HSC Releases Blueprint for Successful CBO Transition to a VBP Environment

Human Services Council Releases Blueprint for Integrating CBOs and Health Care Providers

by Jonathan Lamantia Crain’s Health Pulse  April 18, 2018

As the state moves toward a value-based payment system, New York human services nonprofits that want to form relationships with health care providers have been limited by their own technology, the complexities of contracting and their ability to take on financial risk, according to a new report from the Human Services Council.

To encourage integration of the community based organizations and health care providers, the report recommended that the state help bridge the technology divide that impedes data sharing, review regulations that make it difficult for community-based organizations to partner with providers and health plans and standardize contract language to make it easier for these nonprofits to enter value-based contracts, among other things…..


NYAPRS Note: Here are the primary recommendations of the HSC Report.

The Blueprint: Recommendations for Successful Partnership

The reform effort currently underway, the Delivery System Reform Incentive Payment (DSRIP) program, is a bold step in the journey towards the Triple Aim. In fact, the State is a national leader  in the implementation of VBP. The Commission strongly supports this policy direction and has identified areas that require further work in order for this vision to be realized. We recommend that the State, in partnership with representatives from human services CBOs and health care industry leaders, lead a process to further develop and implement the following recommendations, which  we collectively refer to as The Blueprint. For the sustainable integration of health and human services to take place, the following actions are  necessary:

BRIDGE THE  TECHNOLOGY DIVIDE

Information technology plays a critical role in  promoting  collaboration  and  care coordination, facilitating outcome measurement and reporting, and streamlining payment. Unfortunately, the  current  landscape  is  a  patchwork  of reporting systems that lack interoperability and impede efficient service planning, collaboration, and delivery. In addition, the vast majority of human services CBOs lack the resources to purchase and learn how to use new  systems. Strengthening health  care  information  management  must  begin  with a full assessment of systems that are currently in use across all sectors and collaboration to streamline administrative processes through a system that is available to human services CBOs at no charge.

UNDERTAKE A COMPREHENSIVE REVIEW AND OVERHAUL OF REGULATORY REQUIREMENTS

While the State has moved towards a population health focus that prioritizes outcomes, the legal framework that governs health care and human services has remained largely unchanged, hindering innovation and creating inefficiencies.   In many respects, the State is building a value-based health care system on a volume-based  foundation.  In  addition,  managed  care  organizations  and New York State agencies operate largely in isolation, resulting in redundancy in some areas and inconsistency in others. Conflicting or duplicative regulations increase administrative costs, restrict creativity, and discourage  collaboration.

Together, all sectors must engage in a thorough review of existing legislation, regulations, and policies to identify those that can be streamlined, amended, or eliminated in order to remove barriers to partnering with health care plans and providers. This process  should  also  include  identifying  opportunities to standardize reporting among all payers (by commissioning a universal platform), unifying credentialing, and incentivizing coordination of care. Only with comprehensive, strategic regulatory relief and greater standardization can the Triple Aim be achieved.

MAKE INVESTMENTS AND BUILD SYSTEMS THAT SUPPORT STRONGER AND MORE INFORMED RELATIONSHIPS BETWEEN THE HEALTH CARE SYSTEM AND HUMAN SERVICES CBOS

For the collaboration between health and human services to succeed, formal systems must be established for supporting partnerships between human services CBOs and health payers. Health and human services have long worked in close proximity—often with significant overlap—but for the most part, these sectors have worked in isolation. To work together towards the State’s shared goals, they must have some knowledge of each other’s drivers, challenges, strengths, and limitations. Accordingly, learning and networking opportunities to bring the two sectors together must be fostered. The health care system should also be educated on how to craft requests for proposals (RFPs) for human services  CBO partnerships.

PROVIDE GREATER AND MORE TARGETED SUPPORT FOR ESTABLISHING PROVIDER NETWORKS

Just as human services CBOs must work with the  health  care  system,  they must also collaborate amongst themselves. Collaboration among human services CBOs is more conducive to person-centered, whole health care and allows for better coordination with health care partners to offer inter-related and coordinated services as a continuum of care. Affiliations can increase an individual organization’s capacity for relationship management and contract negotiations, leading to fairer pricing and revenue sharing approaches, more appropriate performance measures, better risk assessment, more streamlined credentialing, sharing of best practices, stronger quality controls, and other positive outcomes. The State should foster the development of affiliations among human services CBOs, informed by examples such as the independent practice association and Behavioral Health Care Collaborative models.

ADDRESS CONTRACTUAL BARRIERS TO VBP PARTICIPATION

In addition to inconsistent or duplicative regulations  and  policies, health and human services providers contend daily with inconsistent or duplicative contractual obligations and terms that discourage, rather than incentivize, better outcomes. Contract variation increases administrative burdens on all

parties because administering, complying with, and delivering on a variety of inconsistent agreements is labor-intensive and increases the risk of error. These burdens are exacerbated by the lack of uniformity in billing and reporting systems and the fact that most human services CBOs lack the resources necessary to assess risk and risk tolerance, negotiate fair terms, and develop sound contracts. Standardized contracts would offer clear pricing and terms of services and include language to minimize human services CBO risk. Replacing the fragmented contracting system with a more consistent and transparent approach would go a long way in helping all sectors collaborate in pursuit of the Triple Aim. Accordingly, we recommend that the State consider endorsing standardized contract language and pricing, looking to existing models such as the Ambulatory Patient Group methodology as examples.

ENSURE THAT MEASURES OF SOCIAL DETERMINANTS OF HEALTH INTERVENTIONS ARE NOT OVERLY CLINICAL

In order to address social determinants of health (SDH) in a meaningful, measurable way, all partners must have a clear understanding of how  they affect health outcomes and what it takes for human services CBOs to deliver effective interventions. Furthermore, outcome measures must take into account the unique nature of social determinant interventions; they should not be overly clinical. Interventions aimed at addressing SDH often take more time than  clinical interventions to yield results, and the results are not easy to capture. The Commission recommends that the State adopt a set of guiding principles for  SDH measurement that reflect this reality.

SHIFT RISK INCREMENTALLY AND COMMENSURATE WITH SERVICE LEVEL

The full effect of SDH interventions will take time to manifest. As such, all stakeholders should allow for the transition to full-fledged  value-based  payment to happen over time, with risk-sharing evolving as the  changes  needed to transition to a more value-based system are made and outcomes become evident. The transition to VBP is a seismic shift, and most human services CBOs have low risk tolerance. Acknowledging and accommodating this reality, while making the investments set forth above, will allow human services CBOs to build stronger systems that enable them to withstand transitions in    the funding environment. In the short-run, therefore, most human services CBOs must continue to be engaged in pay-for-reporting or upside risk-sharing arrangements with bonuses or cost savings.

This is an exciting moment in the evolution of New York’s  health care system. DSRIP has set us on the path towards realizing the State’s vision and presents a remarkable opportunity to build a radically different health care system. With collaboration, strategic investment, targeted technical assistance, and regulatory reform, the State can translate this opportunity into a more cost-effective and sustainable system that delivers better care, better health, and lower cost for all New Yorkers.

https://humanservicescouncil.org/wp-content/uploads/Initiatives/ValueBasedPayment/Value-Based-Care-Report.pd