blue Shield Of Minnesota Partners Launches Value-Based Model With Minnesota Oncology). And some of the other Blues initiatives we have covered include:
- Blue Cross & Blue Shield Companies Join Civica Rx To Manufacture Generic Drugs
- CareFirst BlueCross BlueShield To Enter The Maryland & D.C. Medicaid Markets By Acquiring Two Health Plans
- California Blue Shield Promise & L.A. Care Invest $146 Million In Community Resource Center Expansion
- Capital BlueCross & Prime Therapeutics Form Strategic Partnership
- Blue Cross Blue Shield Of Michigan & Seven Health Organizations Will Share Financial Risk For Consumer Care & Health
- Blue Shield Of California & Lyft Roll Out ‘rideQ’ Non-Emergency Medical Transportation Platform
The push to new financing and reimbursement models is not limited to the Blues plans. Our team has some great new resources that can provide you with market intelligence, tools, and technical support to the evolving value-based landscape. My top recommendations among the many new OPEN MINDS resources are listed below.
Navigating the Path to Value-Based Care: The Journey to Improved Clinical Outcomes
While the goal of value-based care (VBC) is to improve clinical performance and consumer outcomes – it’s not as easy as you may think. This webinar recording outlines the key competencies to find success with VBC through targeted data management.
Succeeding With Value-Based Reimbursement: An OPEN MINDS Reading Book On Organizational Competencies & Management Best Practices For Value-Based Contracting
This guide helps organizations assess readiness for population health and value-based reimbursement (VBR). It includes a curated selection of articles and resources reviewing key competencies for success with VBR.
How To Build Value-Based Payer Partnerships: An OPEN MINDS Reading Book On Best Practices In Marketing, Negotiating, & Contracting With Health Plans
Learn how to develop relationships with the payers in your market, align programs and service goals with payers, and prove that your service lines can achieve both high quality outcomes and lower costs. This reading book includes a curated selection of articles and resources on building successful value-based partnerships while ensuring your organization is demonstrating value.
Rhode Island Behavioral Health System State Profile
One of our state market intelligence profile series (see State Profiles for a complete list), this profile outlines Rhode Island’s Dual Eligible Demonstration, which includes physical and behavioral health services, long-term services and supports, pharmacy, and care management, includes practice performance and improvement measures – specifically, VBPs must constitute 80% of the health plan’s expenditures to clinical professionals.
South Carolina Behavioral Health System State Profile
A new addition to our state market intelligence profile series, this profile outlines the changes in South Carolina, requiring at least 30% of payments to provider organizations must be in value-based arrangements. For those who fail to meet requirements, there is a 25% loss of their quality withhold.
RI International: An OPEN MINDS Organizational Profile
One of our new organizational profiles (for a complete list see Organizational Profiles), the profile of RI International features their innovative organizational approach to value-based care (see Developing A Value-Based Care Model With Peer Support—Two Case Studies). With performance incentives based on metrics, RI International uses peer recovery teams to provide group and one-on-one services to individuals transitioning from hospital-based care.
West Michigan Partnership For Children: An OPEN MINDS Organizational Profile
Another of our organizational profiles, West Michigan Partnership for Children, looks at how they create a strategic link with their participating organizations to benefit from shared outcomes (see Using A Meta-Leadership Approach For Value-Based Social Services). The organization has refined the financial and programmatic skill sets necessary to succeed with performance-based contracting (see Building An Organization That Can Out-Perform The Competition: Value-Based Reimbursement & Performance Management).
OMNI Youth Services: An OPEN MINDS Organizational Profile
The profile of OMNI Youth Services highlights one of the organizations in a network of six Illinois non-profit provider organizations focused on delivering intensive care coordination and timely access to evidence-based treatment to youth throughout the state (see Illinois Launches Pay-For-Success Initiative For Dually-Involved Youth). The initiative measured three outcomes based on metrics to determine overall success with the goal of ultimately reducing or preventing time in institutional care and repeat criminal behaviors.
Managing Diverse Data In Value-Based Reimbursement Models
An organization’s ability to manage and report data can make or break success with VBR contracts. This article outlines how leveraging a fully implemented electronic health record can support organizations in such a feat.
A Beginners Guide To Value Based Reimbursement: Five Things You Should Know
In the transition from volume to value, it’s critical for provider organizations to be prepared – and demonstrate quality over quantity. This step-by-step guide shows you how to overcome challenges to VBR to ensure quality outcomes and effective care.
Ready Or Not: Value-Based Reimbursement Is Here
Although VBR adoption is slow, implementation is starting to gain more momentum. For provider organizations, now is the time to focus on demonstrating value. This article outlines how the right technology and leadership can help separate an organization from the competition – and find success with VBR.
Assessing Leadership & Staff Competencies In The Path To Value-Based Care, An Interview With OPEN MINDS Senior Associate Drew Digiovanni
For a strong foundation with VBR, support should come from all levels of the organizational infrastructure. In this article, Mr. Digiovanni discusses the key competencies needed to reap the benefits of VBR from the chief executive officer to the clinical staff.
And for even more on finding success with VBR contracts, join us June 3 for “Succeeding With Value-Based Reimbursement: An OPEN MINDS Executive Seminar On Organizational Competencies & Management Best Practices For Value-Based Contracting” led by OPEN MINDS Senior Associates Drew DiGiovanni and Kenneth Anderson during The 2020 OPEN MINDS Strategy & Innovation Institute.