positioning fqhcs for value-based payment

Positioning FQHCs for Value-Based Payment

The right changes at the right time.

Outline• Understanding the “New World”

• An Introduction to Health Reform and Payment Arrangements

• The World of Payers• A Framework for Building Value-Based Care

• Patient-Centered Access• Team-Based Care • Population Health Management• Care Management and Support• Care Coordination and Care Transitions • Performance Measurement/QI

• Tying it all together for value-based care

Objectives

• Attendees will be able to identify and define key terminology commonly utilized in value-based payment arrangements.• Attendees will learn the details of common value-based

payment arrangements and the challenges and opportunities associated with the payment design.• Attendees will learn operational strategies for positioning

facilities for value-based payment arrangements.

So What Is Value-Based Payment?• It is a payment model that rewards

providers for meeting certain performance measures for quality and efficiency. It often penalizes caregivers for poor outcomes or increased costs.• Also known as “pay-for-performance“ (P4P)

or “value-based purchasing”.• Contrasted with “fee-for-service” (FFS) or

“volume-based payment”.• ACA pushing towards VBP: ACOs and

quality links to payment.

Intro to Health/Payment Reform

• The Department of Health and Human Services (HHS) focus areas: • Payment Incentives: Tying payment to value through

alternative payment models;• Care Coordination: Care delivery changes through

greater teamwork, integration, coordination of providers across settings, and a focus on population health; • Data and Technology: Harnessing the power of

information to improve care for patients (Burwell, 2015).

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html


Intro to Health/Payment Reform

• CMS Goals: (Announced 1/26/2015)• 85% of all Medicare fee-for-

service payments tied to quality or value by 2016 (90% by 2018).

• 30% of Medicare payments tied to quality or value through alternative payment models by the end of 2016 (50% by the end of 2018).

• First time in history!2011 2014 2015 2016 2017 2018

80

60

37.5

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15

20

37

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40

2.5

1012.5

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25

2.510 12.5 15 20 25

Medicare Payment GoalsCategory 1 Fee-for-service with no link of payment to qualityCategory 2 Fee-for-service with a link of payment to qualityCategory 3 Alternative payment models built on fee-for-service architectureCategory 4 Population-based payment



Väth Consulting, LLC

For complete presentation, please contact Väth Consulting

at vathconsulting.com or [email protected]

positioning fqhcs for value-based payment

Healthcare