Value Based Payment Quality Improvement Program (VBP QIP)

Update Webinar

  • Webinar also available in Portable Document Format (PDF)

September 27, 2017

Today´s Agenda

VBP QIP Financing

VBP QIP Financing – Demonstration Year 3 (DY3) Pairings

VBP QIP SFY 17–18 Pairings & Funding

MCO PPS Facility Gross Funding
Affinity Maimonides Medical Center Brookdale Hospital $31,000,000
Montefiore Hudson Valley Collaborative St. Joseph´s Hospital $7,800,000
Amerigroup Nassau Queens Performing Provider System, LLC Nassau University Medical Center TBD
Emblem Health (HIP) Health and Hospitals Corp. Health and Hospitals Corp. TBD
Excellus Central New York Collaborative, Inc. Lewis County General Hospital $2,036,000
Finger Lakes Performing Provider Systems, Inc. Orleans Community Hospital $1,434,039
St. James Mercy Hospital $1,844,635
Wyoming County Community Health $1,000,000
Mohawk Valley PPS A O Fox Memorial Hospital $1,000,000
Fidelis Maimonides Medical Center Interfaith Medical Center $50,000,000
Kingsbrook Jewish Medical Center $50,000,000
Montefiore Hudson Valley Collaborative Montefiore–Mount Vernon $11,096,728
Nyack Hospital $17,747,861
Nassau Queens Performing Provider System, LLC St. John´s Episcopal $27,650,000
Westchester Medical Center Bon Secours Charity Health $2,898,070
Good Samaritan Hospital Suffern $2,000,000
HealthFirst Maimonides Medical Center Brookdale Hospital $109,000,000
MetroPlus Health and Hospitals Corp. Health and Hospitals Corp. TBD
MVP Montefiore Hudson Valley Collaborative Montefiore – New Rochelle $20,837,141
Westchester Medical Center Health Alliance (Benedictine) $2,999,926
United Health Plan Central New York Care Collaborative, Inc. Rome Memorial Hospital $1,000,000
Maimonides Medical Center Wyckoff Heights Medical Center $70,000,000
WellCare Montefiore Hudson Valley Collaborative St. Luke´s Cornwall $19,301,520
Total VBP QIP Funding $430,645,920

* VBP QIP funding amounts do not include premium admin, surplus, or taxes

VBP QIP Financing

  • At the August webinar, DOH indicated MCOs should continue paying at DY2 rates because the DY3 rates had not yet effectuated.
  • The DY3 rates were loaded on September 6, therefore MCOs should be paying at the DY3 rate.
  • The January 2017 rate package has been approved by the Division of Budget, however, the date to effectuate the rates has not been determined.
  • A reconciliation will be performed at a later date and will eliminate all DY3 variances.
  • For questions on VBP QIP financing, please contact bmcr@health.ny.gov

VBP QIP Financing – Rate Setting Background

Rate Setting Background
  • Rate Setting starts at the beginning of the fiscal year with adjustments made throughout the year
  • The initial rates for the fiscal year are based on enrollment projections thus the need to reconcile later in the fiscal year
    • Any shortfalls or overages are usually reconciled in the last rate package of the fiscal year unless advised otherwise
  • All supplemental programs (VBP QIP, EIP, EPP, AHPP) are sub–components of the rate package, but not the rate package in its entirety
  • Timing of supplemental program payments are impacted by non-supplemental related adjustments/revisions within the rate package(s)
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VBP QIP P4P Updates

Key Deliverable Deadlines

DY3 Q2 concludes on Saturday, September 30th

VBP QIP P4P - Quarterly Improvement Targets
1 – Facilities will report their initial baseline for DY2 Q4. Therefore, there is no measurement associated with this quarter.

VBP QIP P4P – Quarterly Improvement Targets

  • The table below outlines upcoming activities related to DY2 Q4, DY3 Q1, and DY3 Q2 P4P reporting.
Measurement Quarter DY2 Q4 DY3 Q1 DY3 Q2
Measurement Period April 1, 2016 to
March 31, 2017		 July 1, 2016 to
June 30, 2017		 October 1, 2016 to
September 30, 2017
Facility reports measurement information to paired MCO July 31, 2017* October 31, 2017 January 31, 2018
Paired MCO reviews achievement of QIT and prepares payment September 29, 2017 December 31, 2017 March 31, 2018
Paired MCO makes monthly payments to the Facility for achievement of QIT October, November, and December 2017 January, February, and March 2018 April, May, and June 2018
Paired MCO sends P4P Performance Report to DOH January 31, 2018 April 30, 2018 July 31, 2018
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3–Hour Sepsis Bundle Update

Sepsis 3–Hour Bundle Policy Change

Data Source and Adherence Measure

The 3–Hour Sepsis Bundle Performance Measure, while still addressing the same care concept, underwent significant changes regarding the protocol of collecting of the treatment elements. This change was implemented and concerns the data with the service dates starting from January 1, 2017.

Time Period

  • Old 3–hour sepsis adherence measure availability: January 2015 – December 2016
  • New 3–hour sepsis adherence measure availability: January 1, 2017 – on
  • Sepsis will remain pay for reporting through March 31, 2018 and will turn pay for performance in April 1, 2018. The performance measurement period will be April 2017 – March 2018
  • A new baseline will be set in March 2018 based on four quarters of data of the new metric.
    • Scenario 1: If a facility maintains or improves in 3 out of 6 measures, then sepsis will be a "freebie" in this quarter as long as the facility adhered to the reporting deadlines. (120 days post closure of the measurement quarter)
    • Scenario 2: If a facility maintains or improves in 4 out of 6 measures without sepsis, then the measure will have no relevance to their performance. Based on the rolling annual, this "free quarter" will fall off in DY 5.
    • Scenario 3: If a facility has no sepsis cases in any quarter, the measure is invalid.
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VBP QIP Contracting

VBP QIP Contracting Updates

  • Facilities were required to have one (1) Level 1 VBP contract to meet the June 30, 2017 P4R requirement. The MCOs submitted information in accordance with the timeline below.
  • DOH contracts group provided feedback to the contracting MCO on the status of the contracts.
September 8, 2017

Contracting MCO submits updated contract and required documentation to DOH contracts group

Updated Contract Statement and Certification form
Updated contract		 ⇒ September 29, 2017

DOH contracts group makes determination if the contract meets requirements

Contracting MCO and VBP QIP Facility are notified of DOH determination

VBP QIP paired MCO is also notified of DOH determination

Off–menu contracts may take DOH additional time to review. Therefore, if there are delays in DOH feedback, paired MCOs should continue paying out funds for attestation. The paired MCO can perform a reconciliation in the future if the requirement is not met.

Contracting Status

Deliverable Submission/Review Contract Preparation Contract Finalization/Execution
July – Sep Oct – Dec Jan– Mar
  • Facilities submitted all LOIs
  • Facilities submitted one Level 1 VBP contract to DOH
  • Facilities will receive determination on whether contract meets requirements on Sep 29
  • Facilities to begin engaging with MCOs or contracting entity with whom they have an LOI
  • Continue discussions with MCOs or contracting entities
  • Facilities and MCOs expected to have agreed on risk/shared savings, quality metrics
  • For non–TCGP arrangements, evaluate the estimated Medicaid dollars with the arrangement
  • Facilities and paired MCOs should finalize details of contract including data collection methods and physician network
  • Contracts should be nearing readiness for execution

VBP Contracting Survey

  • Survey will be distributed to all VBP QIP facilities on Friday, September 29th
  • Completed surveys are due by Wednesday, October 4th
  • The survey will be used to assess the progress of VBP QIP Facilities in developing VBP contracts with the MCOs required to meet 80% VBP by April 1, 2018
  • DOH will survey again in November and January to monitor VBP QIP Facility efforts and progress

VBP Contract Review for Contract Attestations

Facilities are required to have Level 1 (or higher) VBP contracts with the MCOs required to meet the 80% VBP target by March 30, 2018. The facilities should submit information in accordance with the timeline below.

October 2, 2017 –March 30, 2018
  • Contracting MCO must submit new or amended VBP Contract and the following documentation to DOH contracts group for review contract@health.ny.gov:
    • Contract Statement and Certification Form
    • MCO assigned unique identifier (if amended)
    • Standard Clauses, as needed
    • Off Menu Supplemental Checklist, as required
    • Contract Attestation (sent by facility to DOH and paired MCO)
 ⇒ May 4, 2018
  • DOH contracts group will provide feedback to the contracting MCO and the VBP QIP Facility that either:
    1. Contract is in alignment with the NYS Roadmap and no further updates are needed.
    2. Updates are needed and provide feedback on elements that should be updated to meet roadmap requirements.
 ⇒ May 18, 2018
  • Contracting MCO submits updated contract along with the updated contract statement and certification form to DOH contracts group.
 ⇒ June 29, 2018
  • DOH contracts group makes determination if the contract meets requirements.
  • Contracting MCO and VBP QIP Facility are notified of DOH determination.
  • VBP QIP paired MCO is also notified of DOH determination.

Off–menu contracts may take DOH additional time to review. Therefore, if there are delays in DOH feedback, paired MCOs should continue paying out funds for attestation. The paired MCO can perform a reconciliation in the future if the requirement is not met.

PPS Role
  • Provide support (non–financial) and guidance to participating facilities
  • Flow funds from the MCO to the facility
Facility Role
  • Report quality measure performance to the MCOs
  • Regularly review your FTP to ensure implementation is in accordance with contractual obligations to move towards VBP
  • Improve quality of care
  • Achieve financial sustainability over duration of the program
  • Engage in continuous communication with PPS and MCOs regarding obstacles and successes
DOH Role
  • Provide MCOs with criteria for funds distribution and program administration that aligns with NYS VBP Roadmap
  • Fund the program through MCO Per Member Per Month (PMPM) rate increases inclusive of an administrative fee
  • Provide contracting guidelines and recommendations
  • Monitor the facilities´ sustainability plans and status
  • Communicate facilities´ success/risk with OPCHSM
MCO Role*
  • Validate reporting
  • Communicate with the facility and PPS
  • Collaborate
  • Oversee program
  • Distribute and report on funds

* MCOs are NOT responsible for ensuring that the facilities achieve the goals of VBP QIP

Contracting Checklist

DOH has developed an on–menu checklist to assist MCOs and facilities with successful completion and submission of VBP contracts and to increase the efficiency of contract review. The checklist will provide guidance and ensure compliance in each of the following categories

  1. Type of Arrangement
  2. Definition and Scope of Services
  3. Quality Measures/Reporting
  4. Risk Level and Shared Savings/Losses
  5. Attribution
  6. Target Budget
  7. Social Determinants of Health
  8. Contracting with Community Based Organizations
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VBP QIP Program Reminders

Key Deliverable Deadlines

  • Beginning DY3 Q3, Pay for Performance payments begin. Payment will be tied to reporting baselines to the MCO in DY2 Q4
  • Quality measure performance will drive payment beginning in DY3 Q4 (with the exception of sepsis)
Measurement Quarter DY2 Q4 DY3 Q1
Measurement Period 4/1/2016 – 3/31/2017 7/1/2017 – 6/30/2017
MCO Reviews Achievement, Prepares Payment 9/30/2017 12/31/2017
MCO Releases Monthly Payments for QIT Achievement Oct – Dec (2017) Jan – Mar (2018)
MCO Sends P4P Performance Report to DOH 1/31/2018 4/30/2018

VBP QIP Timeline

Description of Event/Task Deadline/Date Completed Responsible Party
Review and approve DY2 Q4 QITs and begin preparing payment Friday, September 29, 2017 MCO
DY3 Q2 measurement period ends Saturday, September 30, 2017 NA
Begin dispersing funds related to DY2 Q4 achievement of QITs Monday, October 02, 2017 MCO
Collect and report DY3 Q1 P4P data to MCO Tuesday, October 31, 2017 Facility
Review and approve DY3 Q1 QITs and begin preparing payment Friday, December 29, 2017 MCO
DY3 Q3 measurement period ends Sunday, December 31, 2017 NA

Deliverable Submission

Report Submitted by Submitted to Frequency Location
VBP QIP Contracts MCOs DOH As updated contract@health.ny.gov
Remaining contracts and contract attestations due by April 1, 2018 Facilities MCOs & DOH April 1, 2018 vbp_qip@health.ny.gov
Documentation of achievement of P4P metrics Facilities MCOs Quarterly VBP QIP paired MCO
Documentation of approval of P4P deliverables, supporting documentation, and payment date MCOs DOH One month after payment quarter vbp_qip@health.ny.gov
VBP Contracts, Contract Statement and Certification form Contracting MCOs DOH As completed or updated contract@health.ny.gov
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Important Information

VBP Support Materials

VBP Resource Library:
VBP Website:

Thank you for your continued support with VBP QIP!

  • The next VBP QIP Update Webinar is scheduled for October 18th 2017.
  • For questions on VBP QIP quality measures, please email the SPARCS BML at sparcs.submissions@health.ny.gov with "VBP QIP Measures" in the title.
  • For questions on VBP QIP financing, please contact bmcr@health.ny.gov.
  • For other questions on VBP QIP, please contact the VBP QIP inbox at vbp_qip@health.ny.gov.
  • For questions regarding VAP or VAPAP, please contact vapap@health.ny.gov.
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