Value Based Payment June 1, 2017
MCTAC Overview What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State. MCTAC s Goal Provide training and intensive support on quality improvement strategies, including business, organizational and clinical practices to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care. 2
Why Transform?
Contributing Factors New York was spending double the cost per recipient for healthcare as compared to the national average National rankings at best tend to show NYS in the middle of the pack when it comes to overall health care quality NYS Medicaid expenditures were growing at a rate of 10% per year The care delivery system is fragmented, with minimal incentives and infrastructure to coordinate care across systems The current model incentivizes volume instead of value 4
Triple Aim Improve Member Experience Improve Quality of Care Decrease Costs
Value Based Payment Overview
Value Based Payment A way of reimbursing providers focusing on value instead of volume Focus on Quality Outcome Driven Service Goals (the Triple Aim): Improving Quality Reducing Costs Improving the member s experience Levels from FFS to full capitation or bundling Source: NYS DOH VBP Bootcamp #1
Population Impacted by VBP VBP discussed today only applies to the populations covered by Medicaid Managed Care. Do you know the populations you serve? How much of the care you deliver is impacted by VBP?
Level 0 VBP* Level 1 VBP Level 2 VBP Level 3 VBP (feasible after experience with Level 2; requires mature contractors) FFS with bonus and/or withhold based on quality scores FFS with upside-only shared savings available when outcome scores are sufficient (For PCMH/IPC, FFS may be complemented with PMPM subsidy) FFS with risk sharing (upside available when outcome scores are sufficient) Prospective capitation PMPM or Bundle (with outcomebased component) FFS Payments FFS Payments FFS Payments Prospective total budget 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
Consider Possible Contract Options in VBP Independent Practice Associations (IPA) Accountable Care Organizations (ACO) Individual Providers Hospital Systems FQHCs and large medical groups Smaller providers including community based organizations (CBOs) Individual provider could either assume all responsibility and upside/downside risk or make arrangements with other providers; or MCOs may want to create a VBP arrangement through individual contracts with these providers
Types of VBP Arrangements
Myths 1. Everyone must eventually contract at Level 3 (capitation, sub-capitation) 2. A Payer can only reimburse innovative services if provider is in a Level 3 contract 3. FFS and government rates are incompatible with VBP 4. You are supposed to do more with less 5. VBP is about reducing the Medicaid Global Cap spend 6. Only PPSs can contract VBP arrangements 7. VBP is about reducing services offered to Medicaid members
Truths 1. MCOs will be penalized if the Roadmap goals are not achieved (MCOs may pass penalties onto providers) 2. The State will be providing analytical support to the VBP stakeholders 3. VBP provides flexibility in contracting - it is not a 'one size fits all' 4. The goal of VBP is to improve the quality of care and shift spending to keep members as healthy as possible and integrated in their community 5. VBP implementation is an iterative process - the State will keep learning as the process moves forward (pilots will play an important role in this learning) 6. VBP is focused on transparency around costs 7. Providers can continue to be paid FFS while participating in larger VBP arrangements.