VBP Workgroup Meeting February 22, 2018 February 2018 2 Agenda - PowerPoint PPT Presentation

VBP Workgroup Meeting February 22, 2018

February 2018 2 Agenda VI. VBP Roles Document I. VBP Bootcamp Takeaways • Risk Adjustments standards & methodologies VII. VBP Evaluation Report • Implementation options to encourage data sharing between MCO and Provider VIII. MCO Data Sharing Readiness Survey II. MLTC VBP Design Summary IX. VBP Roadmap Update III. Children Subcommittee Follow-up IV. Social Determinants of Health and Community Based Organizations Update • SDH CBO Learning Collaboratives • CBO Engagement & Integration • Tracking VBP SDH/CBO COmpliance V. PPS Sustainability

February 2018 3 I. VBP Bootcamp Takeaways  Risk adjustment in VBP  Implementation options for data sharing between MCO and provider

February 2018 4 Risk Adjustment in VBP Background: During VBP Bootcamps, stakeholders recognized the need to use and better understand risk adjustment given its application in VBP Target Budgets Key elements of risk adjustment are summarized below: 1. Pros and cons of prospective, concurrent and hybrid risk adjustment models 2. Availability of different data sources to enable risk adjustment among plans and providers 3. The innovative trend in the healthcare industry to broaden the application of risk adjustment to address the Social Determinants of Health VBP Workgroup consideration: Q. Should additional language be included in the VBP Roadmap, as a standard or guideline, to illustrate best practices for risk adjustment and govern its application for target budget setting between MCO and provider?

5 February 2018 Implementation Options to Encourage Data Sharing Background: During VBP Bootcamps, stakeholders identified the need for more frequent and timely sharing of data between MCOs and providers to establish well-designed target budgets and improve provider performance. The VBP Roadmap has been updated to improve data sharing between MCO and provider: • “For level 2 and 3 arrangements, the State will monitor the data and information exchanged between MCO and Lead VBP Contractors for the purpose of negotiating target budgets and distribution of shared savings/loss… to help ensure that these financial methodologies are based on timely, frequent and complete data …” • “As a statewide standard, MCOs must include an overview of the data and information the MCO made/will make available to the VBP Contractor for the purposes of negotiating a target budget and distribution of shared savings/loss, when submitting their (MCO) contracts to the State.” VBP Workgroup consideration: Q. Are there additional processes or other options that would support data sharing between MCOs and contracted providers, and how could the State implement these options?

6 February 2018 Additional VBP Bootcamp Key Takeaways 1. Some PPS have developed data analytics platforms and have identified proxy measures. These tools may be available to providers in VBP to: • Provide them with more frequent, timely and available data • Support them with more real time performance measurement capabilities ~ Providers must continue to engage their PPS as they (PPS) evolve and continue to develop advanced tools and capabilities. ~ 2. Recognized need to make rate payment schedules and VBP adjustments more transparent 3. Timely, frequent and complete data sharing between providers and MCOs is critical to improved performance and well-design target budgets

February 2018 7 Additional VBP Bootcamp Key Takeaways (Cont’d) 4. There is a need to clarify how the NYS Behavioral Health Value Based Payment (BH VBP) Readiness Program relates to VBP • The BH VBP program is intended to strengthen behavioral health providers to enable them to engage in VBP as a VBP Contractor or a provider partner. • The BH VBP is not a substitute for VBP 5. There is a need to clarify how Tier 1 CBOs may be engaged in VBP to fulfill the CBO requirement for Levels 2 and 3. • CBOs may contract directly with an MCO to support multiple VBP arrangements in a geographic area • CBOs may also partner with a Lead VBP contractor to support their specific arrangement • MCOs must include the CBO in the 4255 form when submitting the contract to the State

February 2018 8 II. MLTC VBP Design Summary

February 2018 9 Agenda 1. Review of Managed Long Term Care (MLTC) Plan Membership by Product Line 2. Summary of Overall Design, Guidance, and Implementation Support for Level 1 • Level 1 Guidance & Implementation Support • Quality Measure Review & Implementation Support • Finance Guidance & Implementation Support • Summary of Stakeholder Engagement 3. Status of Level 1 Implementation 4. Summary of Overall Design of Medicaid Advantage Plus (MAP), Fully Integrated Duals Advantage (FIDA), and Programs of All-Inclusive Care for the Elderly (PACE) • Review and Recap of MAP, FIDA, and PACE Product Lines • Quality Measure Development & Stakeholder Engagement • VBP Guidance

February 2018 10 Section 1: Review of MLTC Plan Membership by Product Line

11 February 2018 Review of MLTC Plan Membership by Product Line NYS MLTC Plan Enrollment 5,733 4,237 19,213 199,442 8.8% 91.2% 9,243 MAP PACE FIDA MLTC Partial Capitation Enrollment Fully Capitated Plan Enrollment Source: NYS Department of Health, 2018 Monthly Medicaid Managed Care Enrollment, January 2018, https://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/

February 2018 12 Section 2: Overall Design of MLTC in Level 1 - Level 1 Implementation Guidance & Support - Quality Measure Guidance & Support - VBP Finance Implementation Guidance & Support - Summary of Stakeholder Engagement

February 2018 13 Level 1 Implementation Guidance & Support  Summary Implementation Guidance for Level 1 Posted July 2017  VBP University Video Release July 2017  Contract Templates for Licensed Home Care Services Agencies (LHCSAs), Certified Home Heath Agencies (CHHAs) & Skilled Nursing Facilities (SNFs) For LHCSAs/CHHAs – Circulated for Comment in September 2017 & Posted October 2017 For SNFs – Circulated for Comment in October 2017 & Posted in November 2017  Contract Template Submission & DLTC Review Completed November – December 2017  Frequently Asked Questions (FAQs) Document Posted December 2017  Individual Plan CEO Outreach July 2017 – End of Year

February 2018 14 Recap of Level 1 VBP for Partially Capitated MLTC Plans Until such time as alignment with Medicare is possible, Level 1 VBP for partially capitated MLTC plans will be a pay-for-performance (P4P) program based on the potentially avoidable hospitalization quality measure. “If the Medicare dollars cannot be (virtually) pooled with the State’s Medicaid dollars, and savings in Medicare cannot be shared with Medicaid providers (or vice versa), the impact of payment reform for this population threatens to be limited, and long term care providers will have difficulty achieving scale in VBP transformation. T o remedy this, the State is working with CMS to create aligned shared savings possibilities within Medicaid and Medicare. In anticipation, the State aims to treat potentially avoidable hospital use as ‘quality outcomes’ for this subpopulation, improving the quality of life for these members, and rewarding MLTC providers when certain levels of reduced avoidable hospital use are reached. Such arrangements could be treated as Level 1 VBP arrangements, and would be eligible for financial incentives. Improved quality and reduced overall costs can also be realized by delaying or avoiding nursing home admissions through targeted interventions amongst the MLTC population residing at home.” New York State Department of Health, A Path toward Value Based Payment: New York State Roadmap for Medicaid Payment Reform, Annual Update June 2016: Year 2 (CMS-Approved April 2017), p.18.

February 2018 15 Quality Measure Implementation Guidance & Support  Annual Clinical Advisory Group (CAG) Report Published for Measurement Year (MY) 2018 September 2017  Value Based Payment Reporting Requirements Technical Specifications Manual October 2017  MY 2018 Measure List for Partially Capitated Plans October 2017  Measures Calculated for Provider Attributions & Disseminated to Plans for Use October 2017  MLTC Value Based Payment Quality Measure Data Reporting Timeline January 2018

February 2018 16 MLTC VBP Quality Measure Data Reporting Timeline 2016 2017 2018 2019 2020 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 #1: Attrib . 4/16-12/16 Attribution Period #2: Attrib. 10/16-6/17 VBP QI Measurement Period 1/17 - 6/17 7/16-12/16 Baseline Community PAH 7/17 - 12/17 7/16-12/16 Nursing Home PAH 1/17-12/17 Data Releases Attribution Period Attribution 4/17 - 6/18 VBP QI Measurement Period 1/18 - 6/18 MY 2018 Community PAH 7/18 - 12/18 Nursing Home PAH 1/18-12/18 Data Releases Attribution Period Attribution 4/18 - 6/19 VBP QI Measurement Period 1/19 - 6/19 MY 2019 Community PAH 7/19 - 12/19 Nursing Home PAH 1/19-12/19 Data Releases Attribution Period Attribution 4/19 - 6/20 VBP QI Measurement Period 1/20 - 6/20 MY 2020 Community PAH 7/20 - 12/20 Nursing Home PAH 1/20-12/20 Data Releases Legend - Attribution file due to DOH - Preliminary Community Potentially Avoidable Hospitalizations (PAH) data released - Final VBP Quality Incentive (QI) and PAH data released