Master the Business of Healthcare

This module focuses on the history of Value Based Contracting from the passage of the Social Security Act, the creation of CMMI via the Affordable Care Act and the move from one sided risk to two sided capitation as seen in ACO REACH. We will explore the basic building blocks to understand success in two sided risk including quality, technology, care delivery, marketing and financial modeling. At the conclusion participants will be able to understand and synthesize: 

• Key milestones in the move from fee for service to value based contracting
• Essential concepts to creating successful value based contracting programs
• Predictive trends to succeed in the next five years

To create a successful government VBC, it's essential to understand how the ACO and providers are compensated from CMS. In this module we’ll explore the differences in payments between fee-for-service through to capitated arrangements. Focusing on the ACO REACH model we’ll also examine the key differences between a participating provider and a preferred provider and what that matters for payments as well as building a “network”. At the conclusion participants will be able to understand: 

• Payment methods from federal and state entities for FFS vs VBC
• Key concepts in payments including: benchmark, risk scoring, upside and downside risk, 
• Differences and impact between participating and preferred providers 

Counting providers and beneficiaries A core concept in VBC is that a primary care provider is “accountable” for a population of beneficiaries. How do you “count” who’s accountable? In this module we’ll explore the basics of how attribution works, particularly in the ACO REACH model. This is a fundamental building block to being able to create strategies in areas such as: building provider “network”, financial modeling, marketing and communications for prospective and existing  beneficiaries and providers, technology and reporting. At the conclusion participants will be able to understand: 

• What is an “accountable” relationship?
• The fundamentals of provider attribution
• The fundamentals of beneficiary attribution and voluntary alignment

To create financial models, compensation plans and non clinical care priorities, At the conclusion participants will be able to understand: 

• How CMS determines the total cost of care, 
• What factors go into “risk adjustment” and acceptable methods for increasing the documented risk score
• How payments and benchmark are different in the ACO Reach professional versus global models 

While the word “network” has fallen out of favor, the new value based models absolutely require payviders to build a planful group of contracting participating and preferred providers. This module will examine fundamental components of successful contracting and partnerships across the continuum of care. Participants will understand:

• The fundamentals of PMPM payments based on having high percentages of contracted providers
• Important basics of successful REACH contracting and provider communications
• Building a high performing network aligned with care priorities from the pool of participating providers

This session will demystify provider compensation in value based contracting. VBC gives an opportunity for providers to earn more (not less) than fee for service, but most ACOs either don’t know how or choose not to pay providers more. Knowing that having the highest quality primary providers is fundamental to the best care and experience as patients, the session will explore how to build compensation in line with mission. 

• How contracting looks from the provider perspective
• How contracting looks from the practice management perspective
• How contracting looks from the pay-vidor perspective
• The current market for VBC  contracts

The module will go into three areas essential to understanding government value based contracting : quality reporting, health equity and the annual patient satisfaction surveys. At the conclusion participants will be able to understand: 

• Key metrics for quality reporting 
• What is health equity as defined by CMS/ implementing a health equity plan
• What is CAHPS, why it matters and how to impact results 

Having established an understanding of the main building blocks of success in VBC, this module will focus on how to put together an end-to-end set of technology solutions that meet the needs of all the major stakeholders including the patient experience, rev cycle management, attribution, quality reporting and provider relations. 

• The essential pieces of technology needed to run a successful VBC
• A look at the current market of products and services 
• Challenges and opportunities to grow revenue producing products 

In the move from volume to value, healthcare will me moving to a health system without walls. This provides an opportunity to find new ways to deliver care in new locations, different modalities, and using available beneficiary enhancement and beneficiary engagement tools. From this session, participants will understand:

• The difference between beneficiary enhancements and engagement tools
• How to use these optional goodies for maximum results
• Communication and workflow- integrating these tools into practices with members who do and those who do not have APM coverage 

Voluntary alignment is the magic of how marketing dollars and efforts can be used to improve outcomes and experience while supporting patient choice. From this module participants will understand:

• What is voluntary alignment vs claims based alignment
• How to use alignment and education opportunities to empower beneficiaries.
• Fundamentals to create a marketing plan to reach health nomads.