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AACHC | 700 E. Jefferson St., Suite 100 | Phoenix, AZ 85034
Main: 602.253.0090 | Fax: 602.252.3620 | www.aachc.org
Value Based
PurchasingHealth Center Readiness
AACHC Quality Improvement Committee
February 19, 2016
Value Based Purchasing
October’s Discussion
Who/what is driving Payment Reform
Defining “Value” in today’s health care
environment
Health Center’s “Value Proposition” in light of
HEDIS data analyzed by CHiR
Example of a VBP Model incorporating P4P and
Shared Savings
Value Based Purchasing
Today’s Agenda
Revisit the “Value” equation
Elements of Quality and Cost and
Current Payment Methodologies
Assessing Health Center Readiness for
Value Based Purchasing
Defining Value in
Health Care
The Value Equation
Value can be thought of as a simple math
equation:
Identifying/Measuring the
Quality Variable
Example: Your first automobile
Model/Style
Performance
Fuel Economy
Features
Safety
Maintenance
Eco-Friendly
Functionality
What is Quality, Cost, and Value
in Health Care?
Quality is the “outcome” of the health care
services we received
Are we and/or the payer satisfied with the way we were
treated?
Did we get the care we needed to be as healthy as
possible given our health status?
Cost is what we or the payer pays for care
Value is the relative measure of the outcomes
given what was paid for those outcomes
Are we satisfied that we are as healthy as we should
expect given the treatment that was provided?
The Value Equation for
Health Care
Value in Health Care : Is a function of the
cost of delivering outcomes through multiple
providers
Elements of Quality & Cost
and Payment Methodologies
Measuring Outcomes in the
Continuum of Health Care
Clinical Quality Measures – various data
sets
Physical/Oral/Behavioral Health Care
Integration within the PCMH
Care Coordination across the Medical
Community – Access to Care
Patient/Family Engagement
Patient Satisfaction with Service Delivery
Payment for Performance
Measuring Cost Effectiveness
in the Continuum of Care
Preventative Screening and Diagnosis
Rx Reconciliation
Integrated Clinical Team Health Management
Eliminating Duplicative Services
Providing Cost-Effective Alternatives to ER Visits
Reducing Risk of Hospital Admissions &
Readmissions
Engaging Patients in Self-Management
Payment for Cost Savings
Transforming Clinical Practice
to Value Based Care
FFS
Visit
Value
Fee-for-Service – line item reimbursement
PPS Rate – All services “incident to” a Health Center visit
Pay-for-Performanceand community-wide Shared Savings
Assessing Readiness for
Value Based Purchasing
NACHC’s Payment Reform
Readiness Assessment Tool
Supports health center’s success in service
delivery transformation and payment reform
models
Identifies key competency areas needed for health
center engagement
Helps the health center assess its current state of
readiness
Helps the health center identify areas for improvement
Helps the Alliance and NACHC develop/provide training
and technical assistance
Engaging the Right Staff
Assessment Tool Structure
Areas of Competency
Four Domains key to payment reform readiness:
Organizational Leadership and Partnership Development
Change Management and Service Delivery
Robust Use of Data and Information
Financial and Operational Analysis, Management and Strategy
37 Assessment Elements: Seven-eleven descriptive statements, within each competency area, to assist the health center identify its level of readiness
Assessment Tool Structure
Rating Scale
Example
Organizational Leadership & Partnership Development
Example
Change Management
AACHC – March 2016
Baseline Assessment
Involve Leadership and Key Staff
There is no “right answer” or expected readiness
level
Assessment results will not be used to assess
health center performance or compliance
Answering openly and frankly will allow your
health center, the Alliance, and NACHC to identify
useful next steps or questions
Contact Information:
Ginny Roberts
Director of Managed
Care
AACHC
ginnyr@aachc.org
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