At least that is what Don Lee, one of the organizers of the Value Based Payment Forward Conference, thought when he invited me out to cover it for my blog and social media. For those of you who are not familiar with Valued Based Payments (VBP) here is a quick definition…
Value-Based Payment (VBP) means a strategy that is used by purchasers to promote quality and value of health care services. The goal of any VBP program is to shift from pure volume-based payment, as exemplified by fee-for-service payments to payments that are more closely related to both quality and cost outcomes.
https://www.lawinsider.com/dictionary/value-based-payment-vbp
Rather than getting reimbursed per face to face visit you get reimbursed for the overall outcome of an assigned population. This is shifting the way healthcare and mental health is being delivered. The emphasis of the conference is that this method of payment is headed right for us and we need to be prepared. Previously hypothesizing how VBP’s might help with crisis mental health services, I was eager to spend two days in Buffalo, NY to take a deep dive into the topic. Here are themes that emerged..
Data, Data, Everywhere
I can’t even begin to count the amount of times I heard the word “data”. The emphasis on data becomes especially relevant when you try to assign a monetary value to it. Why should a health organization think an social intervention have “value” to begin with?… You guessed it…. It starts with data. Having a “data informed” intervention is not only key for measuring outcomes, it becomes imperative to the development of a value-based payment…
Similar to grant development, organizations need to think strategically about how they can use their data to fund unmet needs. Nonprofit organizations can not rest on data of simply describing numbers of persons served, they have to demonstrate that services can solve a specific healthcare problem. For instance if you are a homeless shelter entering a value based payment agreement, you need to not only need to think about the number of people housed but the potential health outcomes as a result. Easy enough…. right??
Who Gets To Define Value?
Things get messy here and quick. There were strong feelings about who gets to assign value to the importance of the data collected. Is it the Insurance company? Is it the nonprofit attempting to enter a value-based contract? Is it the communities themselves? Is it the hospital or small to medium size health system? Is it patients/caregivers?
This results in the pursuit to align all the stakeholders in an organized manner to define value. Again not so easy…
Attempting to align hospitals, payers, patients, providers, and community based organizations about what a “valuable” outcome is requires tough questions. This can be a challenge but it my contention that non-profits and community based organizations (CBO’s) can bring a ton of value to healthcare to improve outcomes. Presenters offered some frameworks on how to better define value…
The road to defining your value as an organization can be a messy one. But connecting these tough questions to the outcomes data is key. You can create a compelling outcome that your data my improve health outcomes. That introducing intervention X can save the health system Y amount of money. For instance a homeless shelter can demonstrate that providing a insurance member with housing was cheaper than an inpatient stay. However there is one last even more complex hurtle…
Who Defines “The Problem”?
Let’s keep going with interventions for homelessness. Payers may view the cost savings as a “win”. A hospital system might not care as they need the inpatient stay to generate revenue. The endocrinologist that entered into the value-based payment might not care as it may or may not improve the patient’s diabetes. Not only is a clear definition of value difficult to define but the problem(s) in which the intervention is trying to solve needs to be aligned.
This is were I think social work can play a role. We are problem solvers and system thinkers. We are trained to assess complex systems (whether it is family or communities) to produce a positive outcome.
If the Value Based Payment Forward Conference is any indication, we are in for some complex times in healthcare reform. We need to think not in silo’s but in partnership in how we can better serve those in need. As presenter Dr. Alisahah Cole of Atrium Health pointed out, we continue to understand data about underserved populations we have to ask tough questions…
Where healthcare reform takes us is going to require tough answers to even tougher questions. It is going to take innovative collaborations to improve outcome, define value, and more importantly solve “the problem”.
For more tweets and insight from the conference check out my summary via Wakelet:
