At this year’s CASP conference, an insightful discussion unfolded on the topic of value-based care (VBC) measurement, featuring industry leaders Yagnesh Vadgama, Doug Moes, Rebecca Womack, and Raven Health’s very own Tim Crilly. The conversation highlighted the challenges and opportunities in transitioning to VBC models within the autism services sector. The segment’s panelists drove home some key takeaways for the attendees.
Introduction and Perspectives
The discussion featured perspectives from various experts:
- Tim Crilly: SVP of Partnerships at Raven Health, with a background in both clinical and managed care sides of ABA.
- Rebecca Womack: Vice President of Quality Assurance at Verbal Beginnings, focused on policy and clinical solutions intersecting with payer requirements.
- Doug Moes: Chief Clinical Development Officer at the Stepping Stones Group, providing a provider perspective on quality and outcome initiatives.
- Yagnesh Vadgama: Vice President of Autism at Magellan, offered an overview of value-based care from a health plan perspective, advocating for a comprehensive approach that includes various aspects of autism care beyond ABA.
Defining Value-Based Care
Yagnesh Vadgama explained that value-based care is not a novel concept in healthcare, with approximately 60% of healthcare already operating under some form of value-based arrangement, primarily in physical health areas like cancer and diabetes. He emphasized the need to look at autism care holistically, integrating various treatments and services to enhance overall quality and outcomes. “We have to start somewhere,” he noted, advocating for initial models based on case rates with potential for bonuses tied to outcomes on measures like the Vineland.
The Shift from Fee-for-Service to Value-Based Models
The panelists discussed the limitations of the current fee-for-service model, which often leads to inefficiencies and a lack of focus on overall quality. Rebecca Womack pointed out that value-based care forces participants to prioritize time efficiently, focusing on outcomes that matter to families and payers. She stressed the importance of selecting quality metrics that provide a good return on investment for all stakeholders.
Doug Moes highlighted the importance of focusing on quality inputs, such as robust assessment and treatment planning, treatment integrity, and fidelity of implementation. He emphasized the need for partnerships and collaborative efforts to enhance the quality of life for individuals with autism.
Addressing Clinical and Administrative Changes
The transition to value-based care requires significant changes both administratively and clinically. Vadgama mentioned the success of value-based arrangements with providers like Kyo, which have led to greater staff retention and satisfaction. This model allows clinicians to focus more on care coordination and addressing the holistic needs of families rather than just meeting billing requirements.
Womack highlighted the importance of not making assumptions about the knowledge base of practitioners, stressing the need for thorough assessment and training to ensure successful implementation of value-based care.
Technology and Data Integration
The role of technology in supporting value-based care was a major point of discussion. Moes expressed excitement about the potential of technology to ease the burdens on clinicians and improve data collection and analysis. He envisioned a future where AI and machine learning could provide reliable data extraction from audio and video samples, unleashing passive data collection and allowing clinicians to focus more on treatment delivery.
Crilly pointed out the need for integrated systems that can pull together data from various sources to provide a comprehensive view of patient progress and outcomes. He mentioned the potential of remote patient monitoring codes and the benefits of incorporating wearable devices to track sleep and other health metrics.
Standardization and Collaboration
An audience member raised the question of standardizing data reporting between payers and providers. Yagnesh Vadgama acknowledged the importance of this and mentioned that it central to the industry’s roadmap for value-based care. The goal is to move towards more database-type submissions that allow for better tracking and analysis of provider performance and patient outcomes.
Rebecca Womack emphasized the need for the ABA profession to define its own standards and communicate them effectively to stakeholders. She highlighted the importance of balancing clinical decision-making with payer requirements to ensure the best outcomes for families.
Closing Thoughts
The session concluded with a call for collaboration and continuous improvement. The panelists acknowledged that while the transition to value-based care is challenging, it offers significant potential for improving the quality of autism services and achieving better outcomes for families.
Thank you to CASP for hosting such an insightful session!