Value Based Payments are an important part of Managed Care in Healthcare. This is presentation provides basic information about how Value Based Payments #VBP work in Managed Long Term Services and Supports #MLTSS, Behavioral Health #BH

1. Value Based Payments
ARE in Your Future
OCTOBER 2, 2018

2. Agenda
What Brings Us Here
Who is XtraGlobex
What is the Value Based Payment Continuum
What is VBR in Pennsylvania – HeathChoices, Behavioral Health
Where is the Future – MLTSS, I/DD
How to Prepare
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 2

3. What Brings
Us Here
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 3
Managed Care is established in over 23 states
Managed Care Implemented in Physical Health,
Behavioral Health, LTSS and I/DD
PA Managed Care has Value Based Payments in
Physical Health and Behavioral Health
PA MLTSS Roll Out is Underway
PA I/DD Managed Care Discussions Are On-Going

4. 1700 Market Street, Suite 1005, Philadelphia, PA 19103n 856 397 5040n Fady.Sahhar@XtraGlobex.com
Creating Your Exceptional and
Sustainable Competitive Advantage
XtraGlobex is a consulting firm that provides strategy, analytics and communications services
to organizations specializing in healthcare, community-based and professional organizations
serving the Medicare and Medicaid populations and Long Term Services and Supports. We
work with our clients to create exceptional and sustainable competitive advantage, turning
existing challenges into positive solutions and future hurdles into launchpads for growth.
XtraGlobex is a certified WBE and DBE

5. What Are Value Based Payments
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 5
• NOT Payment for Volume
Payment for Value
• NOT Payment for Units / Quantity
Payment for Quality
• NOT Payment for Activity
Payment for Outcomes

6. The Transition From Pay-For-Volume to
Pay-For-Value
About 40% of 2014
commercial health
plan reimbursements
to provider
organizations linked to
value-oriented
initiatives; compared
to 11% in 2013
Encourages the use of
new treatment
technologies and
tech-enabled
platforms for service
delivery
Fee-For-Service
Case Rates &
Bundled
Payments
Capitation &
Population
Payments
Pay-For-
Performance
(P4P)

7. Business Model Transition For Provider Organizations
Payer Policy
Pay-For-Cost/Volume
Payer Policy
Pay-For-Value
Business Model:
What is paid for is
good for the
consumer and is
doing more
Business Model:
Giving the
consumer (and
their payer) good
outcomes at a low
cost, conveniently
A Revolution In
Performance
Management
Required
June 6, 2017 XTRAGLOBEX CONSUMER ENGAGEMENT 7

8. The VBP Continuum
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 8
Payment for
Process /
Alternative
Payment
01
Payment for
Performance
02
Bundled
Payments
03
Payment for
Outcomes
04
Shared Risk
05

9. Pay For Process / Alternative Payments
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 9
Recognizing the Payer’s Most
Desired Process
• Processes as a way of providing the
service
• Processes as repetitive and
predictable
• Processes are trackable and
reported
• Processes can be monitored and
improved
Payments for Uniquely
Credentialed Staff / Organizations
• Individuals / leadership
• Organizations

10. Pay For
Performance
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 10
Performance
Standards Desired
By the Payer
Achievement of Process
Measures – e.g. Time
for Completing Activity /
Frequency of Reporting
Consistency in Providing
Services – Length of
Time in Waiting Room /
Shifts Filled
Quality of
Communications
Indicators of
Efficiency
Utilization vs
Authorization Rates
Staff Turn over ratio
Accuracy of Billing

11. Bundled
Payments
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 11
• Doctor Visit Example
• Family Services in Behavioral Health
• A combination of PAS and Skilled Nursing after ED Event
• Traditionally – focused on episodic / sub-capitation
A collection of Related Services Delivered Together
Bundles within Single Provider Contracts
Bundles with Network of Providers
Usually based on Fee For Service Structure
Discrete and Trackable

12. Pay For
Outcomes
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 12
Results Focused – Payment Based on Payer Objectives
Usually structured as withhold / bonus payout
Involves a level of Risk
Outcomes have to be very specific and controllable!
Cannot get credit for what you do not do or control!
Involves a Level of Risk that should be based on data!

13. Shared Risk
Models
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 13
• Payers WITHOLD
• A PORTION OF PAYMENT
• with an UPSIDE
• Based on DELIVERY and COST!
Providers Share in the POTENTIAL SAVINGS!
Delayed Payments / Bonuses
Rigid Standards for Benefits
Detailed!

14. /
VBR in Pennsylvania
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 14
Well Established
in Health Choices
Rolling Out in
Behavioral Health
Choices – Moving
To Higher Levels
of Risk Sharing –
Network
Management
Opportunities
VBR / Alternative
Payments USED
by all 3 CHC
MCO’s
•Employment Services
•Nursing Home
Transition Services
•Transportation
•Service Coordination
Managed Care in
I/DD

15. Community HealthChoices Update
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 15
Rolled out on January 1,
2018 in 14 SW PA Counties
– 80,000+ Participants,
16,000+ Community
Scheduled on January 1,
2019 in 5 SE PA Counties –
130,000 Participants,
40,000 Community
Challenges:
Consumers Receiving
Services – Minimal
interruptions
Providers Getting Paid –
Improving
Service Coordination
Systems and Authorization
Changing Role of Service
Coordinators
Ancillary Services and
Transportation

16. Customer Satisfaction & Consumer
Experience Monitoring
Focus:
Assess ability to
obtain frequent
consumer
feedback through
easy, non-
obtrusive methods
Key Competencies for Success
Survey tools and processes for obtaining
consumer feedback on the consumer
experience including:
 Access to care
 Facilities
 Interactions with staff
 Effectiveness of treatment
 Net promoter score (consumer
willingness to refer other for
treatment)
June 6, 2017 XTRAGLOBEX CONSUMER ENGAGEMENT 16

17. Clinical Outcomes Tracking – By Consumer
Type & Provider Organizations
Focus:
Ability to track
and analyze
outcomes, identify
options to improve
services, and
quickly change
processes
Key Competencies for Success
 Systems in place to measure clinical
quality of care, patient experience
and service cost measures
 Transparent process to publicly report
outcomes
 Collaborative efforts to identify
performance improvement initiatives
June 6, 2017 XTRAGLOBEX CONSUMER ENGAGEMENT 17

18. NQF National
Core
Indicators –
Aging
&Disabilities
❖ Community participation
❖ Choice and Decision Making
❖ Relationships
❖ Satisfaction
❖ Service Coordination
❖ Care Coordination
❖ Work
❖ Self-Direction
❖ Access Health Care
❖ Medications
❖ Wellness
❖ Rights and Respect
❖ Safety
❖ Everyday Living
❖ Affordability
❖ Future Planning
❖ Control

19. Getting Ready for VBP
Understanding
Processes
Infrastructure
Costs
Quality Measurement and Improvement
Leadership
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 19

20. Understanding Your Processes
Define Key
Processes in
Your Operations
1
Process
Mapping
2
Accountability
3
Process
Streamlining
4
Process
Improvement
5
October 2017 XTRAGLOBEX VBP READINESS 20

21. Understanding Your Infrastructure
Physical
Infrastructure
1
Technology
Infrastructure
2
People
Infrastructure
3
October 2017 XTRAGLOBEX VBP READINESS 21

22. Understanding Your Costs
Beyond
accounting
Aligning
Processes and
Costs
Structural
Costs
Capital Costs
Operational
Costs
Accountability
for Costs
October 2017 XTRAGLOBEX VBP READINESS 9

23. Getting Ready
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 23
Know Your MarketKnow
Know Your ConsumerKnow
Know Your Priorities / Strategic DirectionKnow
Know Your Operations / MeasuresKnow
Know Your Quality / MeasuresKnow
Know Your Costs / Financial Position / MeasuresKnow
Know Your Leadership / MeasuresKnow
Know Your People / MeasuresKnow

24. Onward!
1 7 0 0 M A R K E T S T , S T E 1 0 0 5 , P H I L A D E L P H I A , P A 1 9 1 0 3
F A D Y . S A H H A R @ X T R A G L O B E X . C O M ( 8 5 6 ) 3 9 7 - 5 0 4 0
10/2/2018 RCPA - VBP ARE IN YOUR FUTURE 24