Preparing your organization for the shift to a Value Based Reimbursement (VBR) model is a unique challenge for behavioral health organizations. The conceptual underpinning of VBR is relatively simple: payment based on improved outcomes. However, the implementation of value-based programming presents a long list of competencies to manage care and population health in a new way. The challenge for leadership is to support providers in meeting these new market demands and yet maintain clinical integrity.
Drew Digiovanni is the former director of education with the Medical Group Management Association, where he served over 20,000 practice administrators in primary care, medical specialties and behavioral health. Drew also served as vice president of quality, supporting 150 health centers to provide value-based care for large employers. In his leadership and consulting roles, he has worked with hundreds of health systems around the county, assisting leadership and staff in developing VBR skills.
Drew noted that the first step in developing VBR within an organization is to, “assess the way we view leadership, clinical and staff competencies across the organization. Certainly, we’re having to shift from a focus on productivity to a focus on patient outcomes. And I think that people have been trained and have the skill sets for a productivity-based environment.” In doing this, it helps point of care providers to understand the market demands and the alignment of demands toward improved clinical outcomes.
A second challenge is shifting organizations to a data driven mindset. He noted that it is normal for organizations to resist this change. Noted Drew, “we’re trained to focus on people, not on data necessarily. And so we’ve got to step back and reduce the resistance to a data driven environment through competency development. Our competency development is as much based on attitudinal change as it is on gaining new knowledge and skills.“
Competencies of a CEO
A CEO doesn’t need to have the skills of their C-suite, but they do need to have enough skill to oversee those functions, including Finance, Operations, Human Resources, IT, Quality and Population Health, and Clinical Operations. Clinical leaders and business leaders often see the world through a different lens. The CEO who drives the leadership team to see through the lens of their counterpart helps the organization to support an outcomes-based culture.
Needs for Continuous Leadership Development
“A foundation for VBR, or any large initiative, is to provide leadership development and enhance conflict management skills.” Leaders can better facilitate change using leadership styles that engage clinicians and staff and empower them in the change process. Turf battles between legacy teams and new service line and care management teams may ensure, and conflict management is critical.
Clinician and Staff Development
Staff require education in five key areas: 1. A clear understanding of payer needs and demands; 2. Performance goals; 3. Evidence-based standards within the organization’s scope of behavioral health, clinical care and chronic care management; 4. Patient experience standards that will be measured and reported; 5. How to interpret key performance data. Drew further explains “in the old paradigm, we might hand a client or patient discharge instructions or other patient education information. In an outcome-based environment, staff competencies in working with patients with low literacy skills is essential to helping them comply and stay engaged to achieve our outcome goals.”
Staff education isn’t always focused on knowledge and skills. Changing attitude comes into play when shifting to an outcome focus. Clinicians and staff need to value the changes necessary to drive outcomes. Drew says, “attitude doesn’t change in one conversation and leaders should expect that multiple conversations happen to outline the benefits to organization sustainability and particularly to enhance patient care.”
Engagement with Data Monitoring Through Visual Management
Drew cautions that no program will work without a sound approach for data validation. There needs to be a process which establishes a standardized approach to care, and a focus on evidence-based practices. Said Drew, “I think that the leadership needs to think about what are the standards of care that are driving internal operations, and then looking at how we document and get data into our systems so that we have good data coming out of the system.” A key takeaway that Drew emphasized is that staff and leaders need to know how to configure the EMR to capture that data. The ability to update and customize the EMR will allow for agility to manage your value-based program.
A final thought is the need for investment. The first investment is in technology; however, the larger investment is in human resources. “We need to make an investment to move towards value-based care, and part of that investment needs to be in competency development to address the gaps of our leaders, our clinicians and our staff. There’s going to be cost. It may seem like non-productive time to conduct education and training, but there is a return on investment if we help our teams come up to speed to support this new paradigm.”, says Drew. In the end, the marriage of agile technology with a well-trained workforce bodes well for success in this new value-based world.