MCO Perspectives on Value-Based Care
Community Health Plan of Washington, Molina Healthcare of Washington and Amerigroup share insights on the shift to value-based care and what it means for Southwest Washington.
One of Washington State’s goals for Accountable Communities of Health, including SWACH, is supporting the shift toward value-based purchasing, also known as Value-Based Payment (VBP). VBP incentivizes healthcare providers for quality and outcomes, rather than the traditional approach of paying providers based on the number of patients they see. The goal is to support the triple aim of better health, better care and lower costs. And it’s an important topic for Medicaid providers, given that the state aims to drive 90 percent of state-financed healthcare to value-based models by 2021.
Managed Care Organizations are a key partner in this effort, as they serve the majority of the state’s Medicaid members. To learn more, we spoke with representatives from three plans serving Southwest Washington, including Connie Mom-Chhing and Kat Latet of Community Health Plan of Washington, Victoria Evans of Molina Healthcare of Washington and Caitlin Safford of Amerigroup.
What does the shift to value-based payment (VBP) mean for MCOs and their members?
All three organizations see VBP as an opportunity to improve the whole health of their members, create flexibility and innovation opportunities for providers, and control costs.
From Safford’s perspective, the shift to VBP “creates an opportunity to promote high quality healthcare for our members and allow providers more flexibility to be innovative in how they deliver that care.”
Latet adds that “VBP allows us to focus more on the concept of team-based care, where providers work together and have the flexibility to determine how they can support whole health. We also hope that VBP can support achievement of the quadruple aim (better health, lower costs, better patient experience, and improved clinician experience.)”
Evans explains that shifting from volume- to value-based payment models “enables better alignment between providers and Molina around improving the health of members.” She emphasizes that creating a sustainable value-based ecosystem requires more than changing how providers are paid for services. It’s “a fundamental change in both the models of care, and the very delivery of care.” That fact underlies Molina’s choice to use the term Value-Based Care (VBC), rather than Value-Based Payment.
How will consumers and Medicaid members experience the shift toward VBP?
In terms of the direct impact on the patient experience, Evans explains that “patients who are seen by a VBC provider should experience improved access to care, care coordination and care management support and improved health outcomes.”
Safford adds that it also depends on where a provider is on the VBP continuum. “In the early stages, it won’t look very different for patients. However, as providers move further along the continuum, patients are more likely to see the focus on whole-person care and how their provider can connect with additional services.”
How does VBP support innovation?
The key to VBP-driven innovation, according the MCOs, is flexibility.
Evans explains that as reimbursement shifts from fee-for-service (volume), “providers have greater flexibility to implement new care delivery opportunities that may not have been reimbursable under the traditional system.”
Safford sees VBP allowing providers to look beyond traditional clinical encounters and “think more creatively about how and where they serve people.” For example, connecting them with support services to address social determinants of health such as education, transportation or employment. While these things happen outside of the walls of the traditional healthcare clinic, VBP may open the door for agreements between clinical and community-serving organizations, who can work together to overcome barriers to health.
CHPW’s Chhing is equally excited about opportunities to innovate. However, she also acknowledged that some providers lack capacity to test new approaches. That’s where Washington’s five year Medicaid waiver comes into play, she said. “The opportunity of the waiver is to invest in some of that initial testing, so we can demonstrate results and, hopefully, get to a place where VBP is reinforcing successful innovations.” The waiver provides up to $1.5 billion federal investment over five years for regional health system transformation projects that benefit Apple Health (Medicaid) clients.
How are MCOs partnering with SWACH to support providers during the transition?
Southwest Washington MCOs see ACHs (like SWACH) engaging in a variety of ways, as well as additional opportunities for the future. However, all three MCOs recognize that VBP is not a one-size-fits-all proposition.
Latet highlighted the importance of VBP readiness and collaboration with providers. “VBP is not something that is forced on to providers; it’s about building a relationship and developing shared goals. If providers are not ready for engaging in VBP, we will not be mutually successful.” She also underscored the importance of efforts by SWACH and the Washington State Healthcare Authority (HCA) to assess provider readiness. “This helps identify where we can help support capacity development among our providers.”
The MCOs also point to the potential for match-making and partnership development. “The ACHs can do a lot to help elevate the role and capacity of community partners,” said Latet.
Safford explains that SWACH, MCOs and providers can work together to “identify needs of specific providers and facilitate the creation of innovative partnerships that meet those needs.” For example, if a provider serves a high number of diabetics, the ACH could facilitate a relationship with an organization that provides healthy food. If successful, these types of strategies might be continued as part of a capitated contract with the MCO. She points to partnership opportunities between behavioral health and clinical providers as another example.
Evans gave several examples of how SWACH and Molina are partnering to support providers, including ongoing collaboration “to ensure that our respective VBC and transformation supports and efforts are well aligned and complementary.” For example, Molina partnered with SWACH to pilot PreManage/EDIE connectivity for behavioral health providers in the region. PreManage/EDIE is a technology that helps healthcare providers, social workers, and case managers coordinate care plans for high-needs, complex patients. Molina also shares a monthly dashboard with SWACH with data that offers a window into the current Medicaid Transformation performance measures for Molina members.
How do you see value-based payment impacting behavioral health or rural providers, and what supports are available to them?
MCOs recognize that the transition to VBP occurs on a continuum that’s influenced by a variety of factors, including location, capacity and readiness. Rural providers and smaller behavioral health practices were given as examples of types of providers more likely to need additional support.
Latet emphasized the importance of relationships between MCOs and providers. “it’s important to communicate, engage in assessments, identify gaps and, above all, speak up, be honest about where those gaps are and ask for help.” This helps plans work with providers and develop solutions.
Evans explained that behavioral health value-based incentive models are being created “to support provider practices in moving on their continuum of integration and innovation.” She adds that “Molina is committed to finding payment methods that support practices knowing each practice is in a different place as it relates to integration.”
Safford pointed to technical assistance offered by MCOs, while reiterating that it’s not a one size fits all solution. “We work to ensure that rural providers know they can be in a value-based arrangement. Sometimes that means providers working together. However, it’s often tailored to specific circumstances. For example, when there are fewer providers or hospitals, we may need to provide technical assistance up front around managing the population.”
Chhing described the role of partnerships and innovative solutions. For example, “opportunities to explore partnerships with other rural providers or even technology such as colocation or telepsychiatry.”