Value Based Payment Quality Improvement Program (VBP QIP)

Update Webinar

  • Webinar also available in Portable Document Format (PDF)

January 24, 2018

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
Advocate Community Partners Jamaica Hospital $16,000,000
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
Advocate Community Partners Jamaica Hospital $9,000,000
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 $455,645,920

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

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VBP QIP P4R Updates

VBP QIP P4R – Service Exclusion Waiver

  • Takeaway from the VBP QIP survey – some facilities fear they may not reach the 80% VBP Managed Care dollar threshold for reasons outside of their ability to control.
  • As a response, DOH has created an alternative VBP P4R calculation which will determine a facility´s progress towards the 80% threshold for only Inpatient and Emergency Department Medicaid Managed Care dollars.
    Original Calculation:
    Medicaid Managed Care
    dollars in VBP arrangement
        _____________________________
    Total Medicaid Managed
    Care dollars
    Calculation with Waiver:
    Inpatient & ED Medicaid
    Managed Care dollars in VBP arrangement
        _____________________________
    Total Inpatient & ED Medicaid
    Managed Care dollars
  • Facilities may find the application for the Service Exclusion Waiver on the VBP QIP website.
  • Facilities that request the application will be required to:
    • Identify and explain the reason for requesting the waiver*
    • Identify all facilities or organizations with whom they have attempted to partner or will attempt to partner
    • Detail the value of all existing Medicaid Managed Care contracts as well as the value of all Inpatient and Emergency Department services
  • Applications will be accepted through June 27, 2018
  • The application review process is expected to take no more than 72 hours

*DOH may require additional reporting by the facility in order to monitor progress towards VBP, ensure sufficient dollars are captured in these VBP arrangements, or determine the level of effort the facility has taken to partner with other local healthcare providers

VBP QIP P4R – Contract Submission Deadline

Additional takeaway from the VBP QIP survey – extension of the deadline past April 1, 2018.

DOH will now allow facilities to submit contracts without penalty through June 29, 2018*.

If the June 29, 2018 deadline is missed, the same penalty will apply and will be assessed over the remaining 9 months in the Demonstration Year.

Due date is listed as June 29, 2018 since July 1, 2018 falls on a Sunday*

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VBP QIP Contracting

Contracting Status

Deliverable Submission/Review Contract Preparation Contract Finalization/Execution
July – Sep 2017 Oct – Dec 2017 Jan– Jun 2018
  • Facilities submitted all LOIs
  • Facilities submitted one Level 1 VBP contract to DOH
  • Facilities received determination on whether contract meets requirements on Sep 29
  • Facilities to begin engaging with MCOs with whom they have an LOI
  • Facilities and MCOs expected to have agreed on risk/shared savings, quality metrics
  • Facilities and paired MCOs should finalize details of contract including data collection methods and physician network
  • Contracts must be nearing readiness for submission

VBP Contract Review

  • Facilities are required to submit Level 1 (or higher) VBP contracts with the MCOs required to meet the 80% VBP target by June 29, 2018. The facilities should submit information in accordance with the timeline below.
June 29, 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
    • April 1, 2017 Standard Clauses and the contract must contain the April 1, 2017 Standard Clause Incorporation language
    • Off Menu Supplemental Checklist, as required
    • Contract Attestation (sent by facility to DOH and paired MCO)
 ⇒ August 4, 2018
  • DOH will provide feedback to the contracting MCO, the VBP QIP Facility, and the PPS 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.
 ⇒ August 18, 2018
  • Contracting MCO submits updated contract along with the updated contract statement and certification form to DOH contracts group.
 ⇒ September 28, 2018
  • DOH contracts group makes determination if the contract meets requirements.
  • Contracting MCO, VBP QIP Facility, and PPS 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.

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VBP QIP Program Reminders

VBP QIP Roles and Responsibilities

PPS Role
  • Provide support (non–financial) and guidance to participating facilities
  • Flow funds from the MCO to the facility
  • Monitor facility´s performance
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

VBP QIP P4P – Retiring Measures

  • In the event a facility has selected a measure that has been identified to be retired:
    • The facility must select a substitute measure from the same measure focus area/domain (i.e., timely and effective care)
  • The process once a substitute measure is selected:
    • Facility submits a measure selection form located on the QIP website prior to the expiration of the retiring measure
    • Upon DOH approval, the facility notifies the MCO of the new measure selected
    • Facility submits the baseline and quarterly performance retroactively to 6/2017*
    *All activities originally performed in 6/2017 will need to be completed for the new substitute measure

VBP QIP – Penalties

  • The table below outlines the allocation of P4R and P4P funds in years DY3 through DY5
      DY3 DY4 DY5
    VBP Contracting Progress (P4R) % 50% (Paid in Q1 and Q2) 20% 0%
    Performance Improvement (P4P) % 50% (Paid in Q3 and Q4) 80% 100%
  • If the facility is unable to meet the DY4 P4R requirement of 80% of total Medicaid MCO contracted payments tied to at least a Level 1 VBP arrangement by June 29, 2018, the facility will forfeit 20% of their available award in DY4.
  • If the facility remains unable to reach this milestone by April 1, 2019, the facility will forfeit 50% of the DY5 P4P award.

Key Deliverable Deadlines

  • Beginning DY3 Q4, quality measure performance will drive payment.
  • Quarterly Improvement will be considered achieved for a measure if the most recently completed quarter´s annual rolling results indicate maintaining or improving the level of quality over the preceding quarter´s annual rolling results regardless of the magnitude of improvement.
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 DY3 Q1 QITs and begin preparing payment Friday, December 29, 2017 MCO
DY3 Q3 measurement period ends Sunday, December 31, 2017 N/A
Collect and report DY3 Q2 P4P data to MCO Wednesday, January 31, 2018 Facility
Submit QIT Payment report to DOH for DY2Q4 Wednesday, January 31, 2018 MCO
Review and approve DY3 Q2 QITs and begin preparing payment Friday, March 30, 2018 MCO
DY3 Q4 measurement period ends Saturday, March 31, 2018 N/A
Collect and report DY3 Q3 P4P data to MCO Monday, April 30, 2018 Facility
All VBP Contracts with 80% funds in VBP arrangements due to DOH Sunday, July 1, 2018 Facility

Deliverable Submission

Report Submitted by Submitted to Frequency Location
VBP QIP Contracts MCOs DOH As updated contract@health.ny.gov
Remaining contracts due Facilities MCOs & DOH July 1, 2018 contract@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 February 28th 2018.
  • 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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