Value Based Payment (VBP) Pilot Webinar: October Update
Update Webinar
- Webinar also available in Portable Document Format (PDF)
October 26, 2017
Agenda
| Topic | Duration |
|---|---|
| Target Budget Update | 10 min |
| VBP Pilot Program Adjustment Payout Timeline | 15 min |
| VBP Quality Measures: New Guidance | 15 min |
| HCS Accounts Update | 10 min |
| Next Steps and Open Forum | 10 min |
Target Budget Update
Target Budget Calculations Using 2015 Claims Data
- Target budgets calculated based on 2015 claims data will be released in January 2018
- Shortly after the 2015 data release, the State will be able to release target budgets based on 2016 claims data
- Based on the recent survey results all pilots calculated their own target budgets – thank you!
- Our team will be reaching out to you for the Target Budget numbers that have been calculated by the VBP Pilots.
Note: previously communicated stimulus and performance adjustment amounts remain final.
|top of section| |top of page|VBP Pilot Program Adjustment Payout Timeline
Current Payout Timeline
VBP Pilots will receive financial benefits in the form of stimulus and performance adjustments.
Summary
- First year´s payments are going to be included in the October 2017 premium update.
- Second year´s payment with be paid out in 2018 before the end of the program.
VBP Quality Measures: New Guidance
Measurement Year 2017 Guidance for Cat 1 Measures
The Department has recently finalized the final list of reportable quality measures for MY 2017 and 2018. VBP Pilots need to pay close attention to the Office of Quality and Patient Safety (OQPS) issued guidance in this regard.
Summary
Category 1 Measures: VBP Pilots will be required to report all Category 1 measure data that the DOH has defined as reportable for MY 2017. This will include only a subset of the Category 1 measures.
- VBP Contractors: This will require no additional effort to satisfy reporting requirements.
- MCOs: OQPS will be requesting attribution files from plans per VBP Arrangement to satisfy reporting requirements.
- For MCOs and Contractors: OQPS will be working closely with Pilots to create the infrastructure to address the implementation of measures with additional feasibility challenges beginning in January 2018.
- Details on MY 2017 Reporting Guidance to be provided by the end of October 2017.
- A number of VBP Pilots did not include all Category 1 Measures in the contracts and thus are not compliant with the program requirements. Please review the new measure sets and ensure you are Roadmap compliant. Please submit contract amendments as appropriate.
Guidance for Cat 2 Measures: Requirement Relaxed
Due to the retirement of the following two measures by NCQA: (1) Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis and (2) Use of Imaging Studies for Low Back Pain; the State is relaxing the Cat 2 measure reporting requirement for both years of the program.
Summary
- For MY 2017: No Category 2 measures need to be reported.
- For MY 2018: Only one Category 2 measure needs to be reported.
VBP Pilots need to ensure that they are in alignment with this guidance.
New Roadmap Requirement: Quality and Shared Savings
A new Roadmap change is pending with respect to ensuring that quality is tied to the determination of shared savings in VBP contracts.
Summary
- Requirement: The list of quality measures agreed upon for calculating shared savings and losses must be included in the MCO´s contract. At least one Category 1 pay for performance quality measure, that has been approved by the State, must be used to determine shared savings or losses and listed in the contract. VBP Contractors and MCOs may negotiate to use additional Category 1 and/or Category 2 measures if they choose to do so.
- VBP Pilots that are out of compliance should submit a contract amendment to DHPCO to ensure the alignment with the Roadmap.
HCS Accounts Update
HCS Account Set Up
Creating a HCS account is the first step in gaining access to the Medicaid Analytics Performance Portal (MAPP), which houses the VBP Dashboards.
Pilot HCS Account Set Up
- While some organizations may already have DSRIP HCS accounts, new accounts or designations unique to their VBP entities must be created to permit access to the VBP Dashboards in MAPP
- Once the initial VBP Dashboard Access Form is approved for each VBP contracting entity, the organization will then be able to add their own users to the system
HCS Account Request Form
Pilot HCS Account Set Up
- HCS sent an account request form to Account Directors and Coordinators in the last 24–48 hours from camu.its.ny.gov.
- Filled out, signed and notarized Director/Coordinator Account Request Form must be sent by mail (DOH requires the hard copy) to: 800 North Pearl Street Room 214 Albany, NY 12204–1899.
- Once the forms are received, DOH will mail Personal Identification Number (PIN) Letter and account activation instructions via USPS mail to each designated Account Director/Coordinator.
Account Setup Instructions
This is a sample of the account request form PDF that is populated with the data entered.
- Director must sign #8
- Director´s signature must be notarized #9
- Director must keep a copy of the account request form for account activation
- Director must mail the original to the address provided at the bottom left of the form
Next Steps and Open Forum
Next Steps: Fall / Winter
- 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)
| Lessons Learned | → | Target Budgets | → | VBP Dashboard Release |
|---|---|---|---|---|
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Open Forum
| Are there any additional areas of support that VBP Pilots would like to see? Any immediate concerns or questions? |
| For additional questions, or to share ideas, please contact the VBP mailbox: vbp@health.ny.gov |
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