Value-Based Payment Bootcamp Update
The Department of Health (DOH) held its second Value-Based Payment Bootcamp on June 14 in Albany. The bootcamps are intended to prepare providers and Managed Care Organizations (MCOs) to reach the Medicaid Redesign Team waiver's goal of making 80 percent of all MCO payments to providers through Value-Based Payment (VBP) arrangements by fiscal year 2019-20.
The second session focused on value-based contracting and risk management. It discussed various types of contracts between plans and individual providers or networks, such as independent provider assocations (IPAs) and accountable care organizations (ACOs). It also covered contracts between the IPAs/ACOs and downstream providers, and discussed the key components of a VBP contract:
- The measurement period
- Medical budget target
- Services included
- Calculation and sharing of savings and excess spending
- Reporting
- Financial protections in the event of excess spending
- Quality measures
The Department noted that every Level 2 or 3 VBP arrangement must include a minimum of one CBO (a non-profit, non-Medicaid billing, community-based social and human service organization) beginning in January 2018. The State will make financial incentives available immediately for plans and providers that contract with certain types of CBOs.
The session also covered the new 3-tiered review process for VBP contracts:
- DOH File and Use Review
- DOH Review
- DOH and Department of Financial Services Review
The applicable level of review is based on amount at risk under the contract and its relation to the total amount paid by the plan to the provider or network and to the provider’s or network’s overall Medicaid revenue.
The Department further discussed how a target budget is set and how it may be adjusted for the risk profile of the population and for efficiency and quality. It covered how shared savings and losses may be calculated in relation to the target budget and distributed among providers.
In addition, the session described various risk management mechanisms (e.g., stop loss provisions, risk corridors, etc.) and their importance in VBP contracting. Specifically, the Department described the financial risk curve at the population and episode level and contracting considerations, such as risk corridors and stop loss pricing.
The session concluded with a panel discussion that included representatives of a federally-qualified health center, a behavioral health IPA, and a national health plan, who discussed their experiences with IPA formation and VBP contracting.
DOH stressed that the bootcamps are networking opportunities for providers and plans, as well as educational forums. For those who cannot attend the bootcamps, recordings of the Region 1 sessions will be made available on the DOH website. The slides for the session are available here and a recording will available here. There is also a VBP Resource Library on the DOH website.
DOH will be convening three Bootcamp sessions in each of five regions. Registration information is available here. Registration for sessions in Regions 2 (Mohawk Valley, North Country, Tug Hill Seaway) and 3 (NYC, excluding Queens) is available here.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.