CMS Supporting Value Based Payment during COVID-19

The Center for Medicare and Medicaid Innovation released an updated summary table of adjustments related to Value Based Payment (VBP) models that reflect changes made by CMS for coronavirus-related services.
The summary table supplements emergency rules and waivers granted under section 1135. Included in this table are:

  • Bundled Payments for Care Improvement, Advanced
  • Home Health Value-Based Purchasing Model
  • Integrated Care for Kids (InCK) Model
  • Maternal Opioid Misuse Model (MOM), and
  • Primary Care First— Serious Illness Component.

SAE has VBP experience and can assist with identifying and synthesizing performance outcomes related to services during the pandemic, as well as recovery to “back to normal’ initiatives.

Implementing VBP involves structuring and formalizing services into a continuum and weighing the treatment outcomes to performance requirements with known risks and costs. At this time, services that improve outcomes for individuals and communities impacted by COVID-19 are essential to improve the financial health of organizations while allowing for expansion of treatment offerings. 

Preparation for a VBP agreement involves a deep knowledge and ability to analyze and communicate about:

  • clinical and demographic service population;
  • risks to overall care, risks to episodes of care, and risks to required outcome reporting;
  • operational cost of care;
  • projected cost savings based on provider performance and lowered population risk;
  • service definition in the bundled payment methodology;
  • metrics definition for performance reporting; and
  • revenue management with strong manage care engagement and contracting. 

Develop an understanding of VBP to your mission of service.

With COVID-19, VBP must also include services and outreach activities for vulnerable populations. Using a population health focus to address COVID-19 high-impact communities, measure the performance of teleservices to prevent gaps in care, address palliative and chronic care conditions to mitigate risk for acute care need and improve engagement to care. Additionally, ensure your new teleservice activities do not contribute to barriers-to-care experienced by vulnerable communities. Implement service tracking and monitoring with an understanding of qualitative data and social determinants of health. Get specific about how your team assists clients access teleservices for outcome improvement.

Metrics definition is essential to link services, outcome, risk, and cost at a macro level with the ability to drill down to episodes of care and projected cost savings. A quality improvement and oversight mechanism to track successes and vulnerabilities must be built into the metrics definition and allow for corrective actions and process change because a VBP arrangement is a continuously active and dynamic evaluation of outcome and services.

The Center for Medicare and Medicaid Innovation announced that the Performance Year 1 application portal for the Direct Contracting Professional and Global options is available at https://app1.innovation.cms.gov/dcrfa/dcrfaLogin

Applications for Performance Year 1 are due 7/6/20 by 11:59PM ET. The start date for Performance Year 1 will be 4/1/21. There will be a second cohort of Direct Contracting Professional and Global options that starts on 1/1/22. The application period for this cohort will begin in the first quarter of 2021. 

If you would like to explore how SAE can help you in this arena, email info@saeassociates.com to connect with our team.

Additional Resources:

SAE was very diligent, knowledgeable and savvy in their approach with this project. SAE assisted us during a very critical time of leadership transition with the Behavioral Health Division. SAE was able to respond promptly and guide us through the process of data collection, analysis, and finally to the final product of conceptualizing the value statement. This analysis, which blends clinical and financial analyses, was critical for the survival of at least one, but more likely, four of our behavioral health programs. I am extremely grateful to SAE for their warm and empathetic approach. I consider SAE part of the Goodwill Behavioral Health team, and we look forward to working with them again in the future. – Gloria Choi, Senior Vice President of Goodwill NYNJ