developing your value proposition · •the value proposition is the key driver that will influence...
TRANSCRIPT
Developing Your Value Proposition
Timothy P. McNeill, RN, MPH
What is a Value Proposition
• A value proposition is the service or feature that makes an
organization attractive to potential customers
• The value proposition is the key driver that will influence
a customer to want to do business with your organization
– Tip: Take the perspective of the customer when developing your
value proposition. Design your services in a way to meet the
customer’s need – even if it is not convenient to provide services
the way the customer wants.
– This may require a culture change
What Are the Considerations in Creating Value
• Drivers impacting the customer
– Payment reform
– Risk-based contracting
• Potential competitors
• Quality of service
• History of providing services
• Expertise in a specific area
• Key stakeholders and influencers
Business Acumen and the Value Proposition
• Define your value proposition based on your strengths
and capacity
• Identify the need that you intend to solve in the
marketplace
• Package your services and present the offering to
potential customers
• Your value proposition outlines the need you are
addressing in the market and defines WHY the customer
should buy services from you.
Example of Limited Value
• I am the Director of XYZ Agency. We have a 50 year
history of serving older adults and persons with disability
in our region.
• We have a group of contractors the provide home and
community-based services and deliver evidence-based
programs
• Why would I buy services from this organization?
New Service: Managed Network of HCBS Providers
Defined Value Proposition
MTM’s Preventive Care and Care Transitions Services
Example: Evidence-Based Program Value
Example: Presenting Value to the Customer
What Are the Considerations in Creating Value
• Drivers impacting the customer
– Payment reform
– Risk-based contracting
• Potential competitors
• Quality of service
• History of providing services
• Expertise in a specific area
• Key stakeholders and influencers
Shift Toward Value-Based Purchasing
• Health Reform efforts are shifting the current system
from Fee-For-Service to one that provides incentives for
outcomes.
• A Value-Based Purchasing system provides financial
incentives for outcomes (Value)
– Payment is tied to better outcomes instead of units of service
– There is a detailed assessment of clinical quality and total cost of
care
– Rewards are tied to success with quality and cost
Shift Toward Value-Based Purchasing
• The current system is changing from Fee-For-Service to
payment for outcomes.
• A Value-Based Purchasing system provides financial
incentives for outcomes (Value)
– Payment is tied to better outcomes instead of units of service
– There is a detailed assessment of clinical quality and total cost of
care
– Rewards are tied to success with quality and cost
Where are there costs in the system
• A system that pays for value will focus on where the
highest cost drivers are.
– Complications related to chronic disease
– Institutional Care (Acute and Post-Acute Care)
– Ambulatory sensitive ED visits / admissions
• Preventable
– Readmissions
Value under Payment Reform
• Success in Health Reform requires the adoption of a
population health approach
• Population health includes the following elements:
– Analyzing the population to determine which groups pose the
most risk for reduced quality and/or increased costs
– Developing interventions to address the targeted population
– Monitoring the outcomes for these groups from an established
baseline
• Value is created in population health when an
organization can define how they can impact high-risk
groups
New Business Opportunities Abound
• The shift towards financial incentives that align with
preventing costs has created new business opportunities
– MACRA
• Merit Incentive Payment System (MIPS)
– Must Improve quality and reduce costs or face a
reduction in Medicare reimbursement
– Providers will be compared with comparable providers
– High performers will receive higher reimbursement and
low performers will receive a penalty
– Failure to report – automatic penalty
• Alternative Payment Models (APMS)
– ACOs, Bundled Payment, CPC+
Text
Market Opportunity Analysis
• Hospitals in your market– Readmissions / Admissions
– ER Utilization
– Post-Acute Care Provider Network
• Physician market– Hospital-Owned Practices
– Independent Practices
– Specialists vs Primary Care
• Accountable Care Organizations
• Bundled Payment programs
• Managed Care Organizations
CMS Medicare Chartbook:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf
Nearly 70% of FFS Medicare has 2 or more chronic conditions
Per Capita Expenditures increase as the conditions increase
CMS Analysis: Social Determinants of Medicare Advantage Plan Performance
CMS Analysis: Social Determinants of Medicare Advantage Plan Performance
2019: Expanding Health Related Supplemental Benefits
• The previous regulations limited supplemental MA plan
benefits to health-related services.
– There were specific limitations on supplemental benefits that
include daily maintenance.
• This requirement prevented some plans for designing
supplemental benefit packages that included non-skilled
services that could reduce readmissions or improve health
outcomes.
Value May Change based on the Customer
• ACOs
– 31 ACO quality measures
• Bundled Payment
– 90-day financial risk period
• Medicare Advantage Plans
– HEDIS, STAR Ratings
– Supplemental Benefits Rule Change
• Physicians
– MIPS
• Medicaid Managed Care Plans
– Medicaid Expense reduction
Provider MIPS Categories applicable to CBOs
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• Quality
– Diabetes outcomes
– Depression screening
– Fall risk
• Advancing Care Information
– Referrals to community programs
– Send a summary of care
• Improvement Activities
– Care transitions documentation
– Engagement of community for health status improvement
– Evidence-based interventions to promote self-management
– Chronic care and preventive care management
Value Proposition May Adjust with Policy Changes
– CMS Rule Change regarding Medicare Advantage
Supplemental Benefits
– Health Plans can use supplemental benefits to support
health improvement and cost reduction
– This policy change impacts the value of a service but
should be presented differently depending on the
customer being addressed.
2019 Re-interpretation of the Supplemental Benefit
– “Under this reinterpretation, CMS would allow
supplemental benefits if they are used to diagnose,
prevent, or treat an illness or injury, compensate for
physical impairments, act to ameliorate the
functional/psychological impact of injuries or health
conditions, or reduce avoidable emergency and healthcare
utilization.”
CMS Rule Changes Effective Date
• The Supplemental Benefit and Uniformity Flexibility
rules take effect for the 2019 benefit year.
• 2019 Bid review correspondence will be sent by June 30,
2018.
• 2019 MA Plan bid training began April 2018
• MA plans are preparing their 2019 bids for submission
later this year (2018).
Bipartisan Budget Act of 2018
• Signed into law
• Includes the Chronic Care Act
• Changes required by the Bipartisan Budget Act of 2018
take effect beginning 2020, and subsequent plan years
CMS Guidance Memo Released
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• April 27, 2018: CMS released guidance on services that
can be included as a supplemental benefit. Key
categories include:
– Adult Day Care Services
– In-Home Support Services
– Support for Caregivers of Enrollees
– Stand-alone Memory Fitness Benefit
– Home & Bathroom Safety Devices & Modifications
– Transportation
MA Plan Benefits in the News
MA Plan Benefits in the News
