Value Based Purchasing

ValueAdded

In this Issue:

Certified Peer Specialist Services Webpage Training ................................. 2 Provider Spotlight: Compliance Champion .......................... 3 3rd Annual Provider Appreciation Breakfast ............................................... 4 STAP Packets ....................................... 5 Value Behavioral Health of Pennsylvania on the Move .................... 6 Save the Date: 18th Annual Adult Recovery Forum ................................... 7

January 2018

1 Value Behavioral Health of Pennsylvania, Inc. | ValueAdded | January 2018

In 2018, Behavioral Health Managed Care Organizations (BH-MCOs) will be

required to begin establishing value based purchasing with providers. Value

based purchasing is the Pennsylvania Department of Human Services’

initiative to transition providers from volume to value payment models for the

delivery of behavioral health services. The strategy is to align improved quality

and efficiency of care by rewarding providers for their measured performance

across the dimensions of quality.

The Pennsylvania Department of Human Services is asking that each BH-

MCO move five percent of their medical expenses into value based

purchasing in 2018. By the end of 2019, 10% of the medical expenses must

be expended through value based purchasing, and in 2020, 20% must fall

under a value based purchasing contract. Behavioral Health MCOs can face

penalties in the years 2019 and 2020 if these goals are not met.

There are several kinds of value based purchasing models:

Performance-Based in which payment is linked to provider

performance and require providers to undertake specific activities or

meet certain benchmarks for service. These contracts may include

incentive and penalties, caseloads, and pay for performance.

Bundled and Episodic Model is when a single bulk payment is paid

for all services rendered to treat an individual for an identified condition

during a specific time period.

Shared Savings are supplemental payments to providers if they

are able to reduce health care spending for a definite patient population

relative to a benchmark. The payment is a percentage of the net

savings generated by the provider.

Article continued on page 2.

Valued Provider eNewsletter ProviderConnect & Provider Alerts #

Value Behavioral Health of Pennsylvania, Inc. | ValueAdded | January 2018 2

Value Based Purchasing (continued)

Shared Risk is an arrangement of shared financial responsibility

between the payer and the provider that allows for cost control,

efficiency of service use, and quality. In this arrangement, both financial

savings and losses are shared.

Capitation is a payment arrangement for healthcare service

providers that pays a set amount for each enrolled person assigned to

them, per period of time, regardless of whether the person received

services during the period covered by the payment.

Capitation + Performance-Based Contracting adds performance

based as supplemental incentive to a capitation contract.

Each payment model falls on a continuum of financial risk that rages from low

financial accountability to full financial accountability. The four categories of

financial risk are:

No Risk: Fee-for-Service

Small Risk: Performance-Based Contracting

Moderate Risk: Bundled and Episodic Payment, Shared Savings,

Shared Risk

Large Risk: Capitating and Capitation + Performance-Based

Contracting

Value Behavioral Health of Pennsylvania has submitted their plan to the

Department of Human Services to meet their established goals. We will be

meeting with providers over the next several months and years to ensure a

smooth transition. We will keep all of our providers in the network informed on

our plans.

WELCOME

Effective January 22, 2018, Suzie

Battista, LCSW, LBS will be

joining our VBH-PA/ Beacon team

as an Account Executive. Suzie

comes to us from Family

Behavioral Resources where she

has devoted the last 15 years of

her professional life to improving

the delivery of behavioral health

services for people in

Pennsylvania and Ohio. In her role

as Account Executive, she will

work closely with all departments

to help meet the needs of the

Southwest Six counties.

Welcome, Suzie!

VBH-PA has a new webpage that features

Certified Peer Specialist Services. Join us as

we take a tour of this page. This webinar will

cover state regulations, minimum documentation

standards, and will have a Q & A session at the

end. We look forward to having you join us!

Certified Peer Specialist Services Webpage Training Friday, January 26, 2018

1:00 p.m. – 2:00 p.m.

Webinar Registration Link:

https://beaconhealthoptions.webex.com/beaconhealthoptions/onstage/g.php?

MTID=e456b29dd42ca3dbc2a61746c190adb9a

Webinar Announcement

# Value Behavioral Health of Pennsylvania, Inc. | ValueAdded | January 2018 3

Westmoreland Casemanagement and Supports, Inc. (WCSI) was recognized as

a “Compliance Champion” by the Program Integrity Department of Value

Behavioral Health of PA (VBH-PA) during the 2017 Corporate Compliance and

Ethics Week in November and at the Provider Appreciation Breakfast held in

December for their continual efforts in reducing fraud, waste, and abuse.

Although it was the 43 self-audits submitted by WCSI since 2013 that grabbed

our attention, the VBH-PA Program Integrity Department recently discovered

there is a robust team approach to WCSI’s compliance program that has

evolved over the past several years.

WCSI’s “official” compliance department began in 2013. Currently, it is

comprised of a Quality Compliance Resource Specialist, a Senior Leadership

Resources Supervisor, and three Compliance Officers who are part of the

Compliance Committee. The Compliance Committee is also comprised of a

cross section of departments and positons throughout the organization. In

addition to ensuring that documentation meets expected standards, broad areas

of focus include education and training, complaints, grievances, and incidences.

A compliance hotline is available for customer and employee reporting with the

option to report concerns anonymously.

An effective compliance program requires efforts by many. WCSI’s compliance

department has an active working relationship with program leaders, the internal

auditor, the medical records team, and other areas which embodies a team

approach to compliance throughout their organization. Along with an overall

organizational integrity plan and risk assessment, each program has its own

internal plan that is developed to meet standards, address concerns, and track

patterns gathered through customer surveys and data analysis. Their medical

records staff performs a preliminary review of all claims submitted, and the

internal auditor contacts program leaders with any needed corrections. A more

in-depth review of claims and records at the program level is performed

periodically by the by the Quality Compliance Resource Specialist.

A comprehensive training and education program for WCSI employees helps to

keep compliance a focus. New employee orientation spans four days with one

day devoted to compliance topics which leads into a mentoring component that

lasts several months where the new employee shadows a seasoned staff

member of that program, receiving one-to-one guidance. Existing employees are

reminded of compliance during annual compliance week and throughout the

year, as the compliance department collaborates with other departments and

program leaders to support their quality standards.

With only a glimpse into WCSI’s compliance culture, it is apparent that much

dedication and hard work through a team approach has made WCSI’s

compliance efforts successful. VBH-PA appreciates and thanks WCSI for their

continual collaboration and commitment in the prevention, detection, and

resolution of errors, fraud, waste, and abuse.

Provider Spotlight: Compliance

Champion!

VBH-PA appreciates and

thanks WCSI for their

continual collaboration and

commitment in the

prevention, detection, and

resolution of errors, fraud,

waste, and abuse.

# Value Behavioral Health of Pennsylvania, Inc. | ValueAdded | January 2018 4

3rd Annual Provider Appreciation Breakfast

The third annual VBH-PA Provider

Appreciation Breakfast was held on

December 1, 2017, at the Marriot in

Cranberry, PA. Ninety-four attendees

enjoyed a hot breakfast and helped us

to celebrate our provider network!

After reviewing the results of the VBH-

PA Member Satisfaction Survey and

the Provider Satisfaction Survey, five

providers were recognized for their

outstanding contributions in 2017.

Westmoreland Casemanagement

and Supports was recognized for

their commitment to reduce fraud,

waste, and abuse.

Meadville Medical Center was

recognized for their willingness to

collaborate with VBH-PA on our

Beacon Select Initiative.

AMI Psychiatric Rehabilitation was

recognized for the Outstanding

Program Award bestowed upon them

by the Pennsylvania Association of

Psychiatric Services.

Cornerstone’s Dr. Stephen Neal was

recognized for his APEX award which

represents the pinnacle of service,

quality, innovation, and achievement in

primary health care and designed to

recognize the outstanding efforts to

dedicated individuals and teams who

work in Pennsylvania’s health centers.

Human Services Center was

recognized for their innovation with

their open access option.

Michele Kelly-Thompson, Human

Services Center, wrapped up the

morning by addressing the audience

about the steps Human Services

Center has taken to make their open

access program a success.

We hope you will join us next year as

we celebrate all you do as our network

providers!

Cathy Smith, WCSI

Steven Adams, Meadville Medical Center

Diana McKinney, AMI, Inc. Psych Rehab

Sarah DeCarlo, Cornerstone Care, accepting on behalf of Dr. Neal.

Michele Kelly-Thompson, Human Services Center

Sign-up to receive important event

announcements such as the annual

Provider Appreciation Breakfast and

other VBH-PA trainings and

webinars by registering your name

and email address with us. Go to the

Provider homepage at: http://

www.vbh-pa.com/providers/

and then click on the link: Sign up

for ValueAdded, our provider

newsletter.

By registering your email address

with us, you’ll get important notices

from VBH-PA, along with our

monthly newsletter, ValueAdded.

NEVER MISS

AN EVENT!

# Value Behavioral Health of Pennsylvania, Inc. | ValueAdded | January 2018 5

Evaluations for Summer Therapeutic Activities Program (STAP) must be

comprehensive and include all of the information required in the

Comprehensive Child/Adolescent Strengths-Based Evaluation (Life Domains)

(CCASBE-LD). Abbreviated evaluations will not be accepted to determine

medical necessity for STAP.

If a child is currently receiving BHRS and has a current evaluation that

recommends STAP, there may be no need for either an additional ISPT or a

new evaluation specifically recommending STAP. STAP providers will

maintain a staff ratio that will manage children with no additional TSS. It will,

therefore, be a rare occurrence that a TSS will be authorized for attendance

at STAP.

For all STAP providers, please remember to inquire with your respective

counties to obtain a letter of support. Please remember if you made any

changes to your service description, you will need to submit the changes for

approval to OMHSAS.

Providers who are considering providing a Summer Therapeutic Activities

Program in 2018 are required to submit a VBH-PA application for STAP.

Applications are located on our website at http://www.vbh-pa.com/wp-content/

uploads/sites/9/provider/info/pr/STAP_Application.pdf

Summer Therapeutic Activities

Programs (STAP)

STAP Applications, county

letters of support, and

approved service

descriptions for STAP are

due to VBH-PA/Beacon by

March 15, 2018.

Please consider summer plans when completing

evaluations for children.

STAP Packets for Authorization

Mail complete packets (evaluation, evaluation cover sheet, ISPT sign-in

sheet, treatment plan, plan of care, and family choice form) for STAP

authorizations to: Beacon Health Options, P.O. Box 1840, Cranberry Twp.,

PA 16066-1840, Attention: Clinical Department. This address is for all VBH-

PA members.

Applications, county letters of support, and approved service

descriptions for STAP are due to VBH-PA/Beacon by March 15, 2018,

attention Charlotte Chew, Provider Relations Director, Beacon Health

Options, P.O. Box 1840, Cranberry Twp., PA 16066-1840. These

documents are required every year.

If you have any questions about STAP, please email or call:

Charlotte.Chew@beaconhealthoptions.com or (724) 744-6313.

# Value Behavioral Health of Pennsylvania, Inc. | ValueAdded | January 2018 6

New Claims Addresses

Our paper claims mailing address changed effective October 9, 2017. If you submit paper claims,

please begin mailing your paper claims to the following address. If you are using third-party billers, please

notify your billing agencies of this change. Providers should no longer be using the 516 Pleasant

Valley Road address.

Beacon Health Options

Pennsylvania Claims

P.O. Box 1853

Hicksville, NY 11802-1853

Our new Timely Waiver Request address:

Value Behavioral Health of Pennsylvania

Attention: Timely Filing Committee

P.O. Box 1840

Cranberry Township, PA 16066-1840

Value Behavioral Health of Pennsylvania on the Move!

Name Change Coming in 2018

Consistent with our parent company’s name, we are re-launching our brand and will become Beacon Health

Options in 2018.

We will continue to keep you updated with details about our move as they come in. Check your inbox for emails

from VBH-PA, ValueAdded newsletter articles, and our website for updates. If you have any questions, feel

free to contact us at 1-877-615-8503 or contact your Provider Field Coordinator.

# Value Behavioral Health of Pennsylvania, Inc. | ValueAdded | January 2018 7

Save the Date Value Behavioral Health of Pennsylvania

Presents the

18th Annual

Adult Recovery Forum

Friday, April 13, 2018

Pittsburgh Marriott

North

Cranberry Township

Start thinking about outstanding

individuals whom you would like to

nominate in your county. Visit

www.vbh-pa.com for information

on the upcoming forum and to

download the nomination form.

Deadline for nominations will be

March 1, 2018.

HealthChoices’ VBH-PA members living in Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington and

Westmoreland Counties are invited to attend. Crawford, Mercer and Venango County HealthChoices’ members will have the

opportunity to attend other regionally held VBH-PA Forums in 2018.