The slow but steady adoption of value-based reimbursement (VBR) is reshaping the field—with more integration, different financial models, new clinical protocols, and more. To assist our OPEN MINDS Circle members with this transition, we have developed organizational assessment tools (see Value-Based Reimbursement Readiness Assessment and Managed Care Competencies Assessment), tracked the participation of VBR by provider organizations in our annual survey (see Where Are We On The Road To Value?: The 2019 OPEN MINDS Performance Management Executive Survey), and surveyed health plans on their consumer population health management strategies (see Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing and Delivery System).
But a new development is the move by state Medicaid plans to include intellectual/developmental disabilities (I/DD) and long-term services and supports (LTSS) services in managed care programs (see State Medicaid Programs With MLTSS: The 2019 OPEN MINDS Update). With that transition, more of these services will be included in performance based and VBR initiatives. What are the unique features of VBR in the LTSS and I/DD space, and how do those provider organizations prepare? That was the focus of the session, Preparing I/DD & Other Long-Term Care Organizations For Managed Care: Group Discussion & Workshop, at the 2019 OPEN MINDS Executive Leadership Retreat led by my colleague OPEN MINDS Senior Associate, Ray Wolfe, J.D.
While the shift to managed care programs and VBR is happening across all the entire health and human service market, for I/DD and LTSS provider organizations, the transition is different. Mr. Wolfe noted:
For organizations caring for the LTSS and I/DD communities, these organizations will experience a lot of challenges due to the financial impact of managed care and value-based reimbursement. Executive teams need to shift their focus on what makes organizations strong in this new market landscape. Most policymakers agree that managed care and VBR will continue to increase in these settings due to the growing costs. Currently, 15% of individuals with an I/DD received LTSS through managed care, and 46% receive medical services through managed care—and this number is anticipated to grow rapidly over the next few years.
For provider organizations tracking this market and preparing to optimize their performance in managed care systems, there are five keys to keep in mind —creating a collaborative care network; implementing decision support; measuring consumer experience; monitoring financial performance; and mastering data collection and reporting.
Creating a collaborative care network—A single I/DD or LTSS provider organization probably won’t have the skills and resources to support a consumer’s whole health, and this includes their mental, physical, and social health outcomes. With a model that prioritizes value over volume, the highest quality services and best outcomes are achieved through the integration of physical and behavioral health, along with maintaining communication across the consumer’s health network. Mr. Wolfe explained:
Organizations might not be capable of monitoring physical health outcomes for a consumer, or it may be incapable of appropriately assessing and treating physical health issues on a regular basis. It is essential for the organization to reach out and link with other provider organizations who have that capability. Once those relationships are established, it’s all about communication. Professionals must know what’s going on with consumer’s physical, mental, and social health by integrating the chronic physical health issues into the care plan and maintain regular communication with their physician and family members in the home. To sustain organizational success, building this network of resources within the community is key.
Implementing decision support— Sustainability with VBR reimbursement relies on predictable utilization of resources and using data to make informed treatment decisions. This is essential. Ultimately, it comes down to measuring performance (consumer outcomes, consumer experience, and cost-effectiveness) and changing standard practices to optimize that performance. Mr. Wolfe noted:
Organizations on the road to VBR must standardize service delivery using decision support tools. Assessment and care planning inconsistencies provide ineffective services that are costly to the organization and puts the consumer at risk for worse outcomes. By developing standardized approaches, organizations can maximize value.
Measuring consumer experience— A customer-centric orientation for your organization is necessary for keeping ahead of the competition. Executive teams should plan on measuring consumer preferences and experiences and changing their service delivery system to improve consumer perceptions. Mr. Wolfe said:
In a value-based world that prioritizes consumer perceptions, it is critical to measure consumer experience continuously. For example, to improve consumer convenience, does your organization provide web-enabled access or online forms and assessment tools? Is it easy to make an appointment? Is the process as a new consumer easy to navigate? These elements, in addition to actual service delivery, are critical to consumer experience.
Monitoring financial performance—When adopting a VBR model, executive teams need to report actual performance data, including financial performance, against the organization’s budget and contractual targets. However, this isn’t easily done through traditional means of reporting. VBR requires financial managers to develop new skills. Mr. Wolfe said:
The transition to VBR can cause tension between leadership and the board. The board needs an understanding of each value-based contract and its financial implications. Financial managers need to step up and do more than simply monitoring what the income is. Financial managers need to develop and use the tools to track the leading indicators of VBR performance and act early to improve financial performance.
Mastering data collection and reporting—Every organization must collect and analyze a significant amount of population health data and financial performance data; and do so with real-time reports. When you decide what data to track, can make reports of that data, and then make decisions with those reports, you have mastered this process. But it takes an investment in the technology to make this happen, as well as an investment in staff and continuous training. Mr. Wolfe noted:
The organization’s capacity to collect and analyze data in a structured way is critical. And the organization’s electronic health record functionality must meet VBR requirements and track the necessary data in a way that allows for the reporting of these performance metrics and consumer outcomes. Being able to generate this type of reporting, in real-time, is key to operating successfully under a VBR arrangement.
Is your organization prepared to make the transition to VBR? Although many organizations and leaders face significant challenges during the shift, these five key competencies can separate your organization from the competition in obtaining and sustaining organizational success and valued consumer outcomes.
For more on the skills needed to successfully lead your organization during the implementation of VBR, check out these resources in our OPEN MINDS Industry Library:
- Preparing For Value-Based Reimbursement—Even Before The Contracts Are Signed
- Why Clinical Guidelines Matter More With Risk-Based Contracting
- Getting A Non-Profit Board Ready For VBR
- Your Organization Is Ready For VBR When …
- Crawl, Walk, Run To VBR
- CFOs On The VBR Path
- VBR @ Scale—Changes Required
- How To Prepare For Value-Based Reimbursement: Four Key Competencies For Success
- Key To Community-Based Success—‘Partnerships, Partnerships, Partnerships’
- Coming Up With The Next Big Thing
For even more on the VBR and technology overlap, join us at The 2019 OPEN MINDS Technology & Informatics Institute for the session, “Leveraging Technology To Expand Access, Enhance Consumer Experience & Improve Outcomes In A Behavioral Health Care Marketplace Dominated By Value-Based Models” with Alison Nelson, Senior Vice President, Optum Technology, Optum.
For more on how to successfully lead your organization, stay tuned over the next few days as we discuss leadership in the context of value-based reimbursement, changing regulations, and organizational challenges. You can follow us on twitter @openmindscircle #OMLeadership.