Financing Integrated Social Services for the High-Need, High-Cost Population: Webinar and Resources

Caring for high-need, high-cost patients requires providers to think beyond traditional clinical settings and address the social determinants of health. Yet integrating social services into health care can be a daunting challenge that requires a clear understanding of the target population, available resources, and an effective integration model. 

Building upon the social services integration framework shared in the HCTTF’s first webinar, Integrating Social Services into Care for the High-Need, High-Cost Population, this presentation explores models for financing integrated social service models from the perspectives of two innovative provider organizations.

View the webinar recording.

Download the slide deck.

The Transformation to Value: A Leadership Guide

Webinars:

Transformation to Value: A Provider Perspective
(October 17, 2017 3:00-4:00pm ET)
Featuring Jason Dinger, Chief Innovation Officer of Ascension Health and Rick Gilfillan, MD, CEO of Trinity Health
Listen to the recording.
Download the presentation.

Transformation to Value: A Payer Perspective
(November 2, 2017 4:00-5:00pm ET)
Featuring Kevin Klobucar, Executive Vice President of Health Care Value, Blue Cross Blue Shield of Michigan and Brigitte Nettesheim, President, Transformative Markets, Aetna
Listen to the recording.
Download the presentation.

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Health care industry leaders face incredible challenges in shifting from traditional, volume-driven fee-for-service to value-based payment and care delivery.  The Health Care Transformation Task Force has created a framework to help guide decision makers in their transformation journeys, along with insights from organizations at the vanguard of value.

(PDF version of the Strategy Framework)

Press Release

Full Report

Read the individual reports:

Introduction: Strategic Framework

Health care industry leaders face incredible challenges in shifting from traditional, volume-driven fee-for-service to value-based care. While the public discussion is often about specific value-based payment models, the broader transformation challenges to becoming a truly value-based organization receive much less focus. Committed organizations must often make significant changes to their strategic direction and operating structures, yet leaders don’t always have a clear precedent on how to successfully guide their organizations through these changes.

The Task Force’s Path to Transformation Advisory Group created the Dimensions of Health Care Transformation Strategic Framework (“Framework”) to assist health care leaders as they design and implement their transition to value. The Framework is built on the collective experience and wisdom from organizations that are at the vanguard of value-based payment and care delivery. It reflects introspective questions that change leaders should ask in building out an effective transformation strategy. Read our introductory report to learn more about the Framework.

Strategy and Culture

Successfully changing the culture within all levels of an organization is critical to support value-based payment and care delivery, but also one of the biggest challenges in successful transformation. Culture change involves buy-in across an entire organization (i.e., clinicians, executives, administrative staff, and affiliated partners). This requires an overarching vision for transformation, dynamic and experienced leaders, and an appropriate level of organizational integration and local leadership buy-in to successfully transition within each market. Read the report to learn more about how organizations have addressed strategy and culture change in their own transformation journeys.

Structure and Investments

Structure and investments are critical to the transformation journey because they encompass the physical infrastructure and human capital requirements needed to successfully build a value-based delivery system. Finding the right balance of resources to invest in can be extraordinarily challenging, especially for organizations that are new to value-based care. Many of the executives interviewed discussed the importance of identifying highly skilled, experienced leaders to assist with the transition process. With experienced stewardship, organizations can successfully stand up their value businesses and invest intelligently in infrastructure and resources. Read the report to learn what our leaders had to say.

Operations and Accountability

For organizations that are on the path to value, making the right investments in operations and developing effective mechanisms for accountability can determine success or failure. The Task Force identified three key elements: operational alignment, financial incentives, and quality measurement. Operational alignment ensures that value objectives are managed across lines of business. Financial incentives encourage momentum and commitment from staff toward achieving common value goals. Quality measurement means effectively evaluating and measuring progress toward those value goals. Read the report to gain insight into the successes and lessons learned from transformation leaders.

Performance Management

In the fourth and final dimension of the Framework, the Task Force highlights two key components: Process and Outcomes Evaluation and Financial Modeling. Evaluating progress toward value-based care is critical for the long-term sustainability and success of any value-based initiative. Understanding when to discontinue a program due to financial unsustainability and/or poor outcomes can be just as important as identifying which programs are most likely to yield the best results and returns. For details on how organizations are evaluating progress and making informed decisions on the future of their value-based programs, read the report.

Project Background

Shifting from traditional, volume-driven fee-for-service to value based care is highly challenging, even for the most sophisticated businesses. Health care organizations committed to transforming to value-based payment and care delivery models must often make significant changes to their strategic direction and operating structures. How much work needs to be done to achieve value transformation, however, depends on many factors such as level of commitment, organizational complexity, cultural dexterity, level of change currently underway, and desired goals.

Transformation can be risky, even for those who are further along the transition to value continuum. Organizations must weigh a multitude of variables in their planning processes, and often use internal vetting practices that draw upon both internal and external shared learnings as well as return on investment (ROI) calculations to align transformational goals with current business models. In particular, shared learnings from businesses that have implemented value-based care programs are critically important to help other organizations successfully navigate opportunities and pitfalls.

The Task Force’s Path to Transformation Advisory Group created the Dimensions of Health Care Transformation Strategy Framework (Framework) to assist health care leaders as they design and implement their transition to value. The Framework is built on the collective experience and wisdom from organizations that are at the vanguard of value-based payment and care delivery. It reflects introspective questions that change leaders should ask in building out a transformation strategy.

The Framework also provides the foundation for a series of interviews, and subsequent analysis, that the Task Force conducted to provide additional context on the path to transformation continuum and allow decision makers to benchmark themselves against similar organizations that are actively moving toward value-based care.

Dimensions of Health Care Transformation Framework

The Framework helps organizations assess their transformational maturity across a set of business dimensions (vertical axis) in which they can expect to make transformative changes through three levels (horizontal axis): (1) concept; (2) execution; and (3) sustainability. This Framework charts a course for how organizations can be successful in culturally, structurally, and operationally transitioning to value-based care.

The Framework’s current business dimensions are intended as a core set, with additional dimensions added as appropriate. The example questions and categories provided represent activities that may or may not be happening simultaneously, rather than prerequisites that must be met before an organization may move to the next level. In sum, the Framework is intended to be a dynamic tool, with additional dimensions added over time.

The first level – concept – assesses the needs of the communities or markets to be served and how health care organizations can best tailor value-based care models to serve those needs. Due to the complexities of value-based care arrangements, the concept stage requires education of, and buyin from, leadership groups and an organizational commitment to the culture change necessary to effectively implement value-based care models.

The second level – execution – involves delivering on an action plan for change, including setting a course and timeline for transitioning from fee-for-service to value-based payment models. The leadership education and buy-in from the concept stage is now shared more broadly with the organization. Cultural and operational plans are established to ensure alignment and to promote organizational accountability so that internal teams move toward achieving common goals on consistent timelines, with an established feedback loop to promote continual improvement. All dimensions from the concept stages are now operational and individual/team incentive plans – financial, cultural and/or operational – are in place to tie personal accountability to organizational commitment.

The final level – sustainability – envisions an ideal end state of organizational transformation that reflects aligned goals and objectives, as well as measurable progress toward lower costs and improved quality, outcomes and patient experience. Within the sustainability level, operational scale is achieved consistent with the desired organizational plan, but is not viewed as satisfactorily sustainable by itself.

For most organizations, “sustainability” is an aspirational destination that has not yet been fully achieved. Thus, the definition and specificity of what it means to sustain transformative efforts will likely evolve over time and will be subject to continual advancement/refinement. One constant, however, is the need for continuous improvement to remain successful in providing high-quality, affordable person-centered care.

Health care organizations’ ability to move along the transformation continuum is often dependent on external factors over which the organization has little direct control. External factors may include state insurance regulations; federal policies and requirements; local health information infrastructure; and willingness from others to partner in value-based arrangements. The confluence of these factors will dictate the overall readiness of local markets to support value-based care and will play a large role in whether organizations are able to pursue value transformation

At present, the Framework does not seek to identify specific external factors as prerequisites for, or potential impediments to transformation; rather, it recognizes that the speed and scope of transformation may be restricted by the current ecosystem in which individual health care organizations operate.

Methodology

The Task Force created the Dimensions of Health Care Transformation Framework to assist health care leaders as they design and implement their transition to value. The Framework is built on the collective experience and wisdom from member organizations that are at the vanguard of value-based payment and care delivery. It reflects questions that change leaders should ask themselves in building out a transformation strategy. The Framework was developed from a series of working sessions with the Task Force Path to Transformation Advisory Group, consisting of Task Force members, over a period of several months.

The Task Force used the Framework dimensions to craft an interview guide for members. Task Force staff sought participation from members of the Path to Transformation Advisory Group. Members had the option of participating via phone or through a written response to the interview guide. In total, the Task Force conducted interviews with 12 member organizations, corresponding to over 20 hours of interviews, and received four written responses. The breakdown was as follows:

• 3 payers (two national, one regional)
• 9 providers
• 3 partners (guide providers through value transformation)

Following interview transcription by a professional transcription service, the transcripts and written responses were qualitatively coded using Dedoose, an online coding platform, to highlight and organize key themes among member experiences and observations across each dimension. Task Force staff also completed a summary analysis to enable comparison of approaches and results for similar member organizations. All quotes in this report draw from these interview and written transcripts.

In case you missed it: Learn about common strategies of high-performing organizations in our Levers of Successful ACOs report.

Task Force Provides Input on CMS Proposed Rulemaking on CY 2018 Updates to the Quality Payment Program

The Task Force provides input on the CMS–5522–P:  Medicare Program; CY 2018 Updates to the Quality Payment Program proposed rule addressing the Merit-based Incentive Payment System and Alternate Payment Model Incentives.

Read the full input here

Read more here about our MACRA letter in Modern Healthcare

Task Force statement to the PTAC

As a broad-based group of 43 health care stakeholders representing patients, purchasers, payers and providers, the Health Care Transformation Task Force (HCTTF) strongly supports the transition to value-based payment and care delivery. The HCTTF supports the important work of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to advance development of additional alternate payment models in Medicare. To show support for this initiative, the HCTTF developed a statement on the PTAC which offers recommendations to make the PTAC even more effective.

Read the statement

State Innovation Spotlight: Implementing Multi-Payer Bundled Payment Models - Webinar & Resources

Three states – Arkansas, Tennessee, and Ohio – have implemented bundled payments for the Medicaid population to better control episode cost and quality, while aligning incentives across commercial payers to promote efficiency for participating providers. Our environmental scan of active state bundled payment models identified common episode design parameters including benchmark methodology, episode initiators, and evaluation standards across the states that have implemented bundled payments. However, each state took a unique approach to engaging providers and payers in the transformation. This webinar provided an in-depth case study of the experience in Arkansas, including lessons learned from the process of designing a multi-payer bundled payment program, and integration with other value-based payment models, the payer perspective on participating in the design of bundled payment models in Ohio.

View Presentation Slides

View the Webinar Recording

Additional Resources:

State Bundled Payment Models

State-by-state comparison of active bundled payment programs, including episode methodology and lessons learned from program implementation.

Task Force Comments on LAN Draft White Paper: APM Framework Refresh

In a letter to the LAN’s Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group, the Task Force provides considerations for the refreshed APM Framework.

Read the comment letter

Task Force submits a statement for the record on the CHRONIC Care Act of 2017

The Task Force submitted a statement for the record on the recently reintroduced CHRONIC Care Act of 2017. The Task Force’s statement touches on a number of issues, such as expansion of value-based insurance design, supplemental benefits for Medicare Advantage enrollees, telehealth flexibility, voluntary ACO alignment, and lowered out-of-pocket cost burden for ACO beneficiaries.

Read the statement.

The Task Force provides response to CMS regarding Request for Information on Efficiencies and Flexibilities

The Task Force responded to the Request for Information included in CMS-1677-P: Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Proposed Rule. The ability for providers to be successful in value-based payment models depends on several factors, and one key factor is the capacity to operate under a regulatory framework that is conducive to effective, efficient, patient-centered and high-quality care. The Task Force identified areas of existing Medicare regulatory structures that were designed to support a fee-for-service payment environment that focused on individual service delivery and are not ideal or necessary to support a modernized, value-based world which focuses on greater coordination and integration of care.

Read the full statement here.