The first year of payment reform will offer an

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The first year of payment reform will offer an opportunity to oversee, observe, and evolve payment model operations . More AHS partners, programs and services are expected to join overtime – likely beginning with DAIL and DCF funded programs. 2 4/23/2018
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3 Current Issues A large percent of mental health services in Vermont are provided by non-profit community partners (Designated Mental Health Agencies). Funding for the Mental Health System is capped, the State pays a set amount to each agency. State funded mental health programming is complex and currently resides across 6 Departments and 11 Divisions within the Agency of Human Services. Lack of coordination has resulted in a system of care that can be fragmented, inefficient, and difficult to navigate. Payment structures often vary across programs, and can require complex, confusing and restrictive eligibility requirements and billing practices that limit providers’ flexibility to deliver needed services. How Can Payment Reform Help? Decreases administrative burden; Delivers more predictable payments; Provides flexibility that supports comprehensive, coordinated care; Standardizes an approach for tracking population indicators, progress, and outcomes; and Supports AHS’s goal, moving away from FFS to a more value-based approach to payment. Long Term Goals To promote and improve the mental health of Vermonters by: o Improving the effectiveness and coordination of mental health programs and services around the State; o Simplifying payment structures to increase flexibility and predictability of provider payments; and o Shifting to Value-Based payment models that reward outcomes and incentivize best practices. 4/23/2018
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Value-Based Payment Framework Expressly move from siloed programmatic payment streams to more population-based payments, increasing accountability and risk to impacted providers over time. Simple Incentivize high quality, efficient services and reduce incentive for high service volume. Efficient Increase flexibility in payment to support more efficient delivery of services. Flexible Reduce payment silos and fragmentation across provider and service types. Integrated Connect payments with quality in service delivery and health of Medicaid beneficiaries. Value-Based Align measurement and reporting with values, principles and goals. Standardized Provide data and feedback to providers delivering care to support accountability for quality and cost. Accountable 4 4/23/2018
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Guiding Principles of Payment Reform Healthier People (Improved outcomes and value) Population health focus Increase capacity for prevention and early intervention Efficient quality review and program evaluation processes More standardized tracking of outcomes across programs and populations Better Care (Improved customer experience) Improved access to care Increased integration and collaboration throughout the care planning and delivery process Improved satisfaction System of Care is strengthened Smarter spending (Increased fiscal sustainability)
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  • Fall '19
  • Department of Mental Health, Agency of Human Services

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