Learn how health centers can pace themselves in the journey from fee-for-service payment to value-based payment.

1. Positioning FQHCs for
Value-Based Payment
The right changes at the right time.

2. Outline
• Understanding the “New World”
• An Introduction to Health Reform and Payment
Arrangements
• The World of Payers
• A Framework for Building Value-Based Care
• Patient-Centered Access
• Team-Based Care
• Population Health Management
• Care Management and Support
• Care Coordination and Care Transitions
• Performance Measurement/QI
• Tying it all together for value-based care

3. Objectives
• Attendees will be able to identify and define key terminology
commonly utilized in value-based payment arrangements.
• Attendees will learn the details of common value-based
payment arrangements and the challenges and opportunities
associated with the payment design.
• Attendees will learn operational strategies for positioning
facilities for value-based payment arrangements.

4. So What Is Value-Based Payment?
• It is a payment model that rewards providers
for meeting certain performance measures for
quality and efficiency. It often penalizes
caregivers for poor outcomes or increased costs.
• Also known as “pay-for-performance“ (P4P) or
“value-based purchasing”.
• Contrasted with “fee-for-service” (FFS) or
“volume-based payment”.
• ACA pushing towards VBP: ACOs and quality
links to payment.

5. Intro to Health/Payment Reform
• The Department of Health and Human Services (HHS)
focus areas:
• Payment Incentives: Tying payment to value through
alternative payment models;
• Care Coordination: Care delivery changes through greater
teamwork, integration, coordination of providers across
settings, and a focus on population health;
• Data and Technology: Harnessing the power of information to
improve care for patients (Burwell, 2015).
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

6. Intro to Health/Payment Reform
• CMS Goals: (Announced 1/26/2015)
• 85% of all Medicare fee-for-service
payments tied to quality or value
by 2016 (90% by 2018).
• 30% of Medicare payments tied to
quality or value through
alternative payment models by the
end of 2016 (50% by the end of
2018).
• First time in history!
80
60
37.5
15 12.5 10
15
20
37
55
47
40
2.5
10
12.5
15
20
25
2.5
10 12.5 15 20 25
2011 2014 2015 2016 2017 2018
Medicare Payment Goals
Category 4 Population-based payment
Category 3 Alternative payment models built on fee-for-
service architecture
Category 2 Fee-for-service with a link of payment to quality
Category 1 Fee-for-service with no link of payment to quality
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

7. Väth Consulting, LLC
For complete presentation, please contact Väth Consulting
at
vathconsulting.com or kyle@vathconsulting.com