VBP can benefit your state in multiple ways: 

What is the VBP toolkit?

To understand how PCG can support your state in developing and operationalizing VBP initiatives, we have developed the VBP Toolkit. The VBP Toolkit is a straightforward roadmap to developing and operationalizing a VBP initiative. Using the toolkit, we highlight how PCG can support you along your VBP journey.

Enables a tailored approach

Adaptable to suit your organization’s VBP maturity and comfort level

Includes support from PCG across all or a select number of aspects of the toolkit

The Toolkit allows flexibility and is not an all or nothing proposition. There is no requirement to sign up for all aspects if you have already completed a program evaluation or have a draft design.

The toolkit ensures you can focus on YOUR goals!

The toolkit summarizes the process into the following stages:

1. Program Evaluation and Identification of VBP Opportunities
2. Stakeholder Engagement and Education
3. Program Design
4. Federal Negotiations
5. Program Implementation
6. Ongoing Program Management and Improvement Support 

1.    Program evaluation and identification of VBP opportunities

The first step is evaluating your current Medicaid program, what goals you want to achieve with your program, and identifying how you could go about meeting those goals.

PCG can help conduct a gap analysis to identify where your Medicaid program needs assistance, identify VBP strategies and initiatives designed to address these concerns, and ensure alignment with legislative priorities.

PCG’s approach to assessment preparing for VBP includes:

• Identifying available data sources to support the implementation of outcomes-based arrangements, including providers' current access to and utilization of data.
• Assessing workforce gaps that exist at the provider level, and collecting information on provider shortage by service, region, type
• Ensuring that health equity is considered in the selection of measures and the development of arrangements
• Identifying areas of provider shortage by service, region, and type
• Potential Federal Waiver Implications, and impact of In Lieu Of Services in Managed Care

2.    Stakeholder Engagement & Education

No matter the direction you go in, it is vital to involve all stakeholders throughout the process. A robust stakeholder engagement plan, including communication methods, and training materials can help the success of a project.

PCG has extensive experience working with stakeholders in both an advisory and an educational capacity. We are adept in leading stakeholder engagement activities, including developing and delivering a communication plan to ensure providers and other stakeholders are kept informed while preparing for the development and delivery of future training. PCG can also support the development of survey tools to gather information about providers and their on-the-ground experiences and work directly with stakeholders to make sure concerns are heard and addressed.

3.    Program Design

Program design may include the development of:

• Financial Incentives – By developing clear, achievable financial incentives, we can make sure that provider behavior is aligned with programmatic goals, provider networks are on board with the program, and that programmatic goals mutually benefit all parties.
• Quality/Performance Metrics – VBP initiatives require measurement and evaluation that demonstrate service quality and provider performance. PCG can support you in developing quality and performance metrics that are tailored to your VBP program and measure what it is the program intends to address and improve on.
• Payment Policy and Modeling – You will need to develop payment methods under which your VBP initiative will operate and understand the financial impact of the initiative. PCG has a wealth of experience in health finance modeling and alternative payment modeling to support you.
• Implementation Planning – A well-designed reimbursement methodology is not enough to ensure successful implementation. PCG can assist you in understanding and addressing operational considerations such as training, data collection needs, technology requirements, inflation, and other future methodology updates and administrative support needed to ensure success.

4.    Federal Negotiations

All VBP initiatives need federal approval for implementation. This can be a time-consuming process involving lots of back and forth.

PCG has decades of experience navigating the federal approval process. From drafting state plan amendments and pre-print forms to responding to questions and being involved in discussions, PCG is well positioned to provide you with varying degrees of support throughout the process.

We work with and understand all federal health regulations including:

• 1115 Waivers
• 1915 Waivers
• CMS 2442 Access Rules

5.    Program Implementation

The implementation process, which follows once you have received federal approval, has many moving parts with different timelines and resource requirements. This includes but is not limited to continued stakeholder engagement, updating regulations, drafting policies, operationalizing data collection processes, data infrastructure preparations, provider education and training, and setting up program evaluation frameworks.

PCG is adept at developing detailed plans and timelines to support states in successful program implementation. Our project management processes identify risk and offer proactive solutions to navigate any implementation concerns. We have subject matter experts to work with your data collection tools, update policy guidance, and move the program from idea to reality.

6.    Program Management & Support

Once the implementation phase is over and the program is up and running, there is still work to be done. From conducting data analysis and adjudicating payments to program evaluation and stakeholder training, ongoing program activities guarantee the continued success of the program.

With decades of experience in program management, PCG will make sure stakeholder communication is ongoing, and a regular cadence of training is conducted. With our trained staff dedicated to data analysis and robust performance tools, we will make sure payments are accurate based on data collection and all programs are running .