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.
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
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.