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DOH DSRIP Phase 2 Webinar Offers Additional Detail on Waiver Plans

The Department of Health (DOH) hosted a webinar on Dec. 11th to share details with stakeholders on the recently submitted application to extend and renew the State's Delivery System Reform Incentive Payment (DSRIP) Program waiver. The webinar highlighted the successes of the first phase of DSRIP and described how the second phase would expand and strengthen the value-based payment (VBP) arrangements initiated in the first phase. The slides are available here, and a summary of the application to extend and renew DSRIP (i.e., DSRIP Phase 2) is here.

If the new waiver is approved by the Centers for Medicare and Medicaid Services (CMS), Value Management Organizations (VMOs) would be designated by DOH to support VBP arrangements among managed care organizations (MCOs), providers, and community-based organizations (CBOs). Each VMO would be required to support the five "promising practices" identified in the DSRIP application and could select other promising practices based on community need. The VMOs would not enter into provider contracts with MCOs and would not replace independent practice associations (IPAs) or accountable care organizations (ACOs). Instead, they would provide administrative services such as data analytics, coordination of care management activities, and project management of the DSRIP promising practices. VMOs would be required to have a representative governance structure that reflects the continuum of care, including MCOs and Social Determinant of Health (SDH) Networks. They would be expected to support multi-payer population health initiatives. VMOs would also be required to collaborate with the State's Qualified Entities (health information exchanges) in their operations. VMOs would be eligible to receive funding through a VMO Performance Pool. Awards would be made on a regional basis based on attribution of Medicaid beneficiaries and performance on metrics.

A separate VBP Incentive Pool would make available funding to MCOs based on engagement in qualifying VBP arrangements. These funds would be shared with "advanced VBP network providers." DOH is seeking to incentivize more sophisticated risk arrangements in the second phase of DSRIP and is looking for ways to help providers develop risk reserves through provider collaborations and partnerships with managed care plans.

The new waiver application also provides for the creation and funding of SDH Networks. These would organize "social care providers" in a region and would work with VMOs to ensure that SDH interventions are integrated into the VMOs' population health activities. They would be selected regionally through a request for proposal process.

DOH fielded several questions about funding for providers and models that serve special populations. DOH noted that a VMO could be targeted at a specific population group (e.g., children or older adults), but that such a model might not be fiscally viable. All VMOs would be required to invest funds in the promising practices targeted at special populations (e.g., palliative care, falls prevention, and nursing home transitions). MLTC plans would be eligible for VBP Incentive Pool funding and for a role in the governance of VMOs to the same extent as mainstream managed care plans.

Many questions remain about the ability of MLTC plans and long-term care providers to draw down funding through DSRIP Phase 2. LeadingAge NY will continue its advocacy to ensure a fair share of funding for providers and plans that serve older adults and people with disabilities.

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