VBP QIP: Governance Document Scorecard

Last Edited: June 6, 2016

  • Scorecard is also available in Portable Document Format (PDF, 171KB)

Program Background

The Value Based Payment (VBP): Quality Improvement Program (QIP) was established to assist hospitals in severe financial distress by enabling these Facilities to maintain operations and vital services while they work toward longer-term sustainability, improved quality, and alignment with the state´s VBP initiatives. The program aligns Managed Care Organizations (MCOs), Performing Provider Systems (PPSs), and Facilities in VBP contracts to provide resources that assist Facilities in achieving longer-term sustainability, improved quality, and VBP.

Program Purpose

VBP QIP was designed to provide funding, serve as a catalyst that fosters an operational transformation, and allow struggling Facilities the means towards implementing VBP contracting processes. This is done by aligning PPSs and MCOs with the Facilities to assist in the transition that will help secure the Facilities´ future.

The three parties will jointly develop a VBP QIP contract under the guidance of the Department of Health (DOH) and input from the plan and hospital associations. Using a template developed by the MCO, the facility must develop a transition plan (with input from the PPS) that will help the facility become a sustainable VBP contracting entity. The MCO will then review the transition plan to ensure that it is designed to meet the goals of the Program, that it aligns with the State-developed VBP Roadmap, and that it aligns with the MCO´s Governance Plan.

Governance Documents & Scorecard

The VBP QIP MCO Governance Plans serve as the primary resource to understand how each MCO will oversee its VBP QIP program. Information on organizational structures, partner responsibilities, communication, reporting and payment should be in this document. VBP QIP Governance documents are expected to be in place throughout the duration of a MCO´s VBP QIP program.

The VBP QIP MCO Governance Document Scorecard provided below outlines the areas the Department reviews to make sure that each MCO´s VBP QIP program has a solid approach for administering this program is sound and will foster the parameters that will assist the MCO´s paired Facilities with achieving the objectives of the program.

Approach

This Scorecard reviews the following components of each MCO´s Governance Document:

  • Creation of Organizational Structure and Identification of Responsibilities
  • Creation of Committees, Sub-Committees, and/or Steering Committees
  • Creation and Assessment of Facility Milestones
  • Development of a VBP Transformation Plan
  • Development of a Monitoring Process

Each component of the document is assigned a rating from one to five. The meaning behind each value is noted below. Please note individual metrics must receive a minimum rating of 3, regardless of the overall score achieved for the entire document.

Rating Scale
5 Complete information provided
4 Most information provided
3 Moderate information provided
2 Minimal information provided
1 No information provided

Upon completion of its review, DOH will assign an overall score to the MCO´s VBP QIP programmatic governance document. The minimum score that can be received is 12 and the maximum score is 60, while a score of 36 or higher means that the MCO´s Governance Document provides sufficient information regarding the governance of the MCO´s VBP QIP program. The stronger the VBP QIP document is, the more likely it will be accepted in the occurrence of review by external parties.

Score Ranges
36 and above DOH has determined that sufficient information regarding the governance of the program was provided. As such, only minimal revisions are required.
25 to 35 DOH has determined that the document captures a portion of the information it expects within a governance document. As such, further clarification, detail, or revisions are required.
24 and below DOH has determined that the information provided is insufficient (i.e. very little information was provided and significant follow up is required). As such, DOH recommends substantial updates before the document can be approved.

DOH expects MCOs to review this score card and adapt their VBP Governance Plans to address the areas and information noted above. It is the State´s expectation that the MCO will communicate with the PPS to ensure that the Governance Plan as developed by the MCO synergizes with the Facility Plan. VBP QIP Programmatic Governance Document from the MCOs are due back to the State by Friday, July 8th, 2016.

VBP Governance Document Scorecard

Rating Description Score (1-5)
1. Creation of Organizational Structure and Identification of Responsibilities
a. Creation of an organizational chart that visually outlines the administrative structure of the Program.  
b. Roles and responsibilities of partners (MCO, PPSs, and Facilities) shown in the organizational chart.  
c. Explanation on how the partners (the MCOs, PPSs, and Facilities) will have clear channels of communication, allowing for maximum efficiency and transparency throughout the duration of VBP QIP.
  1. Ideally, governance plan would identify key individuals (with contact information) from each partner to reach out to for various situations/need.
  
2. Creation of Committees, Sub-Committees, and/or Steering Committees
a. Creation of the following:
  1. Program Oversight Committee (should be inclusive of all partners; Chaired by MCO)
  2. If needed, Resource Sub-Committee(s) that will aid the Facility in VBP QIP.
For the committee(s) listed above, provide the following:
  1. Committee responsibilities,
  2. Committee governance,
  3. Committee member expectations,
  4. Names, partner affiliation and contact information for committee members, and
  5. Committee communication plan.
  
3. Creation and Assessment of Facility Milestones
a. Development of a comprehensive set of milestones for Facilities to achieve, which should explicitly outline the MCO´s expectations of the Facilities.
  1. Each partner´s role/expectations in the milestone development process should be stated.
  2. Final milestones, if met, should leave the Facility with a VBP system in accordance with the NYS DSRIP Plan.
  
b. Development of clear methods to assess Facilities against metrics established in the Transformation Plan.  
c. Identification of anticipated roadblocks/obstacles of assessing facility milestones and strategies to successfully overcome these barriers.  
4. Development of VBP Transformational Plan
a. Proposal for cooperative development and maintenance of a clear and concise facility transformation plan with an end goal.
  1. MCO, PPS and Facilities´ roles/expectations in the development of the transformation plan should be stated.
  
b. Identification of anticipated roadblocks/obstacles in the development and maintenance of transformation plans and strategies to successfully overcome difficulties.  
5. Development of a Monitoring Process
a. MCO to create Monitoring Committee who will be tasked with reviewing/assessing the Facility´s progress.
  1. Please provide the following information for the MCO monitoring committee:
    • Committee role,
    • Committee governance,
    • Committee member expectations,
    • Names, titles and contact information for committee members
  
b. Establishment of a monitoring process that identifies duties of all parties involved. Monitoring process should include, but is not limited to:
  1. The frequency of the monitoring,
  2. The duration of the monitoring process (including cure periods), and
  3. If applicable, the role of any other VBP QIP committees in helping to monitor the Facility´s progress
  
c. Defined communication process and timeline to notify VBP QIP partners, committees and DOH of issues including, but not limited to:
  1. Performance or programmatic issues,
  2. Remediation efforts, and
  3. Funds flow issues (which may result from the issues listed above)
  
Total Score (up to 60 points)  

Have Questions? Speak with the DOH Team!

DOH is more than happy to walk through the Governance Document Scorecard with the VBP QIP participant. If an MCO has any questions or would like further clarification as to the review of VBP QIP Governance Documents, please e- mail the DOH VBP QIP team at vbp_qip@health.ny.gov with "VBP QIP Governance Plan" in the subject line.