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Value-Based Payment Bootcamp #3 Focuses on Performance Measurement and Management

The third DOH Value-Based Payment (VBP) Bootcamp, held on July 7th in Albany, focused on the role of quality measurement and performance data in value-based payment arrangements. The slides from the session are available here, and a recording is available here. LeadingAge NY Intelligence articles on the first and second VBP bootcamps are available here and here.

Quality measures are being selected by DOH's Office of Quality and Patient Safety for inclusion in VBP arrangements through consultation with Clinical Advisory Groups. The Clinical Advisory Groups have worked with DOH and its contractor, KPMG, to compile measures deemed clinically relevant, valid, feasible, and reliable. The state is seeking to align its measures with Medicare and other national standards. Two types of measures will be adopted for VBP arrangements:

  • Pay for Reporting Measures: An extensive set of measures that is predominantly process-based and required for monitoring and process improvement (e.g. in diabetes care, reporting % of patients with Blood Pressure in control); and
  • Pay for Value: A limited group of measures that is outcome-based and aligned with DSRIP (e.g. in diabetes care, % of avoidable hospitalizations and avoidable complications).

The measure sets and the reporting of measures will be tested in VBP pilots and will become standard for VBP in 2017. 

Efficiency in VBP arrangements will be determined based on the risk-adjusted total cost of care, ranked against other providers entering into the same type of arrangement. In addition to quality and efficiency measures, target budgets are subject to "stimulus adjustments" to incentivize participation in arrangements that involve both up-side and down-side risk.

Presenters described a three-part process for applying performance on quality measures and efficiency targets to VBP arrangements. First, managed care premiums will be adjusted upward and downward based on the plan's performance. Second, the target budgets for providers participating in VBP arrangements (against which savings or excess spending will be measured) will be adjusted based on their current performance on selected quality measures and on efficiency. To the extent that a VBP contractor is high-performing on quality and/or efficiency, its target budget will be raised. There will be no downward adjustments of target budgets until 2018. Third, quality performance during the contract year will determine the percentage of savings or losses to be shared with VBP contractors.

To support VBP arrangements, DOH will make available a VBP Dashboard to be accessed through the Medicaid Analytics Performance Portal (MAPP) at the end of the 2016 calendar year. PPSs, plans, and VBP contractors will be able to view claims- and encounter-based total cost measures, potentially-avoidable complications, and quality measures specific to each VBP arrangement. Initially, the dashboard will include only data derived from Medicaid-only beneficiaries, not dually-eligible beneficiaries. Data related to dually-eligible beneficiaries will be made available in the Dashboard in 2017.

Presenters also discussed the role of DSRIP Performing Provider Systems (PPSs) in VBP arrangements. While PPSs cannot enter into VBP arrangements directly, unless they organize as an independent provider association (IPA) or accountable care organization (ACO), they may serve as payment reform coordinators and provide analytical support. VBP contractors may work with their PPSs to leverage funds available for health information technology. DOH urged potential VBP contractors to make additional investments in health information technology and to strengthen performance measurement and management capacity in order to ensure success under VBP arrangements.

Registration information for upcoming, live regional bootcamps is available here.

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