On this episode, we talk with Jason Helgerson, founder of Helgerson Solutions Group and Former Medicaid Director for New York and Wisconsin. Jason shares his perspective on Value-based payment progress and direction tells us who needs to get involved and how, and we discuss how to measure success. That is, how will we know if value-based payment has been adequately deployed, and more importantly, how will we know if it’s working?

This episode is sponsored by VBP Forward:

VBP Forward will host its inaugural conference February 20-21, 2019 in Buffalo, NY at the Hyatt Regency Buffalo. The conference will bring together over 200 professionals who serve Medicaid and Medicare special needs or complex populations or have an interest in that value chain. Participants will gain insight into the next generation of value-based payment and will be provided with a roadmap for their path towards effective value payment for special needs populations. In addition to clinical providers, VBP Forward will have a track and focus on guiding community-based organizations down the right path for the collection of social determinants of health and how they can become not only an integral part of care delivery but also the revenue cycle associated with that delivery.

Show notes and Timestamps

2:09 Engaging providers who feel left behind by the Value-Based Payments conversations.

3:18 In New York, 80% of all reimbursement for Medicaid must be under VBP contract by 2020.

5:36 Community Based Organizations are treating the same issues health systems are struggling with. What do CBOs and Health systems need to learn about each other to create new sustainable business models?

9:10 Breaking down the language barriers.

12:49 What has made early pioneers successful?

15:11 How do CBOs explain to plans and health systems what the expected ROI will be? “Walk before you run.”

18:07 Begin the dialog with payors early. You can see this as an opportunity or a threat, but the train has left the station.

21:40 When taking on risk, you’re responsible for more than you were in a FFS model. This necessitates partnerships with CBOs. If you wait, you’re going to have to take what’s left.

22:45 What’s happening outside NY? Examples nationally and abroad. England and NHS

28:15 What about Medicare and commercial payors?

31:15 Measuring success in a VBP future. What does success look like for the state, for CBOs, for doctors, and for patients?

“I think at some point in the not too distant future, we will look back on how we treat people who are sick and with flu-like symptoms almost as bloodletting. Requiring them to leave their homes and go to a clinic to be treated when the technology exists to do bloodwork and other tests in the home; with new telehealth tools to be able to almost do a complete exam on those individuals without them having to leave the comfort of their home, which is in the best interest of the patient and the public’s health, those models are not possible in the traditional FFS system. They are much more possible in a value based world.”

“Consumers having more choices will be the real power of Value Based Payments.”

37:00 How close are we to knowing which clinical outcomes to measure? HEDIS measures taken from claims data measure process and not the true outcome. Patient-reported outcomes are needed to say if patients are getting high-quality services. Beyond healthcare measures, how do we measure the health and wellbeing of a community?

42:00 Helgerson Solutions – What do you do and who do you do it for?

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About Jason Helgerson

Jason Helgerson is an entrepreneur, investor, consultant and social change agent.  After more than 20 years of public service he has embraced the “gig economy” and launched a multifaceted private sector career.  Helgerson Solutions Group LLC (HSG) is focused on helping companies, providers, payers and governments make the move to value in health care.  Jason also advises Private Equity firms and Venture Capital funds that share his commitment to value-based health care.  Jason also works around the world as a Senior Advisor to a global management consulting firm.

Before his move to the private sector, Jason was a nationally recognized leader in public sector health care.  Most recently he was New York’s Medicaid Director, a role he held for over seven years.  New York’s Medicaid program provides vital health care services to over 6.6 million New Yorkers and has an annual budget in excess of $68 billion.  Jason also served as the Executive Director for New York’s Medicaid Redesign Team, nationally recognized as a 2015 Innovation in American Government Finalist by the Harvard Kennedy School of Government.  In this capacity he directed Governor Cuomo’s effort to fundamentally reshape the state’s Medicaid program in order to both lower costs and improve health care quality.  In 2015, Jason was also recognized as a Public Official of the Year by Governing Magazine.

Twitter: @policywonk1


About Helgerson Solutions Group

HSG was founded to make the world a better place.  Its founder, Jason Helgerson, has made that his mission his entire professional life.  He has been a positive and successful change agent in every position he has held.  Most recently he was New York’s Medicaid Director.  In that role he led the state’s historic Medicaid redesign efforts which not only bent the cost curve but improved outcomes for Medicaid members.

A 2018 Commonwealth Fund study found New York to be the most improved state in the nation relative to its overall health system performance and suggested that further improvement was likely thanks to reforms launched by Jason and his team.

Prior to moving to New York, Jason was Wisconsin’s Medicaid Director.  In this role he led the effort to expand access to health care to virtually all state residents.  He also helped lead a major cost-cutting exercise that brought down spending without taking benefits away from a single Medicaid member.  Prior to his Medicaid work, Jason held a series of positions in state and local government leading efforts to reform education, child care, public finance and, of course, health care.


Related and/or Mentioned on the Show

DSRIP and VBP reform

Green and Healthy Homes Initiative

God’s Love We Deliver

Adam Boehler and CMMI

MVP Healthcare

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