Serving the Value-Based Care Community | |
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On January 18, 2024, the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid Services (CMS) announced Innovations in Behavioral Health (IBH), a new eight-year model focused on adult Medicaid and Medicare enrollees with moderate to severe mental health conditions and substance use disorders (SUD). CMS released substantial additional information about the model during a February 29 webinar and intends to release a notice of funding opportunity (NOFO) in Spring 2024.1 IBH will provide funding for states to work with behavioral health practices to develop and implement new care delivery models, with a focus on care management, that aim to integrate physical and behavioral health. The IBH care delivery model must be accompanied by a value-based payment (VBP) methodology. | | |
Accountable Care Organizations are struggling to find specialists to improve value-based care, although it is a top priority Centers for Medicare and Medicaid Services. Meanwhile, ACOs face considerable challenges in effectively engaging specialists, according to a recent study from the Institute for Accountable Care in the American Journal of Managed Care. The predominant influence of fee-for-service payment structures on specialist behavior was cited as a major hurdle by 58% of ACOs. The study analyzed 101 Medicare ACOs participating in either the Medicare Shared Savings Program or the Realizing Equity, Access, and Community Health (REACH) ACO model as of 2023. The researchers found while most ACOs prioritize specialist engagement, less than 10% indicated high levels of engagement in value-based care initiatives. | |  |
Telehealth has been around for decades, but the COVID-19 pandemic thrust it into the spotlight when patients couldn’t see practitioners in-person. Suddenly, telehealth via video, audio, text, and email became a lifeline, one that’s especially beneficial for patients who have an established relationship with providers, those dealing with chronic conditions, people living in rural areas, and those seeking behavioral health services. And, with 90% of U.S. adults owning smartphones, telehealth has the potential to make healthcare more equitable and accessible than ever before. As telehealth utilization continues to climb, it has become increasingly important to consider its impact on the calculation of member risk scores. | | |
As noted in the first article in this series, traditional value-based (VBC) care models are largely focused on economic incentives to healthcare providers and facilities. Many VBC organizations lack the infrastructure in place or scale to integrate factors that impact how patients interact with the healthcare system, engage with care providers, or adhere to treatment recommendations. Failure to consider and address these needs can create obstacles to realizing the full economic and health goals of traditional VBC models. For example, social determinants of health (SDoH), including safe housing, transportation, and neighborhoods; racism, discrimination, and violence; education, job opportunities, and income; access to nutritious foods and physical activity opportunities; polluted air/water; and language and literacy skills, impact more than half of all health outcomes. | | |
Since the Affordable Care Act was signed into law in 2010, CMS has been encouraging physician practices to move from a fee-for-service payment model to one that rewards value. It has been testing models that incentivize clinicians to provide preventive, proactive, and appropriate care that improves patient outcomes and experience and decreases unnecessary healthcare spending. Most recently, it has focused on ensuring health equity across all patient populations. Many practices experienced the financial benefits of value-based care (VBC) during the height of the COVID-19 pandemic, when they received regular per patient payments from value-based care contracts, despite a significant decline in service volume. If your practice was not amongst them, you may still question whether you can maintain profitability under VBC. | | |
Upcoming Sponsored Webinars | |
VBCExhibitHall offers FREE educational webinars for those who are working in value-based care (VBC), or would like to learn more about VBC! We encourage people to attend the live webinars so as to have the opportunity to participate in the Q&A. However, if you are unable to attend, a link to the recorded webinar is sent to all who sign up. Please register using an accurate email address so that you can receive the link to join and to the recording. | | |
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The Medicare Advantage V28 transition:
What we learned in year 1
| April 30, 2024 | 12 PM EST | The impact of V28 on revenue, key diagnoses to focus on, and data- and clinically-driven mitigation strategies. | | |
Navigating MSSP Quality Reporting: EHR Connection vs. QRDA-1 | Expert insights on the pros and cons of direct Electronic Health Record (EHR) connections versus utilizing QRDA-1 for data uploads | | | |
An Inside Look: The Formula for Health Engagement and Revenue Growth |
How to boost engagement and revenue using integrated and enriched health plan and provider data, analytic capabilities, and personalized campaigns | | |
Your ACO Guide to Targeting Costs with Data-Driven Strategies: Data Flush? Best ACO Options for Prioritizing Cost Initiatives Based on RoI | |
The types of data that ACOs have available to them for targeting avoidable costs, and which strategies make the biggest gains
(Part three of a three-part series; focuses on EHR aggregated data)
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Maximizing Healthcare Efficiency: How Deviceless Remote Patient Monitoring Saved a Physician-owned Practice $1.4 Million | How Mankato Clinic deployed Deviceless Remote Patient Monitoring to engage thousands of patients across chronic and mental health conditions and catch patients before conditions exacerbated | | |
How Buena Vida y Salud ACO uses predictive targeting to help keep patients healthy at home |
How the system of Buena Vida y Salud ACO navigates complexities of rising costs and utilization of their aging patient population | | | |
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Your ACO Guide to Targeting Costs with Data-Driven Strategies:
Best Strategies for ACO Cost Control with Quality plus Claims Data
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The types of data that ACOs have available to them for targeting avoidable costs, and which strategies make the biggest gains
(Part two of a three-part series; focuses on quality measure data)
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Check out our Webinar Archive to view past webinars on a variety of value-based care related topics! | | | |
APG Spring Conference 2024 | May 29 - 31, 2024 | San Diego, CA |
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Virtual Fifth National Medicare Advantage Summit | July 9 - 12, 2024 | Virtual | | | |
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Platinum Level Exhibitors
Thank you to our Platinum Level exhibitors! These organizations offer the absolute highest quality products & services to the value-based care community. To learn more & visit their interactive booths, click on the logos below:
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Gold Level Exhibitors
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Find out how your organization can be featured here and receive additional benefits including a customized booth on our website, social media campaigns, hosted and marketed webinars, an interactive session with top-level VBC executives and consultants, and more! Click here! | |
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