Value Based Payment

What is value based payment?
Healthier Washington is the Health Care Authority (HCA) program to achieve better health, better care, and lower costs through a collaborative regional approach that integrates physical and mental health care and pays for value instead of volume.  In order to shift the payment paradigm, the goal is to leverage Washington’s  purchasing power to drive 80 percent of state-financed health care and 50 percent of commercial health care to value-based payment (VBP) by January 1, 2019.  There are four value based payment models currently being tested in our state:

  • Accountable Care Program:  starts with public employees, with reimbursement based on performance across financial guarantees and Washington State Common Measures
  • Multi-Payer: leverages existing data and tools to support providers to coordinate and manage care and share risk across multiple payers
  • Physical and Behavioral Health Integration: accelerates delivery of whole-person care starting with Apple Health beneficiaries in Southwest Washington, making use of co-located services as well as care coordination between physical and behavioral health settings
  • Encounter-based to Value-based:  tests increased financial flexibility in Medicaid for Federally Qualified Health Centers, Rural Health Clinics, and Critical Access Hospitals to support expanded care delivery options like telemedicine.

Where are we now?
This means that in the coming years you will be paid based on health outcomes, or measures, rather that strictly fee-for-service.  Think of payment models as a continuum, with statewide VBP efforts enabling all Washington health care providers to move further along that continuum.  This involves risk sharing and incentives to reward providers for achieving quality.  The HCA convened a pediatric common measures workgroup to ensure the selection of appropriate measures for a pediatric patient population.

What’s next?
Washington State’s HCA has created a Value Based Road Map that outlines efforts for 2017-2021, with the goal of moving from 20% value-based payment in 2017-2021, with the goal of moving from 20% value-based payment in 2017 to 90% value-based payment in 2021.

Starting in 2017, there will be significant changes to Apple Health.  These changes include:

  • Managed Care Organized (MCO) contract requirement that a growing portion of premiums be used to fund direct provider incentives tied to attainment of quality
  • Time-limited funding under the Medicaid transformation waiver will allow MCO’s to earn financial incentives for achieving annual VBP targets
  • Starting in 2018 and annually thereafter, MCO accountability for each of these new contract components will grow progressively
  • A “challenge pool” to provide similar regional incentives for exceptional performance attributable to the broader participants in an Accountable Community of Health (ACH)

How P-TCPI can help you get ready
The first step to achieving your goals for the new payment paradigm is to learn how to report accurate, quality data.  We work with Molina Healthcare to get you quarterly, claims based data that will help you establish an accurate panel of your patients and assess your progress toward standard, HEDIS measures.  View a webinar on “Empanelment” with Jeff Hummel, MD; Beth Harvey, MD; and Phyllis Cavens, MD.

Resource: Value-Based Payment

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