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DOH Presents First Webinar in MLTC Value-Based Payment Learning Series

The Department of Health (DOH) presented its first webinar in a "learning series" on value-based payment (VBP) for managed long term care (MLTC) plans and providers. The webinar included a presentation from VillageCareMAX, an MLTC, and Premier Home Care, a licensed home care services agency (LHCSA), about their approaches to VBP. The presentation slides are available here.

VillageCareMAX described its VBP strategies for both its partially-capitated MLTC plan and its integrated Medicare-Medicaid Medicaid Advantage Plus (MAP) plan. Its partially-capitated plan has recently begun working with its largest LHCSA partners to transition from Level 1 "pay-for-performance" arrangements to shared savings and two-sided risk arrangements. Its MAP plan is working with large physician independent practice associations (IPAs) to implement two-sided risk arrangements in which the IPA is at risk for the "total care" for the attributed members. The IPA's performance is measured against a target budget and quality benchmarks. VillageCareMAX intends to embed a utilization management nurse and a care manager in the IPA practices in order to enable the IPA to have some influence over utilization.

Transparency of data is a key component of both the partially-capitated and integrated plan VBP arrangements. VillageCareMAX shares quarterly scorecards with its provider partners through a shared dashboard. It also shares a "gaps in care" report that identifies areas of need that must be addressed to satisfy metrics.

Premier described its Observe, Ask & Report (OAR) and Continuity of Care pilot programs. The OAR program engages personal care aides in reporting from the home on changes in their patients' conditions via an automated call-in process. LHCSA administrative and clinical staff are trained in the care management process and in MLTC quality measures to enable them to report and respond appropriately. The Continuity of Care pilot involves the delegation of the plan's care management function to the LHCSA and the creation of an interdisciplinary team within the LHCSA to carry out care management, UAS assessments, nurse supervision, and personal care. Under the Continuity of Care pilot, performance on several quality measures showed significant improvement after six months. Most recently, Premier has instituted a team to monitor performance on quality measures daily and to work with the interdisciplinary teams to implement interventions to improve member outcomes.

A recording of the webinar will be made available. DOH expects to provide additional presentations in the learning series in the near future.

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