DOH Seeks Comments on Risk-Based VBP Models for Partial Capitation Plans and Releases VBP Quality Measure Sets for Integrated Plans

The Department of Health (DOH) has released two updates on its value-based payment (VBP) strategy for managed long term care (MLTC). Late last week, it published final quality measure sets for VBP arrangements between providers and Medicare-Medicaid integrated plans. The measure set for MAP and FIDA plans is available here, and for PACE programs, here. Today, the Department convened a meeting with stakeholders to discuss its plans to transition provider contracts with partially-capitated MLTC plans to shared risk arrangements.

The quality measure sets are intended to be used in VBP arrangements that are to be implemented by integrated plans. Integrated plans will face penalties if they do not reach a target of 10 percent of plan expenditures in VBP contracts with providers by April 1, 2018. If the target is not reached by April 1, 2018, the Department will assess a penalty on the plans of 0.5 percent of the marginal difference between the 10 percent target and the reported spending percentage in Level 1 (i.e., shared savings) contracts. Additional information about VBP for integrated plans is available here.

The partial-capitation MLTC VBP stakeholder meeting covered options for advancing to two-sided risk arrangements in MLTC provider contracts. By April 1, 2019, partially-capitated plans will face penalties unless at least 5 percent of their expenditures are incorporated into two-sided (i.e., shared savings and losses) risk arrangements. Under those arrangements, providers must be held accountable for quality and cost. Cost will be measured against a target budget, which will be based on the "total cost of care" delivered under the MLTC benefit package. The meeting included some discussion about the exclusion of certain ancillary benefit costs from the target budget. It also touched on mechanisms for limiting risk, such as stop loss and risk corridors. The slide deck from the meeting is available here.

The Department is seeking comments on strategies for shared risk arrangements under partially-capitated MLTC plans by March 2, 2018, with a goal of finalizing plans and guidance by April 1, 2018. Comments should be submitted here.

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