New Federal Direct-Contracting VBP Models Met With Concern
While some have responded well to new federal direct-contracting value-based payment models with excitement, others believe there are serious flaws in them.
Study Finds Better Outcomes for Medicare Advantage Beneficiaries than Traditional FFS Medicare
Among others, the study found that there were better outcomes in MA than FFS for all populations analyzed in 17 of 22 clinical quality of care measures.
Commitments for 2021 – Onward!
Commitments for 2021 – Onward! THE VBP Blog Looking back at 2020 would be what most of us do this time of year, however, we are always looking forward and Onward! So, there are commitments we making to drive our planning for 2021, we hope these help you to make your own commitments and resolutions for the upcoming year. Photo by Hide Obara on Unsplash Our Commitments for 2021 1. Stay True to Our Mission to be Advocates First We say that every time we introduce ourselves to new clients. We find that having a mission helps guide our decisions, our approach, and recommendations we make. When you think about your own organization: Revisit and update your mission to make… Read More »Commitments for 2021 – Onward!
The Primary Care First Model Explained
The Primary Care First VBP Model Explained THE VBP Blog [12/17/20] The Primary Care First (PCF) model was established by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. It offers a regionally-based, multi-payer approach to primary delivery and payment. By design, PCF allows for increased flexibility and freedom for practitioners to be innovative in their approach to increase quality and reduce costs. PCF will be offered in 26 regions in 2021, including many that were covered in our I/DD Managed Care Review blogs. In those blogs, we covered the ten current programs being offered. Out of those ten, five (New York, Tennessee, Kansas, Arkansas, and Michigan) also have a PCF option. This leaves us hopeful that PCF programs… Read More »The Primary Care First Model Explained
CMS’ Overhaul Could Mean VBP is Working for Consumers
CMS’ Overhaul Could Mean VBP is Working for Consumers The Stark Law has been modernized: Here’s what you need to know THE VBP Blog [11/24/20] This week, CMS announced they were modernizing and updating the Physician Self-Referral Law (i.e. “Stark Law”) to steer it towards a value-based payment (VBP) structure. The core of the law, to protect patients from unnecessary, low quality, and expensive services, will stay in-tact. The new adjustments support the CMS “Patients over Paperwork” initiative of reducing unnecessary regulatory burdens on physicians. Photo by Tingey Injury Law Firm on Unsplash The Stark Law History In 1989, when healthcare was paid for primarily on a fee-for-service (FFS) structure, the Stark Law was put into place to protect patients… Read More »CMS’ Overhaul Could Mean VBP is Working for Consumers
Pay-for-Performance – Developing and Expanding Opportunities
Pay-for-Performance Developing and Expanding Opportunities THE VBP Blog We are circling back to cover pay-for-performance, the second stop on the value-based payment continuum. The pay-for-performance (P4P) model gives providers bonuses for hitting quality and efficiency targets. As we continue to focus on whole-person care, the new normal of hybrid payments continues to shift. According to Health Care Payment Learning & Action Network (LAN), in 2018, 25% of all fee-for-service payments had a link to quality or value, including pay-for-performance models. To understand more of the basics, you can check out our first blog covering P4P. Pay-for-performance is a payment model that attaches financial incentives to provider performance. Incentives can range from small bonuses to large payments, depending on the… Read More »Pay-for-Performance – Developing and Expanding Opportunities
Exploring Bundled Payments
Exploring Bundled Payments THE VBP Blog When we started the VBP Blog back in 2018, we broke down the building blocks in the continuum for Value-Based Payments. In the last blog, we revisited Alternative Payments and what had changed since our original analysis. In this one, we will be covering Bundled Payments and what they mean to Value-Based Payments. Bundled Payments Refresher As a refresher, bundled payments – also known as episode-based payments (EPMs) – are an alternative payment method (APM) in which services are grouped together and a target price is calculated. This target price is the total allowable expenditure throughout an entire episode of care. A bundled price can be set and adjusted based on risk factors, age,… Read More »Exploring Bundled Payments
Alternative Payments Making a Splash
Alternative Payments Making a Splash Examining the ever-changing Value-Based Payments landscape THE VBP Blog Value-Based Payments are a complex topic that is evolving very quickly. Back when we first started this blog in 2018, we began at the very beginning. We feel it’s important to double back on those foundational pieces of VBP as it continues to change. With that in mind, we are starting with Alternative Payment Models. This will be a two-part blog, starting with the national pieces and then working to a regional level. Fee-For-Service Models Traditionally, payment for health services has run on a model called fee-for service (FFS). This simple model means that physicians and healthcare providers delivered in units. This has little to do… Read More »Alternative Payments Making a Splash
Full State Managed Care Review: All 10 Current Programs 2020
Full State Managed Care Review: All 10 Current Programs Is Provider-Led Care the Future of Managed Care Programs? THE VBP Blog [July 30, 2020] Across several months and multiple blogs, we have covered all ten states that feature managed care programs for the Intellectual and Developmental Disabilities population. We saw a wide range of successes, types of programs, and different phases of rollout. With each, we broke down the state’s managing entity, how many consumers were affected, the role of case management, the rollout approach, and more. To make things a bit easier to compare, we also compiled a chart and a presentation [Full State Review Managed Care IDD ] for you to reference. Iowa & Tennessee Kansas & Texas… Read More »Full State Managed Care Review: All 10 Current Programs 2020
A Fresh Approach to Managed Care in NC and NY
Fresh Approach to Managed Care in NY and NC THE VBP Blog We’ve navigated you through 8 of the ten states with a managed care I/DD program and in this blog, we will cover the final two. We have learned a lot about the different approaches, the successful and not as successful programs, and the work that is still left to do. In our next blog, we will recap everything we have learned and what it means moving forward. North Carolina has been working with a form of managed care since 2005, but in 2015 committed to move towards a whole-person managed care approach. Their shift towards a new program has been halted due to legislation struggles and COVID-19, but… Read More »A Fresh Approach to Managed Care in NC and NY