Value Based Payments

Value Based Payments 

The healthcare landscape is rapidly changing, as new payment and program models surface that reward behavioral healthcare organizations based on the value of their care. Previously, increasing the quality of care provided was financially counterproductive, as a provider’s margins would shrink as the quality of care increased due to the inherent costs of providing high-quality care, fewer reimbursable visits needed by healthy clients, and the lack of increased reimbursement based on outcomes. Now, with a new incentive model referred to as value-based payments, how much a provider can earn is directly tied to the quality of care offered, measured by performance metrics. As you can surmise, this approach is heavily data-driven and requires providers to understand how to calculate their cost of care and their value, how to benchmark, and how to forecast. In this course, you will learn about the current healthcare landscape and how networks’ and providers’ margins are not improved by providing their members with the highest quality of care. You will then learn of value-based payments, a promising method for payers that helps to quantify the quality and value of care while sharing accountability and risk with providers. Finally, you will be exposed to various payment models, strategies, and concerns as you attempt to maximize your value of care and margins. This course is appropriate for utilization managers, case managers, and care coordinators, as well as individuals working in provider oversight and relations.


Hours: 1.00


Certificates provided by accrediting body (1 Match)

Commission for Case Manager Certification


This program has been pre-approved by The Commission for Case Manager Certification to provide 1.00 hours of continuing education credit to CCM® board certified case managers.

Course Details

Course Code: REL-PI-0-VBPA
Hours: 1
Type: Online Course
Content Expiration Date: 3/31/2021
Learning Objectives:
Discuss how the current fee-for-service system is failing to promote quality of care.
List the concepts and key elements of a value-based payment model.
Conceptualize the value of your and your networks care.
Explain how payment models are tied to differing levels of accountability and risk.

Section 1: Introduction A. About This Course B. Learning Objectives Section 2: The Current Healthcare Landscape A. Jacob’s Story B. Health Outcomes C. Missing the Mark D. Social Determinants of Health E. Integrating to Improve Member Health F. Can Cost, Quality, and Experience Co-Exist? G. Testing Your Knowledge H. Summary Section 3: Introduction to Value-Based Payments A. What are Value-Based Payments (VBP)? B. How Do You Define Quality? C. Measuring Quality D. Conceptualizing Value in a VBP Model E. Value is Relative F. A Note on Comparing Value G. Achieving High Value in a VBP Model H. Exercise: Where Does My Network Stand? I. Summary Section 4: Value-Based Models In-Depth A. Integration, Accountability, and Risk in a VBP Model B. Low Sharing of Accountability and Risk C. Moderate Sharing of Accountability and Risk D. High Sharing of Accountability and Risk E. Example in Action: Capitation F. Making the Most of a VBP Model: Organization-Level Factors G. Making the Most of a VBP Model: Data H. Care Management in a VBP Model I. Challenges and Barriers in a VBP Model J. Review K. Summary Section 5: Conclusion A. Summary B. Congratulations! C. Course Contributors D. References

Expert Reviewer: Joshua Rubin, MPP
Joshua Rubin is a principal in Health Management Associates’ (HMA) New York City office. His specialty over his nearly two decades of service to New York City’s mental hygiene service system has been service-funding conversions, strategic planning, agency mergers, internet-based treatment, disaster preparedness and response, housing and homelessness, day and vocational services, and crisis services, particularly suicide hotlines. During his time with HMA, he has been deeply involved in New York State’s Care Management for All initiative. Prior to joining HMA, Josh was a government official, service provider, and advocate. During his government service, he was the Assistant Commissioner for Mental Hygiene Policy for the City of New York Department of Health and Mental Hygiene. During his years of city service, he also served as the Assistant Commissioner for Chemical Dependency Services and the Division of Mental Hygiene’s Chief Policy Officer and Chief Administrative Officer. Josh was also the Vice President and Chief Operating Officer of the Mental Health Association of New York City (MHA-NYC). Prior to joining MHA-NYC, Josh was the Director of Policy and Planning for YAI Network, and was on the staff of the Coalition of Voluntary Mental Health Agencies. Josh has a Master of Public Policy degree from the John F. Kennedy School of Government at Harvard University and a bachelor’s degree in religion and the humanities from the University of Chicago. Disclosure: Joshua Rubin, MPP has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Staff Writer: Justin Hess, MS
Justin Hess, M.S. received his Masters of Science in Industrial/Organizational Psychology from Alliant International University and is currently pursuing his doctorate in the same discipline. He has almost 10 years of experience in working with organizations for the purposes of assessment, selection, training, organizational and leadership development, and project management. In these roles, he has directly hired and developed over 85 internal personnel, while also acting as a liaison and directing projects for over 100 external personnel. In the realm of learning, Justin has taught university courses on talent, staffing, and selection, and he has reviewed, managed, or written content for over 400 e-learning courses. Justin is currently the Product Manager for Assessments at Relias. Disclosure: Justin Hess, MS has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Advanced, Intermediate level Social Workers; Case Managers; Nurses; in the following settings: All Healthcare Settings.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.