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DOH Value-Based Payment Work Group Meets

The New York State Department of Health's (DOH) Value-Based Payment (VBP) Work Group met on Oct. 2, 2017 to discuss the implementation of VBP in the managed long term care (MLTC) program, as well as recommendations of the Children's Advisory Group and VBP measure sets for total cost of care/integrated primary care arrangements, maternity care, HIV/AIDS, and Health and Recovery Plans (HARPs). In addition, DOH staff updated Work Group members on upcoming VBP bootcamps, its surveys of managed care plan VBP readiness, and changes in the DOH VBP Roadmap.

The VBP Work Group oversees the development and implementation of the VBP Roadmap and the work of the VBP Clinical Advisory Groups. LeadingAge NY's Dan Heim is a member of the Work Group. The meeting materials are available here and here.

The MLTC portion of the meeting included a discussion of recent changes in the MLTC VBP quality measures and a DOH directive that MLTC plans enter into VBP arrangements with the nursing homes and home care agencies in their networks by the end of the year. DOH has created optional contract amendment templates that may be used by plans and providers to document VBP arrangements. DOH will be providing plans with each contracted home care agency's potentially avoidable hospitalization rate for attributed plan members in October. In addition, it will provide plans with facility-wide potentially avoidable hospitalization rates for nursing homes. Data on provider performance on other quality measures will also be made available. 

The following changes were made to the MLTC VBP quality measures for the 2018 measurement year:

  • The nursing home potentially avoidable hospitalization measure was classified as a Category 1 measure (meaning that it is relevant and feasible) to promote nursing homes to participate in pay-for-performance arrangements based on potentially avoidable hospitalizations.
  • Other nursing home quality measures were shifted from "pay-for-reporting" to "pay-for-performance" to promote nursing homes to participate in pay-for-performance arrangements.
  • A quality measure related to health plan discussions with members about appointing health care proxies was eliminated from the provider VBP measures because it relates to plan performance rather than provider performance.

The list of MLTC VBP measures is available here.

In addition, DOH briefed the Work Group on the following additional recommendations:

  • More advanced (shared savings and two-sided risk) levels of VBP for the partially-capitated MLTC program should be calibrated, with providers experiencing downside risk only as they move to Level 3.
  • Attribution for MLTC VBP should be reexamined as primary, acute, and long term care services for MLTC members become more integrated.
  • Modifications of models of care for MAP, PACE, and FIDA should be pursued with caution, as they may require CMS approval.
  • The state should convene a MAP, PACE, and FIDA stakeholder meeting to address VBP in these programs.
  • Initial development of total cost of care VBP models in MLTC should be larger MAP, PACE, and FIDA plans (e.g., greater than 1,000 members).
  • MLTC VBP quality measure for partially-capitated plans, including the potentially avoidable hospitalization measures, should also be considered for use for MLTC VBP for fully-capitated MLTC product lines.

DOH announced that it has added an MLTC session to its upcoming VBP Bootcamps 2.0. These Bootcamps will be held at five locations, with the first one convening in Albany on Oct. 10th. Register here by 5 p.m. on Oct. 3rd to attend the Albany meeting in person. The Oct. 10th Bootcamp will be webcast live and recorded.

DOH is seeking participants for its MLTC CAG Subcommittee Meeting for MAP, FIDA, and PACE plans. Contact DOH MLTCVBP@health.ny.gov to express interest.

LeadingAge NY will continue to participate actively in these VBP work groups, advisory groups, and subcommittees.

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