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Introduction to Value-Based Payments (VBP)

Gain a better understanding of four core concepts and competencies for value-based care (value-based payments, population health management, risk stratification and care pathways) through these free, one-hour online learning modules that will enhance staff knowledge of topics relating to value-based

The Transforming Clinical Practice Initiative (TCPI) Change Package is a guidance framework document developed by the Centers for Medicare and Medicaid Services (CMS) descrives the changes needed for clinical transformation and value-based payment preparedness. This guide provides concrete change tactics for improving patient and family-centered care design, continuous, data-driven quality improvement, and sustainable business operations.

Success under value-based payment methodologies requires clinics to function in new ways and develop additional skills and competencies. This tip sheet helps leaders develop key messages, communication vehicles and training resources that will promote culture change in a positive and non-threatening way.

This planning guide is designed to help you and your team outline, prioritize and determine an agreed-upon roadmap and timeline to prepare for value-based payments (VBPs).

The Practice Assessment Tool (PAT) is a self-assesment tool that helps providers assess and evaluate progress towards and readiness for value-based service delivery, by benchmarking progress along CMS’s five “phases of transformation.” Originally designed for primary care providers, the National Council for Mental Wellbeing developed the Behavioral Health PAT, which translates milestones to make them relevant and applicable for specialty behavioral health providers.

An adaptable PowerPoint slide deck that includes key messaging on the transition to VBP, the continuum of payment methodologies used in VBP, the role of population health management and quality improvement, and staff roles in transformation. The template includes helpful tips for presenters and guidance on how information may be tailored to reflect the needs of your organization.
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Clinical Resources

This toolkit supports individual practitioners including case managers, therapists and peer specialists, as well as organizations seeking to strengthen their capacity and skills in improving patients’ adherence with their medication regimens. Behavioral health, integrated health and other settings providing medication services may use some or all of the information and tools provided in the toolkit to promote the safe and effective use of medication and to reduce the risks associated with non-adherence.

Staying Well and Achieving Goals (SWAG) is a guided handout program designed to support providers in engaging clients with schizophrenia in developing the strategies and skills needed to stay well through providing a structured set of printable clinical guidelines to be delivered over multiple sessions – breaking strategies and skill building into manageable, actionable focus areas.

These two interactive online learning modules for prescribers address the use of Clozapine and Long-Acting Injectables through real-life case studies, scripts for communicating with patients, prescribing guidelines and commonly asked questions.

This guide is a call to action for psychiatrists, other clinicians and behavioral health organizations to increase the use of LAMs, which are also known as long-acting antipsychotic medications and long-acting injectables.
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Operational Resources

This toolkit – complete with staff training exercises, worksheets, tips on goal setting, and more – will help providers build a sustainable quality improvement framework in your organization.

The Transitions of Care Planning Guide is designed to support practices in strengthening their organizational capacity to safely and effectively transition clients between care settings. Practices can use the guide to create and execute their own strategy to collaborate with other providers to identify the barriers to smooth transitions and identify, implement, and evaluate collective solutions.

This fillable companion worksheet of key elements from the Transitions of Care Planning Guide helps create and execute a strategy for collaborating with other providers to facilitate improved transitions of care.

Care pathways play a major role in the movement from fee-for-service to value-based payment by providing a mechanism to coordinate care, reduce fragmentation and constrain rising health care costs. This toolkit guides providers through the process of mapping and implementing evidence-based, population-focused care pathways.

The Risk Stratification Tool and Chronic Conditions Calculator, plus the companion User Guide, can help clinicians: determine which patients need your attention by highlighting service utilization and costs related to your patient populations, support your staff to reduce risk for targeted populations, and quantify and document your value to payers.
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Making the Business Case for VBP

In the spring of 2019, the National Council for Mental Wellbeing partnered with the Center for Health Care Strategies to conduct an environmental scan of value-based payment models for behavioral health services. The culminating report, Behavioral Health Provider Participation in Medicaid Value-based Payment Models: An Environmental Scan and Policy Considerations, details existing models, where they are being adopted and highlights lessons learned and recommendations for state and federal policymakers.

Having a clear understanding and ability to articulate the value that you bring as a behavioral health provider is essential to positioning your organization for value-based payment arrangements. This tip sheet was designed to guide providers through the process of developing and marketing their value proposition.
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Examples from the Field

What does healthcare transformation and innovation in action look like? This compendium of posters from behavioral health organizations in New York State who participated in the Transforming Clinical Practice Initiative initiative, detailing initiatives, lessons learned and outcomes in reducing all-cause hospital re-admissions and improving client care.

This report details the impact, lessons learned and recommendations from implementation of Care Transitions Support Services (CTSS). CTSS provided short-term, transitional support for clients discharged from a psychiatric hospitalization with the goal of goals of achieving outpatient visits within 7 or 30 days post-discharge and reducing 30-day mental health and all cause readmissions.

This report explores core business competencies that many organizations struggle with including: budget management and return on investment calculations, transparent sharing of financial data, and demonstrating the value organizations can bring to value-based payment models. Generated through a series of interviews, this resource distills best practices and lessons learned from high-performing behavioral health practices.