Value-Based Payment (VBP) models are rapidly transforming the healthcare landscape, shifting the focus from volume to value. For primary care practices, especially those within the Oregon Primary Care Association (OPCA) network, understanding and implementing VBP is crucial for sustainable success and improved patient outcomes. This resource library serves as your essential “Oregon Primary Care Association Vbp Tool,” offering a curated collection of articles, guides, webinars, and more to navigate the complexities of value-based care adoption.
Understanding VBP: Foundational Resources
To effectively utilize VBP tools and strategies, a strong foundational understanding of value-based payment models is necessary. This section provides overviews and key insights into the “how” and “why” of VBP, essential for both healthcare systems and individual practitioners.
Driving Health System Transformation – A Strategy for the CMS Innovation Center’s Second Decade
This white paper from the Centers for Medicare & Medicaid Services (CMS) Innovation Center outlines their strategic direction for the next decade.
- Key Points: Delve into lessons learned from the CMS Innovation Center’s first ten years, understand their strategic goals, and explore next steps across five key areas. Discover new models and concepts being explored to drive healthcare transformation. Relevance to Oregon Primary Care: Understanding the CMS Innovation Center’s direction is vital as Oregon’s healthcare initiatives often align with or are influenced by federal strategies. Primary care practices in Oregon can leverage these insights to anticipate future VBP trends and prepare accordingly.
Alternative Payment Model (APM) Framework White Paper
The Health Care Payment Learning and Action Network (LAN) APM Framework White Paper establishes a national approach to value-based payment models.
- Key Points: Learn about the LAN’s classification of APMs/VBP models, categorized into four types and eight subcategories. Grasp the decision rules that standardize classification efforts. Relevance to Oregon Primary Care: The LAN framework provides a common language and structure for understanding VBP. Oregon’s healthcare system, including CCOs and primary care practices, often utilizes this framework, making it a crucial tool for consistent understanding and implementation of VBP models.
This brief from State Health and Value Strategies/Bailit Health provides concrete examples of payment models within the LAN Framework categories.
- Key Points: Explore diverse examples of VBP models within each LAN category, drawn from federal, state, and health plan programs. Relevance to Oregon Primary Care: Provides practical examples of how VBP models are implemented in real-world settings. Oregon primary care practices can gain valuable insights into different VBP structures and identify models that may be suitable for their practice.
Value-based Payment: Is It Disrupting Health Care for the Better?
A webinar by OHA and Health Management Associates exploring the benefits of VBP for providers and patient care.
- Key Points: Understand the “why” behind VBP for healthcare providers. Learn how VBP contracting models can support efforts to improve patient health outcomes and how traditional fee-for-service models can limit patient access to comprehensive care. Relevance to Oregon Primary Care: This webinar, tailored for providers, directly addresses the motivations and advantages of adopting VBP in primary care settings within Oregon. It highlights how VBP can empower practices to enhance patient care and move beyond the limitations of fee-for-service.
Value-Based Payment Technical Guide for Coordinated Care Organizations
The Oregon Health Authority’s technical guide detailing VBP expectations for Coordinated Care Organizations (CCOs) in Oregon.
- Key Points: Gain insights into Oregon’s specific VBP expectations under Medicaid coordinated care organization (CCO) contracts (“CCO 2.0”) for 2020–2024. Review OHA’s VBP expectations and technical guidance. Relevance to Oregon Primary Care: Crucially important for Oregon primary care practices participating in or interacting with CCOs. This guide clarifies the VBP landscape within Oregon’s Medicaid system and helps practices align their strategies with state expectations.
What Do You Need to Know to Negotiate VBP Agreements?
A provider-focused webinar from OHA and Health Management Associates guiding healthcare professionals through VBP agreement negotiation.
- Key Points: This webinar, designed for providers, offers guidance on evaluating and negotiating VBP offers. Relevance to Oregon Primary Care: Equips Oregon primary care providers with the necessary skills to confidently navigate VBP contract negotiations. Understanding negotiation strategies is essential for practices to secure favorable and sustainable VBP agreements.
Risk Stratification: Managing Patient Populations Effectively
Effective VBP implementation relies on the ability to manage patient populations and stratify them by risk. These practical guides provide valuable approaches to risk stratification, a critical component of proactive and value-driven primary care.
An article from the Journal of Health Care for the Poor and Underserved demonstrating a risk stratification approach in a primary care setting.
- Key Points: Examine a practical approach to risk stratification using a sample of patients in an urban academic family medicine clinic over two years. Learn a simple risk stratification method for identifying common conditions among high-risk patients. Relevance to Oregon Primary Care: Provides a real-world example of risk stratification implementation in a primary care setting, particularly relevant for practices serving underserved communities in Oregon. This practical approach can be adapted and applied in various primary care contexts.
Risk Stratification Action Guide
The National Association of Community Health Centers’ action guide on risk stratification for community health centers.
- Key Points: Developed for community health centers, this guide discusses population health management and risk stratification goals. It outlines a stepwise process to categorize patients’ risk level based on the number of clinical conditions. Relevance to Oregon Primary Care: Highly relevant for community health centers and primary care practices within the OPCA network that focus on population health management. This guide offers a structured approach to risk stratification, enabling practices to prioritize care and resources effectively.
Risk Stratification: A Two-Step Process for Identifying Your Sickest Patients
An article from Family Practice Management describing a two-step risk stratification process for primary care practices.
- Key Points: Learn how a practice applied a structured approach to determine patient health risk levels and used this information to improve care team support. Understand how risk stratification enabled the practice to provide risk-stratified care management. The article includes a risk stratification algorithm tool and considerations for workflow changes to enhance care management. Relevance to Oregon Primary Care: Offers a practical, two-step process and algorithm for risk stratification that primary care practices in Oregon can implement. The focus on workflow changes is particularly valuable for integrating risk stratification into daily practice operations.
Attribution: Defining Accountability in VBP
Understanding patient attribution methods is essential for leaders to align attribution approaches with their system’s needs in VBP models. These resources clarify why the chosen attribution method significantly impacts performance measurement and accountability.
Patient Attribution: Why the Method Matters
An article from the American Journal of Managed Care assessing the impact of different patient attribution methods.
- Key Points: This paper evaluates the impact of five common patient attribution methods on measuring healthcare cost, quality, and utilization metrics within an integrated healthcare delivery system. It emphasizes that reliable identification of the physician-patient relationship through attribution is critical for accurately evaluating healthcare processes, efficiencies, and outcomes. Relevance to Oregon Primary Care: Highlights the importance of selecting the appropriate attribution method for accurate performance measurement in VBP arrangements, particularly within Oregon’s CCO model. Understanding the nuances of attribution is crucial for fair and effective accountability.
Whose Patient Is It? Patient Attribution
A briefing paper by Milliman describing various attribution methods and considerations for their use in value-based payment.
- Key Points: This classic paper succinctly describes several attribution methods and considerations for their application. It summarizes key attribution terms and methods essential for successful accountability models in VBP. Relevance to Oregon Primary Care: Provides a foundational understanding of patient attribution methods, which is essential for Oregon primary care practices engaging in VBP contracts. The paper’s clarity on different methods helps practices make informed decisions about attribution in their VBP arrangements.
Evidence-Based Care and Workflows: Implementing VBP Successfully
Explore proven strategies and evidence-based approaches to help primary care practices successfully implement VBP agreements and optimize care delivery workflows for value.
Improving Access to Care: Telemedicine Across Medical Domains
An Annual Review of Public Health article examining the impact of telemedicine on access to care and health outcomes.
- Key Points: This review examines the impact of telehealth on access to care and health outcomes for various conditions, including stroke, heart disease, and pregnancy. It also assesses how telehealth can enhance care under VBP. For specific medical conditions, telemedicine has shown improved health outcomes and cost reductions. It has improved prenatal access and outcomes and enhanced access for underserved and rural patient populations. Relevance to Oregon Primary Care: Highlights the strategic role of telemedicine in improving access to care, particularly in rural Oregon, and its alignment with VBP goals. Primary care practices can leverage telemedicine to enhance care delivery and improve outcomes under VBP contracts.
Value-Based Toolkit for Primary Care Providers
A toolkit from the University of Washington guiding primary care providers in developing strategies for value-based payment success.
- Key Points: This toolkit guides practices on developing a practice strategy and operational transition plan to succeed with a mix of fee-for-service and VBP contracts. Part 1 explains principles, approaches, and tools to improve total cost of care and quality. Part 2 offers a practice-specific analysis and decision-making process for developing an operational transition plan. It includes downloadable examples, tools, templates, and guidelines to improve VBP performance. Relevance to Oregon Primary Care: Provides a practical, step-by-step toolkit specifically designed for primary care providers transitioning to VBP. Oregon practices can utilize these resources to develop and implement effective VBP strategies, improve performance, and navigate the shift from fee-for-service.
Performance Measurement: Metrics and Benchmarks for VBP Contracts
Clinicians and system leaders can utilize these resources to understand how to select appropriate metrics and benchmarks for VBP contracts, ensuring effective performance evaluation and improvement.
Determining Performance Benchmarks for a Medicaid Value-Based Payment Program
A webinar and slide deck from the Medicaid Innovation Accelerator Program on setting performance benchmarks for Medicaid VBP programs.
- Key Points: This resource provides several approaches for setting performance benchmarks for VBP in Medicaid. It emphasizes stakeholder involvement in benchmark development, choosing benchmarking methods that suit context and goals, setting benchmarks to motivate improvement, and allowing for benchmark adjustments over time. Relevance to Oregon Primary Care: Directly relevant to Oregon’s Medicaid-focused CCO system. Oregon primary care practices can apply these principles to understand how performance benchmarks are set within the state’s VBP programs and how to effectively meet or exceed those benchmarks.
Measuring Success in Health Care Value-Based Purchasing Programs
A RAND Health Quarterly review of literature on value-based purchasing programs and expert panel discussions on benchmarks.
- Key Points: This review analyzes published literature on value-based purchasing programs and includes expert panel discussions on benchmarks. The review focuses on three VBP models: pay-for-performance programs, accountable care organizations, and bundled payment programs. Relevance to Oregon Primary Care: Provides a broader perspective on measuring success in various VBP models, relevant to Oregon’s adoption of ACO-like structures through CCOs. Understanding the benchmarks used in different VBP models helps Oregon practices prepare for diverse performance expectations.
A resource from Mathematica Policy Research addressing challenges in measuring performance with small numbers in PCMH and ACO settings.
- Key Points: Provides strategies for accurately measuring performance with small panel sizes and across small numbers of organizations. It offers concrete strategies and resources to address methodological challenges when evaluating performance and applying financial incentives and disincentives in smaller practices or networks. Relevance to Oregon Primary Care: Particularly relevant for smaller primary care practices within the OPCA network or smaller CCOs in Oregon. This resource offers practical solutions to overcome statistical challenges in performance measurement when dealing with smaller patient populations.
Performance Benchmarks for VBP Models
An OHA and Health Management Associates webinar focused on performance benchmarks for VBP models within the CCO context.
- Key Points: This CCO-focused webinar discusses considerations for developing performance benchmarks for population-based and episode-based VBP models within Oregon’s CCO framework. Relevance to Oregon Primary Care: Directly relevant to Oregon CCOs and primary care practices participating in these networks. The webinar provides specific guidance on developing and understanding performance benchmarks within the Oregon VBP landscape.
The American Academy of Family Practice (AAFP) criteria and principles for selecting performance measures in VBP.
- Key Points: Summarizes the AAFP principles and criteria for selecting performance measures in VBP. It highlights that performance measures can overlap with quality measures that accelerate internal clinical improvement. Relevance to Oregon Primary Care: Provides a family medicine perspective on performance measure selection, aligning with the focus of many primary care practices within the OPCA network. The AAFP criteria offer a framework for practices to evaluate and select relevant and impactful performance measures.
Practice Facilitation Handbook: Module 7. Measuring and Benchmarking Clinical Performance
Module 7 of the Agency for Healthcare Research and Quality’s Practice Facilitation Handbook, focusing on measuring and benchmarking clinical performance.
- Key Points: Offers a concise overview of how to measure and benchmark clinical performance, part of a broader toolkit for practices on performance measurement. It provides a high-level understanding of selecting clinical performance measures and benchmarking. Relevance to Oregon Primary Care: Provides a foundational understanding of performance measurement and benchmarking, essential for primary care practices initiating or enhancing their VBP efforts. This module offers a starting point for practices to build their performance measurement capabilities.
Promoting Health Equity: Addressing Disparities in VBP Models
These resources explore how to design VBP models that not only improve value but also advance health equity and address social determinants of health, crucial considerations for equitable healthcare delivery within Oregon and beyond.
Accelerating Health Equity by Measuring and Paying for Results
An issue brief from Families USA discussing the necessity of measuring and paying for health equity within payment models.
- Key Points: Discusses the critical components needed for payment models to effectively address health equity. It emphasizes that failing to measure and pay for equity can lead to missed opportunities to reduce health disparities and may even worsen existing inequities. Relevance to Oregon Primary Care: Highlights the ethical and practical imperative of incorporating health equity into VBP models, especially within Oregon’s diverse communities. Oregon primary care practices can use these insights to advocate for and implement VBP models that actively reduce health disparities.
A Health Affairs article presenting a return-on-investment analysis of a community health worker intervention addressing social needs.
- Key Points: Presents an ROI analysis of the Individualized Management for Patient-Centered Targets (IMPaCT) program, a standardized community health worker intervention addressing unmet social needs for disadvantaged populations. The study found that every dollar invested in the community health worker intervention returned $2.47 to an average Medicaid payer within a fiscal year. Relevance to Oregon Primary Care: Demonstrates the value and ROI of community health worker programs, which are increasingly recognized as essential for addressing social determinants of health and improving health equity in Oregon. Primary care practices can explore integrating community health workers into their VBP strategies.
How Community Health Workers and Promotores Can Support Individuals with Complex Needs amid Covid-19
A webinar from The Playbook discussing the role of community health workers in supporting individuals with complex needs during the COVID-19 pandemic.
- Key Points: This resource presents evidence-based practices for caring for people with complex health and social needs. The slide deck overviews the role of community health worker programs in addressing COVID-19 impacts and improving health equity. It provides examples of how value-based care has driven health systems to consider community-based care strategies, including integrating community health workers and community-based organizations into networks for shared savings and care partnerships. Relevance to Oregon Primary Care: Emphasizes the growing importance of community health workers in VBP models, particularly in addressing complex needs and health equity within Oregon communities. It encourages primary care practices to consider integrating community health workers into their care teams and VBP arrangements.
The Path Forward for Mental Health and Substance Use – Health Equity for All Americans
An initiative from the National Alliance for Healthcare Purchaser Coalitions outlining reforms to improve mental health and substance use equity.
- Key Points: Presents five evidence-based reforms to improve health equity in mental health and substance use care, developed by a coalition of purchasers, provider groups, and payers. Reforms include improving in-network access to behavioral health specialists, expanding screening and testing for behavioral conditions, expanding behavioral health integration into primary care, improving tele-behavioral health, and resolving mental health parity issues. Relevance to Oregon Primary Care: Highlights the critical need to address mental health and substance use within VBP models and provides actionable reforms. Oregon primary care practices are increasingly integrating behavioral health, and these recommendations are valuable for enhancing equitable access to mental health services within VBP frameworks.
The Role of Social Determinants of Health in Value-Based Payment Models: A Rural Perspective
A recorded webinar from the National Rural Health Resource Center focusing on the role of social determinants of health in rural value-based payment models.
- Key Points: This webinar highlights how rural health providers collaborate with community-based organizations to address social determinants of health (SDOH), resulting in improved health outcomes, reduced costs, and advanced health equity. It overviews SDOH and their impact on rural health, provides examples of rural providers leveraging VBP to address SDOH, and lists resources to support rural providers and community partners in addressing SDOH. Relevance to Oregon Primary Care: Specifically addresses the challenges and opportunities of addressing SDOH in rural settings, highly relevant to Oregon’s rural primary care practices. It offers examples and resources for rural practices to effectively integrate SDOH considerations into their VBP strategies.
Using VBP to Reduce Health Disparities
An Oregon Health Authority webinar led by national expert Marshall Chin, MD, on applying VBP to reduce health disparities.
- Key Points: This webinar, led by Dr. Marshall Chin, guides CCOs and health system partners in applying lessons from care transformation and VBP models across the U.S. to reduce health disparities. Relevance to Oregon Primary Care: Provides expert guidance on leveraging VBP as a tool to actively reduce health disparities within Oregon’s healthcare system. Oregon primary care practices can benefit from the insights and strategies shared by Dr. Chin to enhance their equity-focused VBP initiatives.
Emerging Trends in VBP: Adapting for the Future
Stay ahead of the curve with these resources exploring emerging trends in VBP, including lessons from the COVID-19 pandemic, efforts to address health inequities, and the expanding role of telemedicine in value-based care models.
A Health Affairs Blog article proposing a payment policy reboot based on lessons learned from the COVID-19 pandemic to improve value-based payment.
- Key Points: This article addresses three healthcare areas impacted by COVID-19 and suggests adaptations to improve healthcare quality and value going forward. Key lessons include the feasibility of delivering cost-efficient, patient-centered care through widespread telemedicine, the healthcare system’s capacity to efficiently meet patient needs in the right setting, and the pandemic’s stark exposure of social determinants and structural racism, highlighting the need to reshape VBP to address disparities. Relevance to Oregon Primary Care: Offers valuable insights into how the COVID-19 pandemic has reshaped the VBP landscape and what adaptations are needed for the future. Oregon primary care practices can learn from these lessons to build more resilient and equitable VBP models.
Eliminating Inequity in Health Care Demands Measurement in Real Time
A Milbank Quarterly article discussing the need for real-time measurement to effectively address health inequity in healthcare.
- Key Points: This resource summarizes and discusses the issues of addressing health inequity, emphasizing the need for real-time information grounded in actual practice. Relevance to Oregon Primary Care: Underscores the importance of timely and accurate data for monitoring and addressing health inequities within VBP models in Oregon. Real-time measurement is crucial for effective interventions and for tracking progress towards health equity goals.
Learnings from COVID-19 and How They May Impact the Adoption of VBPs
An OHA and Health Management Associates webinar examining the role of VBP during the pandemic and its future impact on patient care.
- Key Points: This provider-focused webinar examines the role of VBP during the pandemic and its evolving impact on patient care in the future. Relevance to Oregon Primary Care: Provides Oregon primary care practices with specific insights into how VBP performed during the pandemic and what lessons can be applied to future VBP strategies. Understanding the pandemic’s impact on VBP is crucial for adapting and strengthening these models.
Telemedicine: What should the Post Pandemic Regulatory and Payment Landscape Look Like?
A Commonwealth Fund issue brief examining the impact of telehealth policies during COVID-19 and providing recommendations for future telemedicine guidelines.
- Key Points: This issue brief examines the impact of telehealth policies implemented during the COVID-19 pandemic and offers recommendations for future telemedicine guidelines. It emphasizes the importance of monitoring telehealth regulations for VBP models that incorporate telehealth to enhance access to care. It suggests limiting telehealth payments to services for selected patient populations and health conditions or to providers paid by VBP to encourage high-value use and discourage overuse. Relevance to Oregon Primary Care: Provides crucial guidance on the future of telemedicine within VBP models, especially relevant as Oregon continues to expand telehealth access. Oregon primary care practices need to stay informed about evolving telehealth regulations and payment policies to effectively integrate telemedicine into their VBP strategies.
This “Oregon Primary Care Association VBP Tool” resource library is designed to empower primary care practices with the knowledge and resources needed to thrive in a value-based payment environment. By exploring these materials, your practice can enhance its understanding of VBP, implement effective strategies, and ultimately deliver higher-value, more equitable care to your patients.
