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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 Fady.Sahhar@XtraGlobex.com

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.