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Demystifying Value Based Payments Fady Sahhar, XtraGlobex, Inc. October 2017
Demystifying Value Based Payments
Fady Sahhar, XtraGlobex, Inc.
October 2017
Agenda
• Welcome
• Defining Value Based Payments
• CMS Guidance on VBP
• The Pennsylvania Experience and MLTSS Application of VBP
• Getting Ready for VBP – Five Tenets
• Questions
October 2017
XtraGlobex VBP Readiness
2
Defining Value Based Payments
• What is Value
• How Value is Works
• Why should you care
October 2017
XtraGlobex VBP Readiness
3
The Pennsylvania Experience
• Health Choices History with VBP
• Behavioral Health History with VBP
• MLTSS
October 2017
XtraGlobex VBP Readiness
4
Implications of PA Experience
• Not on day 1…. But it’s coming
• Rebalancing
• Quality
• Pay for Performance
• Measures of Quality
October 2017
XtraGlobex VBP Readiness
5
Getting Ready for VBP in MLTSS
• Understanding • Processes
• Infrastructure
• Costs
• Quality Measurement and Improvement
• Leadership
October 2017
XtraGlobex VBP Readiness
6
Understanding Your Processes
Define Key Processes in Your Operations
1
Process Mapping
2
Accountability
3
Process Streamlining
4
Process Improvement
5
October 2017 XtraGlobex VBP Readiness 7
Understanding Your Infrastructure
Physical Infrastructure
Technology Infrastructure
People Infrastructure
October 2017 XtraGlobex VBP Readiness 8
Understanding Your Costs
• Beyond accounting
• Aligning Processes and Costs
• Structural Costs
• Capital Costs
• Operational Costs
• Accountability for Costs
Quality Measurement and Improvement
1
Define Quality
• Process
• Outcomes
• Satisfaction
2
Benchmarks
• National
• State
• MCO
October 2017 XtraGlobex VBP Readiness 10
Establishing Quality Goals
• Pick Your Battles!
• Focus on goals that matter to:
• Consumers
• Stakeholders
• Regulators
• Payers / MCO’s
• Your Leadership
• Quality Goals to Differentiate Your Organization
Measurement and Tracking
• Consistency
• Accuracy
• Oversight
• Transparency
• Reporting
October 2017
XtraGlobex VBP Readiness
12
Culture of Quality
• Not a Project
• Clarity of Purpose
• Individual and Team Accountability
• Leadership Accountability
October 2017
XtraGlobex VBP Readiness
13
Leadership
• Leadership Inventory
• Leadership Development
• Leadership Commitment
October 2017
XtraGlobex VBP Readiness
14
Questions / Discussion
October 2017
XtraGlobex VBP Readiness
15
1700 Market Street, Suite 1005, Philadelphia, PA 19103n 856 397 5040n [email protected]
Creating Your Exceptional and Sustainable Competitive Advantage
XtraGlobex is a consulting firm that provides strategy, analytics and communications services to organizations specializing in healthcare, community-based and professional organizations serving the Medicare and Medicaid populations and Long Term Services and Supports. We work with our clients to create exceptional and sustainable competitive advantage, turning existing challenges into positive solutions and future hurdles into launchpads for growth.
