MediStrategy with Kip Piper Episode 10:
Value-Based Purchasing with Healthcare Consultant Nancy Kohler of Sellers Dorsey
Summary
Savvy consumers seek the best value for their money, evaluating the benefits of a product prior to purchase. Elsewhere in the economy, it seems obvious that we should hold a manufacturer accountable for delivering a quality product. With health care reform, this concept has at last been applied to medical care via the value-based purchasing model. Rather than simply paying fee-for-service which rewards volume, health care consumers, health plans, and purchasers - state Medicaid programs, federal Medicare program, and employers - can hold providers responsible for outcomes.
As a consultant with Sellers Dorsey, Nancy Kohler provides assistance in federal and state health policy issues, financial analysis, and project management. Before joining the firm, she played a key role in the implementation and operational aspects of the Statewide Quality Care Assessment for the Pennsylvania Department of Human Services. The initiative provided millions of dollars in revenue to the Commonwealth's many hospitals and modernized Pennsylvania Medicaid hospital reimbursement.
Ms. Kohler's comprehensive portfolio of experience includes both large and small scale public health program operations, policy development and fiscal analysis. She spent 20-plus years at KePRO, dedicating the last six years of her tenure as the vice president of public programs. Nancy Kohler has her master’s degree in Health Services Administration and is a Registered Health Information Administrator and Certified Professional in Healthcare Quality.
In this episode, she outlines the core characteristics of the value-based purchasing model, the challenges faced by Medicaid in transitioning to value-based purchasing, and the federal and state collaboration key to further reform efforts. Well-versed in how current legislative proposals might affect value-based purchasing, Kohler explores Congress' efforts to repeal and replace the ACA, the fate of MACRA, and HHA Secretary Price’s advocacy for relief from administrative burdens.
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Topics Covered
[2:48] How Kohler got involved in value-based purchasing
Working in healthcare for 25 years Managed large, complex federal and state projects in quality improvement Appreciates the diversity of a career in health care management Values the ability to make an impact on the health and well-being of populations served Welcomes the opportunities for innovation and learning Led TRICARE national quality monitoring contract, gained insight into how managed care organizations provide oversight Current role involves value-based purchasing initiatives for several state Medicaid programs[6:47] Goals of value-based purchasing model
Control rising costs Improve outcomes Replace ineffective volume based fee-for-service model[7:36] Core characteristics of value-based purchasing
Measures provider performance Assigns accountability (transparent, timely, actionable approaches) Uses reimbursement/incentive pay to achieve quality-related goals Aligns finances of reimbursement with patient outcomes Places providers at risk for their performance Drives care delivery reform[11:01] Challenges faced by Medicaid in transition to value-based purchasing
Complying with fluid, highly complex federal regulations Limited experience with new payment models Complexity of implementation Limited resources Budget planning processes Collection, exchange, a and integrity of data[14:08] The role of the state with respect to value-based purchasing
Hold providers and managed care organizations accountable for cost and quality of care Lead and grow innovations in VBP Implement alternative payment models (states as laboratories of reform)[20:38] The role of federal collaboration in furthering state level reforms in payment and care delivery
Joint financing States design program within federal standards HHS can waive certain Medicaid requirements, provide funding for options not otherwise allowed Trump administration proposed changes (limit federal financing, increased flexibility for states)[27:03] Kohler’s work to further value-based purchasing initiatives
Assist states in developing VBP strategy Draft proposals that ensure improved outcomes Design innovative solutions specific to the state’s needs[30:37] How proposed legislation to repeal and replace the ACA may affect value-based purchasing
VBP models enjoy bipartisan support Transition to VBP in motion, likely to continue HHS Secretary Price advocates relief from administrative burdens of ACA Proposals make system more straightforward and less complex[35:54] The pace of value-based purchasing initiatives
Delay in bundled payment programs Possible changes in the mechanics VBP will continue to gain momentum[42:27] The shift of risk to providers
Unsustainable growth of healthcare costs Providers accountable for driving cost-effective care, improved quality and better patient outcomes Even if ACA repealed/replaced, move to alternative payment models likely to remain ACA replacement proposals seek to make APM participation easier for providers[44:56] How the Medicare Access and CHIP Reauthorization Act (MACRA) fits within payment reform
Enacted two years ago Moves Medicare Part B physician reimbursement to value-based model Created a new quality payment program Drives providers to alternate payment models such as accountable care organizations (ACOs) and bundled payment No talk of MACRA repeal at presentConnect with Nancy Kohler and Sellers Dorsey
Connect with Kip Piper, MA, FACHE, Host of MediStrategy
About MediStrategy and Kip Piper
The MediStrategy podcast offers informative interviews with healthcare leaders and insights on hot business and policy issues in Medicare, Medicaid, and health reform. Health executives, policymakers, entrepreneurs, authors, and other influencers share challenges and opportunities in America’s rapidly changing $3.2 trillion health care system.
MediStrategy is hosted by Kip Piper, a top expert on Medicaid, Medicare, and health reform. A prominent consultant, speaker, and author, Kip Piper advises health plans, state Medicaid agencies, hospitals and health systems, provider associations, life sciences companies, and investment firms.
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