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Value Based Payment Resources

Section 1: What are Value-Based Payment (VBP) Arrangements?


What are Value-Based Payment Arrangements and How Do They Differ from Fee-for-Service?


National Council for Behavioral Health
Big Ideas Fast: Value-Based Payments for Administrators

https://www.youtube.com/watch?v=XRwsQdLHvn8

A brief four-minute video to help health care program administrators better understand how value-based payment arrangements differ from traditional fee-for-service models and what this transition means providers.


New York State Department of Health: Value-Based Payments

https://www.youtube.com/watch?v=9D4M-QsaNfM

The video gives an overview of what value-based payments are, their vital role in the New York State Medicaid program and how it will help to improve patient outcomes.


New York State Department of Health: Value-Based Payment for Providers

https://www.youtube.com/watch?v=_mvfd5GXvvs&t=2s

This video highlights how value-based payment will reshape the New York State health care system and the key role providers play within VBP.


Institute for Health Care Improvement (IHI): IHI Triple Aim Initiative

http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

This webpage has introductory information on the IHI Triple Aim, a framework: improving the patient experience of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost of health care.


Annals of Family Medicine: From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

http://www.annfammed.org/content/12/6/573.full

This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.


Institute of Medicine: The Health Care Imperative: Lowering Costs and Improving Outcomes

https://www.ncbi.nlm.nih.gov/books/NBK53906/

This article provides introductory information on VBP arrangements and how they improve outcomes, cost and efficiency.


New York State Department of Health: A Path Toward Value-Based Payment: Annual Update June 2016: Year 2
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/2017/docs/2016-06_vbp_roadmap_final.pdf


Washington State Health Care Authority (HCA): HCA Value‐Based Road Map, 2017‐2021

https://www.hca.wa.gov/assets/program/vbp_roadmap.pdf

This Washington State Health Care Authority (HCA) roadmap lays out HCAs goal of linking 90 percent of HCA provider payments – through Apple Health (Medicaid) and the Public Employees Benefits Board (PEBB) Program – to quality and value by 2021.


Types of VBP Arrangements and Frameworks

 

New York State Department of Health: A Path Toward Value-Based Payment: Annual Update June 2016: Year 2 https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/2017/docs/2016-06_vbp_roadmap_final.pdf

 


Scattergood Foundation: Payment Reform and Opportunities for Behavioral Health: Alternative Payment Model Examples
http://www.scattergoodfoundation.org/sites/default/files/Scattergood_APM_Final_digital.pdf
This paper provides information on health care payment reform, alternative payment models (APMs) and examples related to VBP initiatives in behavioral health settings.

 


Health Care Payment Learning and Action Network (LAN) Alternative Payment Model (APM) Framework
http://hcp-lan.org/workproducts/apm-whitepaper.pdf

This whitepaper provides an overview of the APM framework – a federally supported framework being used nationally across public and private payers to monitor adoption of APMs (another name for VBPs). The APM framework is defined and recommendations are provided for on how various stakeholders can use the framework to accelerate payment reform.


New York State Department of Health: A Path Toward Value-Based Payment: Annual Update June 2016: Year 2 https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/2017/docs/2016-06_vbp_roadmap_final.pdf
This document is a roadmap that defines what arrangements constitute value-based agreements for New York state. The roadmap will be updated annually to ensure that best practices and lessons learned are incorporated into the state’s overall vision.


Deloitte: The Road to Value-Based Care
https://www2.deloitte.com/insights/us/en/industry/life-sciences/value-based-care-market-shift.html
This article provides information on value-based payment models for health care, how they differ from traditional patient care and business models and how organizations can effectively make the shift.


Factors Supporting the Movement to VBP Arrangements

 

Health Care Payment Learning and Action Network (HCP/LAN): Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage, and Fee-for-Service Medicare Programs
https://hcp-lan.org/groups/apm-fpt-work-products/apm-report/
This document is a status report on the adoption of APMs in different health insurance markets (Medicare Advantage and fee-for-service, Medicaid and commercial insurance programs).


CMS: Quality Strategy
https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/qualityinitiativesgeninfo/downloads/cms-quality-strategy.pdf
This article provides an overview of the CMS quality strategy and how it guides the activities of all agency components working together toward transformation.


Strategy and Innovation: Drivers of Market Change – VBP Reform
https://cdn-static.findly.com/wp-content/uploads/sites/6/2016/02/Drivers-of-Market-Change_ValueBasedPaymentReform-March-2015-public-version%255B1%255D-1.pdf
This article reviews VBP models, the history of health care payment reform, the present status of initiatives to increase quality and future reform goals.


What Does This Mean for Behavioral Health Organizations?

 

National Council for Behavioral Health: Creeping and Leaping from Payment for Volume to Payment for Value

https://www.thenationalcouncil.org/wp-content/uploads/2014/09/14_Creeping-and-leaping.pdf

This article provides an overview of the service delivery and payment models that are emerging for behavioral health providers as health reform continues to unfold.


National Council for Behavioral Health Case Rate Toolkit: Preparing for Bundled Payments, Case Rates and the Triple Aim

https://www.thenationalcouncil.org/wp-content/uploads/2013/10/National-Council-Case-Rate-Tool-Kit.pdf


National Council for Behavioral Health Case Rate Toolkit Presentation

https://www.thenationalcouncil.org/wp-content/uploads/2013/10/Case-Rate-Presentation-FINAL.pdf

This toolkit and presentation provide details on VBP models and transitioning to VBP arrangements.


Healthcare Financial Management Association (HFMA): Incorporating Value in Behavioral Health

http://www.hfma.org/Leadership/Archives/2017/July/Incorporating_Value_in_Behavioral_Health/

This article the challenges and benefits of value-based behavioral health models.


Section 2: Value-Based Payment Essentials


Population Health Management

 

Center for Integrated Health Solutions (CIHS): Population Management in Community Mental Health Center-Based Health Homes
https://www.integration.samhsa.gov/integrated-care-models/14_Population_Management_v3.pdf
This paper provides an overview of Population Health Management, key principles and steps to implementing a population health management approach in Health Homes.


IBM Watson Health: A Roadmap for Population Health Management
https://www.pcpcc.org/sites/default/files/resources/PHM-IBM_Watson-RR.pdf
This paper provides an overview of how population health management has become an important focus for health care organizations as they prepare for value-based reimbursement and risk contracting.


American College of Health Executives (ACHE): The Journey to Value-Based Care for Population Health
https://www.ache.org/abt_ache/JF15_F3_reprint.pdf
This paper explores how to move integrated delivery systems to population health for VBP environments.


Identifying Appropriate Performance Metrics

 

Health Affairs: How Value-Based Payment Arrangements Should Measure Behavioral Health
https://www.healthaffairs.org/do/10.1377/hblog20161129.057660/full/
This article provides recommendations on behavioral health performance measurement strategies that providers, payers and agency directors should consider as they enter into VBP arrangements.


Open Minds: Value-Based Reimbursement – The Numbers Are In
https://www.openminds.com/market-intelligence/executive-briefings/value-based-reimbursement-numbers/
This article focuses on the most common measures in value-based payment contracts.


National Council for Behavioral Health: Practice Transformation Academy CEO Call #1
This presentation includes information on selecting appropriate performance metrics for VBP environments and how they lead to lower costs and efficiency for organizations.
Webinar recording: https://attendee.gotowebinar.com/recording/7814308688630608385
Slides:https://www.nationalcouncildocs.net/wp-content/uploads/2017/12/17-0907_PTA-CEO-Call-1.pdf


 

Center for Quality Assessment and Improvement in Mental Health (CQAIMH): National Inventory of Mental Health Quality Measures
http://www.cqaimh.org/quality.html
This website is CQAIMH’s inventory of quality measures provides a searchable database of more than 300 process measures for assessment and improvement of mental health and substance abuse care.


SAMHSA: National Behavioral Health Quality Framework (NBHQF)
https://www.samhsa.gov/samhsa-data-outcomes-quality/samhsas-efforts
This resource is a guiding document for identification and implementation of key behavioral health quality measures for use in agency or system funding decisions, monitoring behavioral health of the nation and delivery of behavioral health care.



Agency for Healthcare Research and Quality (AHRQ): National Quality Measures Clearinghouse
https://www.qualitymeasures.ahrq.gov/
The AHRQ National Quality Measures Clearinghouse is a public resource for summaries of evidence-based quality measures and measure sets. NQMC also hosts the Department of Health and Human Services (HHS) measures inventory.


The Community Technical Assistance Center of New York (CTAC): Output to Outcomes
http://outcomes.ctacny.org/
This website is a resource to help clinics and mental health agencies throughout New York state integrate outcome measures into their clinical treatment.


DLA-20: Mental Health Outcomes Measurement

DLA-20: Mental health outcomes measurement


This website provides information on the DLA-20 assessment.



New York State Department of Health (NYSDOH): Administering the Patient Health Questionnaires 2 and 9 (PHQ 2 and 9) in Integrated Care Settings
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/2016-07-01_phq_2_and_9_clean.pdf
This article addresses frequent questions on the use and administration of the PHQ 2 and 9 as preventive
depression screening tools in the integrated care setting.


American Psychiatric Association (APA): Mental Health Performance Measures
https://www.psychiatry.org/psychiatrists/practice/quality-improvement/mental-health-performance-measures
This measures spreadsheet is a comprehensive collection of performance measures that pertain to mental health.

 


Evidence-Based Guidelines

 

SAMHSA Mental Health Treatment Evidence-Based Practices (EBP)
https://www.samhsa.gov/ebp-web-guide/mental-health-treatment
The Evidence-Based Practices (EBP) Web Guide features research findings and details about EBPs used to prevent and treat mental and substance use disorders.


PEW Charitable Trust: Results First Clearinghouse Database
http://www.pewtrusts.org/en/multimedia/data-visualizations/2015/results-first-clearinghouse-database
This website is a one-stop online resource providing information on the effectiveness of various interventions as rated by eight national research clearinghouses.


AHRQ: National Guideline Clearinghouse
https://www.guideline.gov/
AHRQ’s National Guideline Clearinghouse is a public resource for summaries of evidence-based clinical practice guidelines.


Advanced Integrated Mental Health Solutions (AIMS) Center: Evidence-Based Behavioral Interventions in Primary Care
https://aims.uw.edu/evidence-based-behavioral-interventions-primary-care
This website provides evidence-based behavioral interventions for primary care, including a resource library and implementation guide.

 


Building a Quality Improvement (QI) Infrastructure

Human Services Research Institute(HSRI): Selecting Process Measures for Quality, Improvement in Mental Healthcare

http://www.cqaimh.org/toolkit.website.pdf
This toolkit provides process measures for the evaluation of adult mental health systems.
This website provides public health and quality improvement resources and tools


Health Care Transformation Task Force: The Transformation to Value: A Provider Perspective Webinars

https://www.youtube.com/watch?v=jUELHhG8230&t=2824s

These webinars introduce the Task Force’s new series, Transformation to Value: A Leadership Guide, and facilitate a conversation with Trinity Health’s Rick Gilfillan and Ascension Health’s Jason Dinger about the successes, challenges and lessons learned from their experiences as provider systems in transitioning to value.

Link to Transformation to Value series: http://hcttf.org/resources-tools-arch…


Health Compass: How to Develop a Monitoring and Evaluation (M&E) Plan

https://www.thehealthcompass.org/how-to-guides/how-develop-monitoring-and-evaluation-plan

A how-to guide that providing step-by-step instructions on how to develop an M&E plan.


HRSA: Managing Data for Performance Improvement

https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/managingdataperformanceimprovement.pdf

This training module highlights the importance of effective data management to improve performance of an organization’s health care systems.


National Council for Behavioral Health: Building your Organization’s Culture of Quality Improvement

This webinar helps enrolled organizations meet three key milestones necessary for transitioning to VBP arrangements and provides guidance on how to implement a formal quality improvement methodology.


National Council for Behavioral Health: Creating Rapid Cycle Change

This webinar explores how Rapid Cycle Change can be applied to quickly target and test system improvements over the course of a few months using plan-do-study-act (PDSA).


National Council for Behavioral Health: Choosing A Good Key Performance Indicator

https://www.thenationalcouncil.org/wp-content/uploads/2016/06/Choosing-a-Good-Key-Performance-Indicator-Document.pdf

This infographic includes the four components that make up good key performance indicators.


National Council for Behavioral Health: Data, Information, Knowledge and Action Graphic

https://www.thenationalcouncil.org/wp-content/uploads/2016/06/Data-Information-Knowledge-Action.pdf

This infographic shows how data, information, knowledge and action play a role in the PDSA roadmap.


National Council for Behavioral Health: PDSA Roadmap

https://www.thenationalcouncil.org/wp-content/uploads/2016/06/PDSA-Roadmap.pdf

This resource is an infographic of the PDSA roadmap.


Section 3: Value-Based Payment Initiatives


National-Level VBP Initiatives

 

CMS: Overview of the CMS Quality Strategy

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/CMS-Quality-Strategy-Overview.pdf

This fact sheet provides an overview of the CMS quality strategy that guides the activities of all agency components working together toward transformation.


CMS: The Medicare Access and Chip Reauthorization Act Of 2015 Path to Value

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf

This infographic provides Information on MACRA, Merit-Based Incentive Payment System (MIPS) and CMS strategic goals.


CMS: Quality Payment Program

https://qpp.cms.gov/

This provides information on the CMS Quality Payment Program (QPP).



National Council for Behavioral Health: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

https://www.thenationalcouncil.org/macra/

This webpage provides foundational knowledge on MACRA, and CMS’ Quality Payment Program, which has two parts: The MIPS and the Advanced Alternative Payment Models (Advanced APMs).


CMS: Alternative Payment Model (APM) Overview

https://qpp.cms.gov/apms/overview

This website provides an overview of the CMS APM payment approach, and Advanced APMs.


CMS: Transforming Clinical Practice Initiative (TCPI)

https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/

This website provides an overview of the CMS funded Transforming Clinical Practice Initiative designed to help clinicians achieve large-scale health transformation.


Care Transitions Network for People with Serious Mental Illness

https://www.thenationalcouncil.org/care-transitions-network-people-serious-mental-illness/

This website provides an overview of the Care Transitions Network, one of 29 Transforming Clinical Practice Initiative (TCPI) Practice Transformation Networks, that helps organizations in New York state move into value-based payment arrangements and reduce all-cause re-hospitalization rates for people with serious mental illness.



CHCS: Adapting the Medicare Shared Savings Program to Medicaid Accountable Care Organization

https://www.chcs.org/media/PaymentReform031813_4.pdf

This brief explores the shared savings approaches of Minnesota and New Jersey, which both used the Medicare Shared Savings Program (MSSP) as a foundation for their Medicaid ACO shared savings programs.


CHCS: State Innovations in Value-Based Care: ACOs and Beyond

https://www.chcs.org/news/state-innovations-value-based-care-acos-beyond/

This resource is a presentation on the current landscape of state-based Medicaid ACO programs across the country as well as future opportunities for Medicaid ACOs. The presentation also explores other opportunities for states to advance value-based payment models in Medicaid.


Medicaid and CHIP (MAC): Continuum of New Integrated Care Models in Medicaid – Key Program Features

https://www.medicaid.gov/state-resource-center/mac-learning-collaboratives/downloads/vbp_continuum-brief-july-2012.pdf

This infographic provides an overview of integrated care models in Medicaid and associated program features.



State-Level Value-Based Payment Initiatives

 

Center for Health Care Strategies (CHCS): Value-Based Payments in Medicaid Managed Care:

An Overview of State Approaches

https://www.chcs.org/media/VBP-Brief_022216_FINAL.pdf

This brief explores several state options for using managed care contracts to accelerate VBP adoption at the provider level.


New York State Department of Health: A Path Toward Value-Based Payment New York State Roadmap for Medicaid Payment Reform

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/vbp_roadmap_final.pdf

This New York State Medicaid reform roadmap provides an overview of the elements the state and its stakeholders consider to be the payment reforms required for a high-quality, financially sustainable Medicaid delivery system.


New York State Department of Health: VBP for Providers

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_providers/index.htm

This resource is a toolkit for providers as they transition to VBP arrangements in New York state.


MaineCare Services: Value-Based Purchasing Strategy

http://www.maine.gov/dhhs/oms/vbp/VBP%20Intro.html

This resource provides an overview of the Department of Health and Human Services and Office of MaineCare VBP strategy to improve the quality and cost of care for MaineCare members. Three major initiatives are part of this VBP strategy: Health Homes, Behavioral Health Homes and accountable communities.


Washington State Health Care Authority (HCA): HCA Value‐Based Road Map, 2017‐2021

https://www.hca.wa.gov/assets/program/vbp_roadmap.pdf

This Washington State HCA roadmap lays out HCAs’ goal of linking 90 percent of HCA provider payments – through Apple Health (Medicaid) and the Public Employees Benefits Board (PEBB) Program – to quality and value by 2021.


Washington State HCA: Clinics Transition to New, Value-Based Payment Model

https://www.hca.wa.gov/assets/program/APM4-fact-sheet.pdf

This fact sheet provides information on Washington state’s alternative payment methodology known as APM4. It is the fourth iteration of an alternative payment methodology in Washington.


Washington State HCA: Value-Based Purchasing

https://www.youtube.com/watch?time_continue=5&v=bkBbcWldZHs

This HCA video provides an overview of the Healthier Washington strategies, which involve achieving the Triple Aim of better health, better care and lower costs. The video also explains the Washington state goal of shifting reimbursement strategies away from a system that pays for volume of service to one that rewards quality and outcomes.