Overview of Value-Based Payment
Social Determinants of Health and CBO Workgroup
- Overview is also available in Portable Document Format (PDF, 626KB)
October 26, 2015
SCAA
Schuyler Center for Analysis and Advocacy
Shaping New York State public policy for people in need since 1872
Value-Based Payment
- The next step toward delivery system reform and payment reform.
- Current system pays for inputs rather than outcome and do not adequately incentivize prevention, coordination, or integration.
- CMS has approved NYS´s "Roadmap" to value-based payment and workgroups are working now to make recommendations for how to implement.
- VBP not only focused on saving money for the State, but to allow providers to increase their margins by rewarding value.
- By the end of DSRIP year 5, NYS aims to have 80-90% of total Managed Care Organization/Provider payments (in total dollars) be value-based payments.
VBP Social Determinants of Health & CBOs
- Social Determinants of Health and CBOs is one of several workgroups developing recommendations re: implementation of VBP.
- VBP Roadmap identifies importance of SDH in reaching the State´s goals and promises that "the framework for value-based payment will maximally incentivize providers to focus on the core underlying drivers of poor health outcomes - whether traditionally in the medical realm or not." (VBP Roadmap, p. 28, June 2015)
CDC Definition of SDH
- Economic and social conditions that influence the health of people and communities. These conditions are shaped by the amount of money, power, and resources that people have, all of which are influenced by policy choices. Social determinants of health affect factors that are related to health outcomes.
- Factors related to health outcomes include: How a person develops during the first few years of life (early childhood development); How much education a persons obtains; Being able to get and keep a job; What kind of work a person does; Having food or being able to get food (food security); Having access to health services and the quality of those services; Housing status; How much money a person earns; Discrimination and social support
http://www.cdc.gov/nchhstp/socialdeterminants/faq.html
VBP Social Determinants of Health & CBOs
- Social Determinants of Health
- Economic Stability
- Education
- Heath and Healthcare
- Social, Family and Community
- Neighborhood and Environment
- It is widely understood that SDHs play a much larger role in peoples´ health than does medical care, but our medical care system has, for the most part, not engaged in addressing SDH.
VBP SDH & CBO Recommendations
- Recommendations developed to date include those on the following topics:
- Recommendations to Incentivize Providers/MCOs to Encourage Development of Social Determinant Initiatives
- Methods to Measure the Success of the Programs Implemented
- Methods to Capture Savings Across Public Spending*
- Addressing/Developing Action Plan for Housing Determinants
- Recommendation to be developed based on the remaining agenda item:
- Identifying how CBOs can successfully support the broader VBP strategy and draft an action plan designed to make available the technical assistance and training necessary to bring the CBOs up to speed.
- Workgroup developed an illustrative (not exhaustive) "menu" of interventions to address SDHs.
- Focused on interventions that are evidence-informed.
- Includes, for example, maternal, infant early childhood home visiting; Triple P Parenting; care coordination; housing.
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