DOH Presents MLTC Value-Based Payment Plans to Advisory Group

The Department of Health (DOH) presented its plans for value-based payment (VBP) under Managed Long Term Care (MLTC) to the MLTC Clinical Advisory Group (MLTC CAG) late last week. The presentation indicated that pay-for-performance arrangements in partially-capitated plans would be emphasized at the outset. It delineated three categories of quality measures for consideration in VBP arrangements, with Category 1 measures to be implemented in the first "measurement year" – 2017. Currently, the source of funds identified for incentive payments is the existing MLTC Quality Incentive Pool, which is derived from a withhold from plan premiums. The Department's slide presentation is available here. Additional information about the Department's MLTC VBP strategy is available here.

The Department will be convening the CAG again in August or September to discuss possible approaches to VBP through Medicare-Medicaid plans, such as Fully-Integrated Duals Advantage (FIDA) plans, Programs of All-Inclusive Care for the Elderly (PACE), and Medicaid Advantage Plus (MAP) plans. It is encouraging providers and plans to move beyond pay-for-performance and propose to the Department VBP arrangements that involved shared savings or shared risk.

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