powered by LeadingAge New York

DOH Holds Level 2 VBP Webinar

Last week, the Department of Health (DOH) held a webinar on its plans for Level 2 Value Based Payment (VBP) for partially-capitated Managed Long Term Care (MLTC) plans. For those unable to view the webinar, DOH has made available a recording here. We expect that it will also be available on the VBP Resources Library page. The slides are available here. Highlights of the webinar and some additional information is provided below:

  • In response to feedback from LeadingAge NY and others, DOH has shifted away from requiring shared savings/shared risk based on total cost of care for Level 2 VBP for partially-capitated MLTC plans. Instead, they will be requiring, at a minimum, pay-for-performance arrangements that include both bonuses and penalties based on provider performance on quality measures. Plans and providers may, if they choose, enter into arrangements that involve shared savings/shared risk.
  • The pay-for-performance arrangements must involve performance on the potentially avoidable hospitalization measure and at least one additional, approved MLTC quality measure. They must also include penalties of at least 1 percent of the annual payments from the plan to the provider, if the provider fails to meet performance targets on the quality measures.
  • At least 5 percent of a plan’s total annual expenditures (presumably its spending on MLTC benefits) must be in these Level 2 arrangements.
  • LeadingAge NY has asked DOH to document the components of the numerator and denominator for these calculations. In particular, we have asked about the treatment of pass-through dollars. DOH has promised to get back to us with answers.
  • To qualify as a Level 2 arrangement, the plan must implement a Social Determinants of Health (SDH) intervention and a contract with a qualifying community-based organization (CBO). Plans will have flexibility to select and design their own SDH interventions. The SDH intervention need not be delivered by the CBO.
  • DOH has not yet determined how nursing homes will be treated in the context of MLTC VBP. It has also not determined whether contracts with care management providers can be used to satisfy the Level 2 VBP requirement.

We have been asked to provide feedback on this plan by May 31st. Please provide your comments, concerns, and additional questions to us as soon as possible if you would like them included in our comments. We are especially seeking feedback on how nursing home contracts should be treated in this new approach.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124