Before we begin, reminders for today’s webinar Audio Connection: 415-655-0002 Audio Code: 926 554 775 To ensure everyone is able to hear today’s presentation, we ask that all webinar participants please: Do NOT place your phone line on hold during the webinar Ensure your web cam is turned OFF Use the CHAT function to ask your questions Getting Ready for VBP March 28, 2018 1
Getting Ready for Value Based Payment: STRATEGY AND INFORMATION MANAGEMENT Getting Ready for VBP March 28, 2018 2
Today’s Presenters Meaghan Baier Boris Vilgorin, MPA Margot Hughes- LMSW Assistant Director Healthcare Strategy Officer Lopez, MPH Strategic Operations McSilver Institute for Assistant Vice-President McSilver Institute for Poverty Policy and Research OneCity Health Services Poverty Policy and Research New York City Health + Hospitals Getting Ready for VBP March 28, 2018 3
Disclosures The presenters have no actual or potential conflict of interest in relation to this presentation. The members of the Planning Committee have no actual or potential conflict of interest in relation to this presentation. Getting Ready for VBP March 28, 2018 4
Agenda The Landscape of Value Based Payment Overview of tools and methods to assess VBP readiness to inform planning strategies Strategy development and execution, including creating and managing effective work flows for deliverables and goals Introduction to data analytics; relevance to the partner and the network Getting Ready for VBP March 28, 2018
About the McSilver Institute The McSilver Institute for Poverty Policy and Research at New York University Silver School of Social Work is committed to creating new knowledge about the root causes of poverty, developing evidence-based interventions to address its consequences, and rapidly translating research findings into action through policy and practice. Getting Ready for VBP March 28, 2018
In order to ensure our work is culturally and contextually appropriate for the populations we serve, the McSilver Institute employs a collaborative model via partnerships with policymakers, service organizations, community stakeholders, and consumers. Getting Ready for VBP March 28, 2018
In New York, McSilver directs the state-funded Community Technical Assistance Center ( CTAC) and Managed Care Technical Assistance Center ( MCTAC ), which provide a range of trainings, tools, and intensive support to help New York’s behavioral health safety net stay afloat. Getting Ready for VBP March 28, 2018
The Landscape of Value Based Payment (VBP) Getting Ready for VBP March 28, 2018
NYS VBP Roadmap DSRIP allows the state to implement payment reform Encourages DSRIP to promote and implement Value Based Approaches By year 5, all Managed Care Organizations must reward value over volume and implement Value Based Payment. Ensure that the new system is sustainable. Getting Ready for VBP March 28, 2018
Path Toward Value Based There will not be one path towards Value Based Payments. Rather, there will be a menu of options that MCOs and Providers can jointly choose from. Getting Ready for VBP March 28, 2018
Contextualizing Key Foundational Concepts of Value Based Purchasing (VBP) Getting Ready for VBP March 28, 2018
VBP Key Concepts Triple Aim • Improve Member Experience • Improve Quality of Care • Decrease Cost Value not Volume Aligned Incentives Change in Focus Getting Ready for VBP March 28, 2018
Change In Focus Providers get paid based on value/quality rather then volume Providers will be held accountable for both quality and cost of care Performance Measures: Not just outcomes Efficiency and Effectiveness Aligning incentives Getting Ready for VBP March 28, 2018
Incentive Alignment Payer Agency Network Consumer /Client Program Staff Supervisor Getting Ready for VBP March 28, 2018
Performance Standards Standards Based On Will Vary Payer Needs Change Based On Overtime State Measures Getting Ready for VBP March 28, 2018
VBP Contracting Models and Risk Sharing Getting Ready for VBP March 28, 2018
MCOs and Contractors can choose different levels of Value Based Payments In addition to choosing which integrated services to focus on, the MCOs and contractors can choose different levels of Value Based Payments Level 3 VBP (feasible after experience Level 0 VBP* Level 1 VBP Level 2 VBP with Level 2; requires mature contractors) FFS with upside-only shared savings available when FFS with risk sharing FFS with bonus and/or Prospective capitation PMPM outcome scores aresufficient (upside availablewhen withhold based on quality or Bundle (with outcome- (For PCMH/IPC, FFS may be outcome scores are scores based component) complemented with PMPM sufficient) subsidy) Prospective total budget FFS Payments FFS Payments FFS Payments payments No Risk Sharing Upside Risk Only Upside & Downside Risk Upside & Downside Risk *Level 0 is not considered to be a sufficient move away from traditional fee-for-service incentives to be counted as value based payment in the terms of the NYS VBPRoadmap. Source: VBP Bootcamp#1 37 Getting Ready for VBP March 28, 2018
Shared Savings Level 1 – FFS w/Upside Risk Only Payment Continues to be FFS Shared Savings Potential • If savings and quality is achieved No Downside Financial Risk Lower Shared Savings Compared to Level 2 and 3 Getting Ready for VBP March 28, 2018
Shared Savings Level 2 – FFS w/Upside and Downside Risk Payment continues to be FFS Shared savings potential • If savings and quality is achieved Downside financial risk if shared savings in not achieved Higher shared savings compared to level 1 Getting Ready for VBP March 28, 2018
Shared Savings Level 3 Capitation payment: based on per member per month No FFS payment Shared savings potential • If savings and quality is achieved Downside financial risk if shared savings in not achieved Higher shared savings compared to level 1 and 2 Getting Ready for VBP March 28, 2018
Value Base Payment Contract Types Getting Ready for VBP March 28, 2018
Types of VBP Arrangements Types Total Care for General Integrated Primary Care Care Bundles Special Need Population (TCGP) (IPC) Populations Definition Party(ies) contracted with Patient Centered Medical Episodes in which all Total Care for the Total the MCO assumes Home or Advanced costs related to the Sub-Pop • HIV/AIDS responsibility for the total Primary Care, includes: episode across the care • Care management care of its attributed continuum are measured • MLTC • Maternity Bundle population • Practice transformation • HARP • Savings from downstream costs • Chronic Bundle (includes 14 chronic conditions related to physical and behavioral health related) Contracting Parties IPA/ACO, Large Health IPA/ACO, Large Health IPA/ACO, FQHCs, IPA/ACO, FQHCs, and Systems, FQHCs, and Systems, FQHCs, and Physician Groups and Physician Groups Physician Groups Physician Groups Hospitals Source: VBP Bootcamp #2 Getting Ready for VBP March 28, 2018
Total Care General Population Special Need Population • HIV/AIDS • MLTC • HARP Includes All Services (Inpatient and Outpatient) Members can only be enrolled in on population Getting Ready for VBP March 28, 2018
Integrated Primary Care Episode of Care Focuses on Chronic Conditions Consists of Three Components • Preventative • Chronic Conditions (14 identified conditions) • Sick Care – Upper Respiratory Infection – Allergic Rhinitis/Chronic Sinusitis Episode – Routine Sick Care Episode Getting Ready for VBP March 28, 2018
Integrated Primary Care (IPC) Arrangement Preventive Care • Preventive Care Episode Component Includes Care activities such as wellness visits, • Arrhythmia/Heart Block/ Conduction Disorders Episodes checkups, immunizations, • Asthma Episode screening laboratory tests. • Bipolar Disorder Episode • COPD Episode • Coronary Artery Disease Episode • Depression & Anxiety Episode Chronic Condition Component • Diabetes Episode IPC Includes disease • GERD Episode Arrangement management and • Heart Failure Episode secondary prevention • Hypertension Episode activities to 14 chronic conditions identified as • Low Back pain Episode priority by the state. • Ostooarthritis Episode • Substance Use Disorder Episode • Trauma & Stressors Disorders Episode Sick Care Component Includes care for symptoms such as headache or abdominal pain and minor • Chronic Sinusitis/Rhinitis Episode acute conditions and • URI Episode procedures. • Routine Sick Care Episode Source: DOH VBP Fact Sheet IPC Arrangement Getting Ready for VBP March 28, 2018
Member and Episode Eligibility Medicaid MCO members are only included in the IPC Arrangement once they have triggered one of the episodes within the three components of care. The IPC Arrangement only addresses a subset of services provided to members based on the services addressed through the three components of care. Only those services and associated costs captured by the episodes triggered will be included in the Arrangement. Getting Ready for VBP March 28, 2018
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