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DOH Value-Based Payment Work Group Discusses Next Steps in VBP

The Department of Health's (DOH) Value-Based Payment (VBP) Work Group met on Dec. 11th to discuss strategies for strengthening and expanding VBP arrangements under Medicaid managed care and managed long term care (MLTC). The meeting included an update on VBP penetration to date and a description of the State's application to extend and renew its Delivery System Reform Incentive Payment (DSRIP) waiver. In addition, representatives of Elderplan; HealthPlus; Molina; Coordinated Behavioral Health Services, IPA; and Adirondacks ACO provided managed care plan and provider perspectives on issues such as quality measurement, data sharing, setting target budgets and risk, integration of behavioral health and primary care, and social determinants of health (SDH) and engagement with community-based organizations (CBOs). The meeting slides are available here.

DOH noted that the State is within reach of its VBP goal under the first phase of the DSRIP waiver of having 80 to 90 percent of managed care payments to providers made through value-based arrangements. As of March 31, 2019, more than 74 percent of all managed care payments were made through VBP contracts. Nearly 49 percent of payments by fully capitated managed care plans were made via Level 2 or Level 3 risk-sharing arrangements. Nearly 10 percent of payments by partially capitated MLTC plans were made through Level 2 arrangements. In order to meet the State's waiver goals, at least 15 percent of partially capitated plan payments must be made through Level 2 or 3 arrangements by March 31, 2020. DOH also reported that it has approved over 100 SDH VBP contracts, including 22 contracts with MLTC plans and 11 contracts with Programs of All-Inclusive Care for the Elderly (PACE). A list of approved SDH interventions is available here.

DOH described its intention to replace the Performing Provider Systems (PPSs) with Value Management Organizations (VMOs) in the second phase of DSRIP and to designate SDH Networks. If the waiver amendment is approved by the Centers for Medicare and Medicaid Services (CMS), the new VMOs would provide technical support for VBP arrangements, quality improvement, data analytics, and care coordination. The SDH Networks would bring SDH interventions to scale and support CBO engagement in data collection and exchange and in risk arrangements.

DOH facilitated a roundtable discussion with the managed care plans, provider networks, and other meeting participants, posing questions such as:

  • How do you select quality measures for VBP, and what happens when a small number of members/patients are dispersed among many providers or a particular measure has a small denominator?
  • What quality measures could be used for SDH interventions?
  • Could DOH require plans and providers to share specified data elements, and what would those be?
  • How can providers and plans move to more robust levels of risk while satisfying financial reserve requirements?
  • What are the key themes for structuring shared savings across multiple providers, especially when they are not the lead VBP contractor?

A representative of Coordinated Behavioral Health Services, IPA spoke about the challenges faced by behavioral health care providers in engaging in risk-sharing arrangements with plans and other providers. VBP contracts with fully capitated plans typically attribute members to their primary care provider, which bears the risk in the VBP arrangement. The behavioral health providers may play a key role in maintaining the overall health of the member, but they typically do not share in the risk or the incentives. However, the IPA has recently begun to participate in a risk-sharing arrangement with a large primary care provider.

LeadingAge NY urged the Department to tailor its approach to SDH for the older adult population, recognizing that many of the SDH interventions identified by DOH are either inapplicable to older adults or are already covered benefits in the MLTC program. Moreover, partially capitated MLTC plans do not accrue savings from avoided hospitalizations. DOH noted that the reference to "toxic stress" as a key SDH in the DSRIP Phase 2 waiver application includes social isolation.

LeadingAge NY also requested a more targeted work group meeting on VBP for long-term care providers and plans. DOH said that it would be convening meetings with smaller groups early next year.

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