The InVisionary

In a recent blog post published by The Provider Alliance (TPA), InVision Human Services CEO, Kim Love, wrote about the challenges providers have faced during the early stages of Performance Based Contracting (PBC) implementation. While recognizing it’s less than perfect, Kim also outlines ways in which the new PBC system could transform our industry stating, “One of the shining lights is the tacit acknowledgment from ODP that, simply put, it requires more resources to support those with the highest levels of need.”
 
There has been much communication to staff regarding PBC, and we have spent time during our most recent Quarterly Catch-Up forums discussing the standards established by ODP, and what InVision is doing to achieve the Clinically Enhanced Residential Provider status; however, some team members still do not understand the full impact of PBC and what it means to them.
 
In this article, I will attempt to provide some additional clarity of the status of PBC, and what the implications are for us, both in the short and long term.
 
Following a 45-day public comment period, ODP recently announced changes to PBC including a reduction in the number of measures, changes to “new referral” requirements, and an adjusted timeline. A comprehensive list of changes will be included in the revised PBC Implementation Plan scheduled for release on July 19, 2024.
 
ODP has modified the timeframes for residential providers to submit data to support tier designation.
 

• Providers may submit information between August 1-31, 2024 or between February 15 and March 15, 2025.
• Providers that submit data in August 2024 will be reviewed using calendar year 2023 data and will be notified of tier placement in November 2024.
• Providers that choose to submit data in February-March, 2025 will be reviewed using calendar year 2024 data and will be notified of tier assignment in May 2025.

Our ultimate goal is to achieve top tier status as a Clinically Enhanced Residential Provider. Why is this important to InVision? Only Clinically Enhanced Residential Providers will be able to accept new referrals for people in Needs Group 4 and higher. InVision has built its reputation on being one of only a few providers in the state who specialize in supporting people who are most challenging to our system. Over 40% of the people we currently support fall into these Needs Levels. If we cannot bring in new referrals, future growth within our residential program among people in Needs Group 4 and higher would be significantly impacted. There are also the financial implications. In addition to the overall proposed rate changes that are included in the governor’s budget, the 8% increase in revenue Clinically Enhanced Residential Providers can receive would have an enormous impact on us as an organization.
 
There is much work to be done, and while our goal is to reach the Clinically Enhanced status, if we cannot achieve that goal by July of next year, while not ideal, it will not negatively affect the people we support regardless of Needs Group. Primary Provider status allows us to continue provide our services while we work to meet that standard of Clinically Enhanced Residential Provider in July of 2026.
 
Our leadership has developed and is implementing action plans based on achieving the Clinically Enhanced status. This is an exciting time for our industry. As Kim stated in her TPA article, “…if we embrace Performance Based Contracting, it could be the catalyst for a transformative shift in our industry, one that our industry hasn’t experienced in decades.”
 
As more information is revealed once ODP issues their revised PBC Implementation Plan, additional communications will be available to explain the further changes to the system.
 
ODP will conduct a webinar for residential providers on Monday, July 22, 2024, from 3 PM-4 PM to review publications, changes made as a result of public comment, and instructions for tier determination and data submission. Click here to Register. The webinar will be posted on the MyODP Performance-Based Contracting Webpage.