Transcript Document

Giving Value Back to the Provider
2008 Provider Webinar
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Agenda
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Welcome and Introductions
Overview of ValueOptions®
ValueSelect Program
CE City
On Track Outcomes Program
Electronic Fund Transfer
ProviderConnect Demonstration
Questions and Answers
ValueOptions
ValueOptions
• Founded in 1986
• Privately held and physician-owned
• Committed to principles of recovery
• Diverse client base – over 24 million lives
– Employer Solutions Division covering 12% of
Fortune 100’s
– Health Plan Division with 23 health plan clients
covering 4.7million lives
– Federal Division (TRICARE) with 3 Million lives
– Public Sector Division with over 50 Government
clients covering over 4 million lives in 11 states
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ValueOptions’ National
ValueOptions’
National Footprint
Footprint
Latham
Troy
Detroit
Boston
Trafford
Colorado Springs
Colorado
Springs
Trafford
Topeka
Reston
Topeka
Phoenix
Long Beach
Durham
Hartford
New York City
Hamilton
Norfolk
Virginia Beach
Santa Fe
Irving
Dallas
Jacksonville
Headquarters
Tampa
Service Centers
Corporate Support Offices
24.7 million covered lives
Total Locations - 19
> 1 million lives
> 300,000
> 100,000
< 100,000
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Medicare/Medicaid Regions
ValueOptions’ National Footprint
ValueOptions of California
manages eligibility and
authorizes behavioral health
services for children and
adolescents in more than 30
counties across the state.
Managing Medicaid
behavioral health services
in 40 Colorado counties,
Colorado Health Networks
won national recognition for
its transition to a recoverybased model of care.
ValueOptions of Kansas
recently implemented a
statewide program designed to
enhance substance abuse
services provided through
federal block grant and
Medicaid dollars.
Value Behavioral Health of
Pennsylvania serves Medicaid
consumers in 14 counties,
customizing operations to meet
the unique needs of each county.
The Massachusetts Behavioral Health
Partnership is a statewide entity that
focuses on consumer-led initiatives,
performance-based contracting, and
behavioral health integration with primary
care services.
Medicare/Medicaid Health Plans
Reflecting a growing national
trend of braiding state child
welfare funding with Medicaid
dollars, the Connecticut
Behavioral Health Partnership
manages services statewide for
children and families.
Medicare/Medicaid Health Plans
ValueOptions New Jersey
manages an innovative statewide
system of behavioral care for atrisk children and their families.
Blending 17 funding streams to
serve the state’s Medicaid and
uninsured populations,
ValueOptions New Mexico
provides an integrated system of
mental health and substance
abuse services.
Serving the Dallas metropolitan
area and seven surrounding
counties, ValueOptions NorthSTAR
blends funding streams to improve
service delivery integration and
manages an innovative pharmacy
program.
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In Illinois, ValueOptions is
implementing a program for the
Division of Mental Health to aid the
transition from a grant-based to a feefor-service financing system and
review, improve the quality, and assure
the appropriateness of community and
hospital-based mental health.
Delivering Medicaid
behavioral health services for
children and adults across
Florida, Florida Health
Partners received a national
award of excellence for being
an effective, efficient provider
organization.
In North Carolina,
ValueOptions conducts
statewide behavioral health
utilization management and
review of ten distinct levels of
care.
ValueSelect Program
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Whatisisthe
theValueSelect
ValueSelectProgram?
Program?
What
 Program is made up of three innovative components:
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ValueSelect provider designation. ValueOptions® established a
designation for providers who are committed to applying evidence based
treatment approaches in gathering treatment in their work with patients.
Expectation of ValueSelect providers include:
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Providing outcomes data: by 3rd session and after discharge
Employ VO guidelines
Maintain VO access standards
Show evidence of training in EBP
Use electronic transactions
Use Report Card Data to improve practice patterns
ValueOptions® encourages feedback from our members based on their
experience with their providers. With this feedback, ValueOptions® helps
to ensure high quality behavioral health services. Members complete the
survey by calling the toll –free number, (866) 250-1743 and answering the
brief survey telephonically or by accessing the survey at the ValueOptions
website.
• Network open by application to any ValueOptions contracted provider.
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Select Provider
Network
ValueSelect
Network Status
 ValueSelect Provider network
 Network open by application to any VO
contracted provider, but active recruitment
efforts target high volume providers (25+
members/year
 4590 VSP providers as of 9/30/08
 Treating 29,356 members
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Core Credentialing Criteria (applicable to all ValueOptions providers)
MHSA
EAP
● NCQA Standards
● 2 years verifiable EAP experience
● Accredited (JCAHO, CARF, COA, AOA)
● 3 Years Post Licensure
● CEAP eligible
● Meets program level criteria requirements
● Highest Level of independent
practices in state
● 1 year substance abuse experience
● State licensure & malpractice requirements
Administrative Criteria for
ValueSelect
Provider meets ValueSelect Provider
compliance requirements, including:
● uses ProviderConnect
● supplies member outcome data via
outpatient review form & discharge
summary
● promotes member questionnaire
VALUESELECT
CONTRACTED MHSA
OUTPATIENT PROVIDER
Criteria:
● Provider Quality Profile (PQP)
meets thresholds for:
● Utilization mgt measures
● Quality measures
● Complaints
● Provider submits evidence of
advanced training in one of the
following:
● Cognitive Behavioral Therapy
● Dialectical Behavioral Therapy
● Anxiety Disorders
● Affective Disorder
● Eating Disorders
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FACILITY
VALUESELECT
CONTRACTED EAP PROVIDER
Criteria:
● Certified EAP provider
● Meets thresholds for EAP
provider quality profile tool
Member reported results related to:
● Job performance
● Work attendance
● Relationship with others
● Satisfaction with EAP counselor
VALUESELECT
CONTRACTED MHSA & EAP
PROVIDER
Criteria:
● Must meet all requirements
from Contracted MHSA
Outpatient Provider &
Contracted EAP Provider
Clinical & Quality Criteria
for ValueSelect
Clinical/Quality criteria vary for each type of
provider (see boxes below)
VALUESELECT
CONTRACTED FACILITY /
HIGHER LEVEL OF CARE
Criteria:
● Meets Utilization Mgt
criteria
● Meet Quality Measures
(HEDIS) requirements
VALUESELECT
DIAGNOSTIC SERVICE PROGRAM
Criteria:
● Facility has active full accreditation status given by appropriate
accreditation entity (preferably TJC or CARF)
● Targeted program exists in self-contained unit or a clearly identified
treatment track
● Program/facility offers a continuum of care across multiple levels
● Program demonstrates positive treatment outcomes
● Program has acceptable utilization statistics relative to populations
treated
● Per diem and episode of care costs are within reasonably accepted
ranges
● Program demonstrates positive quality of care measures (e.g.,
recidivism; complaints; adverse incidents; HEDIS measures)
● Program has evidence-based treatment guidelines and protocols
and delivers care accordingly
● Program demonstrates the use of individualized treatment plans
● Program has positive reputation among peers and stakeholders
G:\Johnna’s Files\ValueSelect\02.08.08 VS Provider Designation.vsd
Select
Provider Designated
Network Providers
ValueSelect
 Incentives
• Treatment episode authorizations – provider driven
• ValueSelect Provider designation and other information
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used to help steer member selection
Comparative data on Report Card for practice
improvement
Discounts on continuing education training
Claims, Customer Service and TechHelpLine liaison
assistance
Access to AchieveSolutions
Report
Card
Data
Elements
Report
Card
Data
Elements
 ValueSelect provider compared to other ValueSelect
providers of same discipline in Metropolitan Statistical
Area (MSA)
 CPT (procedure) codes and number of sessions
 Diagnostic categories of members
 Caseload by age range
 Average number of visits by case
 Outcomes data (risk and impairment)
 Satisfaction survey results
 Quality issues
 Members migrating to higher level of care
 Pattern of use of web-based applications
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CE City
… staying connected to ValueOptions
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ValueOptionsValueOptions
Velocity eCME Velocity
LearningeCME
Management
System
Learning Management System
•Tools to Manage Your Maintenance
of Licensure for Multiple States of
Licensure
•Largest Online Library of Indexed
and Accredited High Quality CME
Activities
• Ability to Develop a Curriculum of
Online CME Activities-Come Back as
Often as You Need To….
•Self Paced Learning-24 X 7
Availability
• Fully Automated –Certificates
Available in Real Time
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Customized Home Page to
Highlight Special/Newly
Launched Programs
ValueOptions
Velocity eCME Learning Management
ValueOptions Velocity eCME Learning Management System
System Registration Process
Registration Process
Begin on the ValueOptions
Home Page
User accesses link from
Provider Home Page on
ValueOptions Website
Seamless Login
From the Provider Tab
with Your Current
Login
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ValueOptions
Velocity
eCME
Learning
ValueOptions Velocity
eCME
Learning
Management System
Management System
View Front Matter
VIEW ACTIVITY
MY TRANSCRIPT
CME/CE
Reports
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Evaluation +/- Post test
CME CERTIFICATE
Additional Site Additional
Features Site Features
My Preferences
Rate It
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Site Tutorial
On Track Outcomes Program
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What is On Track Outcomes?
 A client-centered outcomes management program
 Designed to support providers as they help EAP
participants achieve their goals
 Utilizes a standardized, participant-completed
questionnaire and rapid feedback to provider
Disclaimer: The ValueOptions On Track Outcomes for EAP program does not make recommendations or
decisions about appropriate clinical care or service. Any questionnaires, reports, guidelines and
other material related to this program are intended as an informational aid to providers. They do not
substitute for or limit in any way the use of other resources and the provider's own professional
judgment in the delivery of EAP counseling services.
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OnOn
Track
Benefits
for Providers
Track
Benefits
for Providers
 Compare client progress to benchmarks “Is this treatment working for this patient?”
 Assist identification of potential self-harm and
substance abuse risk
 Detect possible barriers to effective treatment
 Encourage client engagement
 Aggregate outcomes: evidence of value and
effectiveness of EAP services
 Recognition through ValueSelectsm designation
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Outcomes-Informed Care: Key Elements
 Using an outcome measure that is sensitive
to patient change
 Repeated patient assessment
 Ability to track patient change and compare
Case is not
to “typical” profile
“on track” –
high risk for
poor outcome
Wellness Assessment
Expected Change
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40
Actual score
WA-Adult Score
Global 35
Distress 30
Score 25
85% percentile
Predicted Score
20
15th percentile
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Clinical cuttoff
10
5
0
Intake
3
6
9
Weeks
20
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Getting Started with On Track
1.
Register at www.psychoutcomes.org/ValueOptions
- An email address and an NPI are required to register
2.
Review the Confirmation Email with the On Track Clinician ID
3.
Download and Print the Client Feedback Form (CFF)
4.
Administer the CFF to all New ValueOptions® EAP Clients
- And “Information for EAP Participants”
- 1st, 3rd and closing session
- Enter a unique “Case Number” on the CFF
5.
Fax the CFF to 866-408-7240
6.
Login to www.psychoutcomes.org/ValueOptions for CFF
results
- CFF results are typically available within 1 business day
- Client Outcomes Toolkit requires the use of Microsoft Excel
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www.psychoutcomes.org/ValueOptions
www.psychoutcomes.org/ValueOptions
New users
register here
Links to other
ACORN
information –
not specific to
On Track
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Client Feedback Form (CFF)
 Client-completed 20-item
questionnaire designed for
adults and older adolescents
 Customized for VO, using
items from an item bank
Item Groups
 Global Distress:
1-10
 Risk of self-harm:
5
 Substance use:
11-13
 Work productivity: 14-15
 Therapeutic alliance: 16-18
 Background items: 19-20
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Clinician’s Outcomes Home Page
Your user name and
clinician ID
Email for suggestions,
comments, general
questions (non-urgent)
Email for web site, data,
and toolkit issues
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Clinician’s Outcomes Toolkit
4 different tabs
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Clinician’s
Outcomes
Toolkit:
Summary
Clinician’s Outcomes
Toolkit:
Summary
Results from
most recent
CFF – High
outliers in red
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Questions and Discussion
Resources for Questions
• Frequently Asked Questions
On the web site, near bottom of the ValueOptions page
• Technical/Data/Web:
Email to [email protected]
• General comments or questions:
Email to [email protected]
or
Call On Track Customer Service 866-476-9796
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Electronic
Fund
Transfer
… helping you with your business needs
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WELCOME!
Welcome to PaySpan Health, an enhanced payment and reconciliation
solution.
This new solution will enable you to receive faster payments through
electronic deposits with complete remittance details.
You will have numerous online capabilities to search claims and remittance
details and produce custom reports.
Pay Span Functionality
General Features
• PaySpan provider site has an online security subsystem that allows you
to control each user’s access to specific customer applications, individual
reports and web site features.
• PaySpan provider site’s security control includes controlling access to the
following functions:
Managing accounts
Reconciling payments
Viewing payments online
Viewing account configuration
Administering user rights
Accessing individual rights
• PaySpan provider site logs all user activity on the PaySpan provider site.
• PaySpan provider site provides Online Help on every screen.
• PaySpan provider site supports Internet Explorer 5.0 and above.
Providers received a Registration Enrollment Letter explaining the registration process in the summer. The letter provided
the required Registration Code. Providers will need their Provider Identification Number (PIN) – this is your ValueOptions
Pay to Vendor Number, Tax Identification Number (TIN), bank routing and account information found on a check to start the
Provider Registration and access into the PaySpan system. NOTE: Do not pull this information from a deposit slip as your
bank routing information is different than what is reported on the check. If you have issue attaining a registration code,
please email [email protected], in the email please provide the pay to vendor number and your tax
identification. You will find your vendor number on any ValueOptions provider voucher that is sent to you. For email
responses please allow 24 – 48 hours.
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your unique registration code:
xxxxxxxx
pay to vendor number
for eft registration only:
DEMO HEALTHCARE PARTNERS
4439 EASY ST
ANYTOWN, MA 12345
A123456
To Our Providers:
ValueOptions now offers Providers PaySpan Health - a solution that delivers Electronic Payments (EFTs), Remittance Advices
(ERAs), and much more. FREE to (insert Payer Name here)
Providers, the solution enables online presentment of remittances, and straightforward reconciliation of payments to empower our
Providers to reduce costs, speed secondary billings, and improve cash flow.
Convenient Payments
PaySpan Health gives you the option to receive payments according to preference: electronically direct to a bank account, or
by
traditional paper check. You are also able to choose the method in which you receive remittance information:
Electronic remittance advices presented online and printed on location.
HIPAA 835 electronic remittance files for download directly to a HIPAA-compliant
Practice Management or Patient Accounting System.
Provider Benefits
As a Provider, you can gain immediate benefits by signing up for PaySpan Health:
Reduce accounting expenses – Electronic remittance
advices can be imported directly into Practice
Management or Patient Accounting Systems,
eliminating the need for manual re-keying.
Improve cash flow – Electronic payments can mean
faster payments, leading to improvements in cash flow.
Maintain control over bank accounts – You keep
TOTAL control over the destination of claim payment
funds. Multiple practices and accounts are supported.
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Match payments to advices quickly – You can associate
electronic payments with electronic remittance advices
quickly and easily.
Maintain control over remittance formats – You can
choose from a large library of formats for remittance
advices you will receive.
Manage multiple Payers – Reuse enrollment information
to connect with multiple Payers. Assign different Payers to
different bank accounts, as desired.
www.payspanhealth.com
www.payspanhealth.com
Log onto:
www.payspanhe
alth.com
Select Secure
Registration
button.
Registration Code
Screen will appear.
PaySpan Health
Customer Service
Support Phone
Number.
877-331-7154
Hours 7AM – 9 PM
(EST) Monday Friday.
Download User
Guide – Help Menu
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Register for PaySpan
Attention Providers:
If you register for PaySpan
between the dates of November 5th
and November 21st, ValueOptions
will be doing a random drawing of
50 providers. If your name is
picked you will receive an
American Express $25.00 gift card.
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Provider Relations
Creating new choices for our
providers today and tomorrow.
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Integrated Systems
NETWORKCONNECT
Robust network management
and provider relations
CARECONNECT
Superior clinical case
management and data collection
PROVIDERCONNECT
Secure, online administrative
self-service for providers
TELECONNECT
Easy-to-access telephonic selfservice for providers and members
SERVICECONNECT
MEMBERCONNECT
Industry-best customer service
and issue resolution
Online self-service and awardwinning content for members
Technology + Innovation + Service + Access
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ProviderConnect (www.valueoptions.com)
Benefits of using ProviderConnect:
• Eligibility and benefit verification
• Authorization status and view
authorization letters
• Claim status
• Single and batch claims submission
• Send Inquiries
• Request Authorizations
• Provider Data Sheet – Coming Soon
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How
toAccess
AccessProviderConnect?
ProviderConnect?
How to
 All In Network providers will be able to obtain
online registration per provider ID number via
the website
 To obtain additional logons for ProviderConnect
– contact the ValueOptions® EDI Helpdesk at
(888) 247-9311 and press option 3, Monday thru
Friday, 8a.m. – 6 p.m. EST
– The TAT for additional logons is 48 hours
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How
to Access
ProviderConnect?
How
to Access
ProviderConnect?
 Access thru www.valueoptions.com within
the provider section of ValueOptions®.
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Demonstration
of of
ProviderConnect
Demonstration
ProviderConnect
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ProviderConnect
Login
Screen
ProviderConnect
Login
Screen
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Questions and Answers
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Thank you!
Please remember to complete your evaluation forms
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