DOH Announces Plans for Value-Based Payment Pilots
The Department of Health (DOH) described its plans to cultivate Value-Based Payment (VBP) pilots at a meeting of all Medicaid managed care plans on February 10th. The pilots, which would be launched this spring, are expected to provide lessons and best practices for the broad-based expansion of VBP models under New York’s Medicaid waiver. In addition, the pilots are intended to support refinement of the VBP quality measures selected by the State’s VBP Clinical Advisory Groups. According to DOH, providers are already coming forward with ideas for pilot VBP arrangements, and it is expecting plans to participate. The presentation slides are available here.
The State’s value-based payment “Roadmap,” which was approved by the Centers for Medicare and Medicaid Services (CMS) as a key element of the Medicaid waiver, provides that at least 80 to 90 percent of managed care plan payments to providers must be made through value-based arrangements by 2019 (and at least 35 percent of payments made by mainstream managed care plans must be made through arrangements with both upside and downside risk). The State has convened a series of subcommittees and advisory groups to design the parameters of approved VBP arrangements and to recommend proposed regulatory reforms to support those arrangements. LeadingAge New York has been actively involved in these subcommittees and in the Managed Long Term Care (MLTC) Clinical Advisory Group.
DOH intends to begin with 15 pilot VBP arrangements with two to three payer-provider partnerships per arrangement this spring. Pilots must have significant attributed members (e.g., 10,000 non-duals for an integrated primary care pilot, 5,000 for a chronic care bundle pilot). They may begin at any level of risk, but must reach two-sided risk by the second year. In order to stimulate engagement in pilots, DOH will make available technical assistance, data, enhanced administrative payments and participation bonuses for plans and performance and stimulus adjustments for providers.
Beginning in 2017, DOH plans to make incentive payments to Managed Care Organizations (MCOs) to reward higher value care and impose penalties on plans that fail to meet VBP milestones. Performance adjustments may result in MCO rate increases or reductions based on efficiency and quality. Stimulus adjustments will be applied to reward MCOs that achieve higher rates of VBP contracts with two-sided risk.
The Department indicated that its timeline for MLTC VBP pilots may be slightly behind the timeline for mainstream plans. It is, nevertheless, seeking pilot proposals from long-term care providers and MLTC plans. This spring, DOH will also initiate VBP “boot camps” on a regional basis to educate stakeholders about VBP, assist with readiness, and discuss lessons learned through existing models.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.