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Value-Based Care and Delivery System Reform

Value-based care (VBC) ties payments to the quality of care provided and patient outcomes. As the health care landscape recognizes this shift from volume to value, state Medicaid programs are working with their federal partners at CMS to innovate at the forefront of payment and delivery of health care. Sellers Dorsey collaborates with policy makers to develop and negotiate state Medicaid reform initiatives, including waivers and pre-prints, value-based purchasing arrangements, expansion of managed care to new populations, and other services.

With a deep knowledge of Medicaid managed care programs, we have experience to implement proven concepts and insight to develop effective new approaches. Medicaid programs, providers, and managed care organizations alike wish to leverage the potential of value-based care, and Sellers Dorsey is a capable partner in this important area.

Value-Based Care and Delivery System Reform

Sellers Dorsey operates at the intersection of industry, policy, and government, helping an array of clients in these and other ways:

  • VBC strategy development and health system transformation
  • Devising and implementing new value-based payment (VBP) reforms
  • Developing and negotiating 1115 Medicaid waivers
  • Facilitating commissions, committees, and task forces to drive stakeholder feedback and support for Medicaid reform initiatives
  • Managed care program planning and procurement
  • Understanding and translating state-led reform initiatives around policy, operations, and financing
  • Leveraging value based purchasing and alternative payment model requirements and opportunities
  • Predicting the impact of various payment models across the continuum of care
  • Assisting in decision-making of VBP negotiations and design
  • Designing payment methodologies, patient attribution consideration, quality measurement, and measurement scoring and weighting
  • Providing recommendations to improve performance scores to secure payment
  • Assuring measurement and reporting are performed accurately and within regulatory guidelines
  • Preparing for and winning new Medicaid business through successful responses to requests for information and requests for proposals to ensure responses meet state requirements
  • Assisting in the readiness review process, ensuring that new programs are ready to meet the needs of the states and beneficiaries
  • Determining whether contractual requirements are met and eligibility for additional incentive payments (as applicable) are subject to any penalties
  • Providing guidance to ensure accuracy and validity across regulatory, financial, and legislative mandates
  • Preparing evaluation reports as required for state-directed payments
  • Educating stakeholders and improving relationships with members, providers, advocates, and public officials through stakeholder engagement strategies
  • Applying the latest in health care trends, best practices, and regulations to your business, including VBP initiatives

Delivery System, VBC, and Health Policy Experts Who Get Things Done

Sellers Dorsey includes former state Medicaid officials including Medicaid Directors, hospital and health plan executives, clinicians, and provider organization leaders responsible for the development, financing, administration and operation of Medicaid programs and health care delivery in various settings and through both fee-for-service and Medicaid managed care delivery systems. These are just some of the seasoned Medicaid experts at Sellers Dorsey:

Gary Jessee
Senior Vice President
Pat Brady
Managing Director
Ann Spishock
Managing Director
Nancy Kohler
Vice President

Gary Jessee assists states, managed care organizations, service providers, and support vendors working within Medicaid. For 20+ years, he’s worked in health and human services at state and national levels, and his successful tenure in Texas state government comprises several leadership roles, including State Medicaid Director.

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Offering 20+ years’ experience with federal and state health policy, Pat is an authority on Medicaid financing. She provides public and private sector clients with strategic, policy, and technical assistance throughout revenue maximization initiatives and long-term care programs, particularly Medicaid managed care programs.

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Bringing 30 years of Pennsylvania government experience to Sellers Dorsey, Ann provides our Harrisburg team with strategic guidance and leadership. On top of Medicaid funding, health care reimbursement, and health and human service policy, she is also well versed in PA’s budgeting process, governmental programs, and political acumen, making her an invaluable asset to clients.

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A resident Value-Based Purchasing (VBP) expert, Nancy works with clients on VBP in Medicaid managed care and Medicaid financing. Prior to Sellers Dorsey, she was integral to PA’s Statewide Quality Care Assessment, and her comprehensive experience includes public health program operations, policy development, implementation, fiscal analysis, and strategic positioning.

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Client Success in Value-Based Care and Delivery System Reform

Sellers Dorsey has worked in over 40 states and has a keen understanding of the impact of federal policy on state operations and the related implications for Medicaid providers. Our considerable experience has taught us that every state environment is different and requires nuanced solutions to meet regional needs as well as federal regulations.

Continual Growth in Knowledge and Relationships

Through our ongoing work and our relationships with key decision makers and thought leaders in the private sector and in state and federal governments, Sellers Dorsey remains well informed of the latest rules and guidance from CMS and trends and innovations emerging from the private sector. Our staff regularly communicates with leaders and staff of organizations and affiliations in the industry, and they attend events with these influencers and decision makers year-round.

Please let us know if you would like to meet a member of our team at an upcoming event. If you are an event organizer and are interested in hearing one of our thought leaders speak to your audience please contact us at info@sellersdorsey.com.

Contact Sellers Dorsey

If you would like additional information or wish to speak to any of our experts about issues facing your managed care organization, please get in touch and we will have a conversation at a time that's best for you.

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