National Council For Behavioral Health: State Medicaid Perspectives on Value-Based Purchasing Laura Kate Zaichkin Deputy Chief Policy Officer Washington State Health Care Authority 1
HCA: Purchaser, Convener, Payer Purchases health care for over 2.2 million people through Medicaid and PEBB Spends $10 billion annually Large network overlap between programs Value-based purchasing mandate 2
HCA: Purchaser GOAL: Move 80 percent of state-financed health care to value-based payments AND 50% of the commercial market by 2020. Increase the use of value-based contracting for Medicaid and public employee purchasing. E2SHB 2572 3
Federal and Washington State Purchasing for Value Goals Healthier Medicare WA 50% 30% In 2016 at least 30% of Medicare payments are linked to quality and value in Alternative Payment Models (APMs) or VBP arrangements. 50% In 2018 at least 50% of Medicare payments are so linked. These payment reforms are expected to demonstrate better outcomes and lower costs for patients. 4 In 2019 at least 50% of commercial health care payments are linked to quality and value in Alternative Payment Models (APMs) or VBP arrangements. 80% In 2019 at least 80% of state-financed health care payments are so linked.
CMS Alternative Payment Model Framework http://hcp-lan.org 5
HCA as First Mover for Delivery & Payment Reforms Lead by Example: Public Employee & Medicaid Payment (2.2M) Common purchasing approach VBP RFI (April 2014) Medicaid: Integrated payment reform, Health Homes State Employees: Accountable Care Program Leverage Clinical Policy Expertise & Purchasing Power through State Contracts 80% network overlap Core Measure Set Evidence-Based Clinical Guidelines High cost drugs (Hep C) Shared Decision Making Medicaid: No payment for early elective deliveries (July 2015) State employees: TJR bundle, 2017 Multi-Purchaser Market Convener Encourage purchasers to adopt value-based payments Align public and private purchasing expectations and payment strategies WHA ACO Purchasing Guidelines 6
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Key Strategies Purchase high-value care 4 Payment Redesign Models with clinical and financial risk, starting with Medicaid and PEBB Fully integrated managed care Accountable Care Program (ACP) for PEBB members, 2016 and expansion 2017 Puget Sound High Value Network UW Medicine ACN Total Joint Replacement COE for PEBB members, 2017 Virginia Mason Medical Center selected Engage purchasers, providers and payers to accelerate transformation Medicaid Transformation Waiver Clinical integration of physical and behavioral health Price and quality reporting Spread and scale ACP program to other purchasers Convene multiple payers to encourage alignment Align with federal VBP movement CMS Goal: 50% of Medicare in Alternative Payment Models by 2018 Medicare Access and CHIP Reauthorization Act (MACRA) Adopted Learning Action Network (LAN) Alternative Payment Model Framework for HCA Paying for Value Survey Highly connected and engaged in LAN and various national committees Help accelerate payment models 8
VBP Driving System Transformation Status Quo (Volume-Based) System Fragmented clinical and financial approaches to care delivery Uncoordinated care and transitions Unengaged members left out of their own health care decisions Variation in delivery system performance (cost and quality) with no ties to clinical or financial accountability and transparency 9 Transformed (Value-Based) System Integrated systems that pay for and deliver whole person care Coordinated care and transitions Engaged and activated members who are connected to the care they need and empowered to take a greater role in their health Standardized performance measurement with clinical and financial accountability and transparency for improved health outcomes
Contact: Laura Kate Zaichkin, Deputy Chief Policy Officer laura.zaichkin@hca.wa.gov 360.725.1635 www.hca.wa.gov www.hca.wa.gov/hw 10