Overview of 2026 Value-Based Payment Roadmap Update
- Template is also available in Portable Document Format (PDF)
New York State Office of Health Insurance Programs
April 2026
New Requirements – VBP Roadmap Update
Facilitating Targeted VBP Arrangements
Plans required to offer at least one VBP arrangement that addresses an identified health disparity
Goal:Progress past TCOC-focused arrangements to arrangements that focus on specific populations, target disparities, and reward measurable improvement in outcomes
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Streamlining Quality
Plans required to have a maximum of ten quality measures within each VBO contract
Goal:Reduce burden and confusion for providers; streamline quality goals across arrangements
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Requiring Data Transparency
Plans must provide providers with the information that is used to calculate their arrangement specific targets prior to finalization of the arrangement
Goal:Create an equal and transparent playing field for provider-plan negotiations
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VBP Level Refinement
VBP levels 1-3 redefined; addition of category 3B
Goal:Support higher-risk VBP arrangements with clearly defined parameters
Facilitating More Targeted VBP Arrangements
- Plans required to evaluate quality/outcome data and identify 2 disparities, then create and offer at least one VBP arrangement focused on reducing them
- OHIP will administer a template to MCOs that requires them to identify these disparities, summarize the methodology behind the process, and detail a planned approach to develop a VBP approach aimed at closing identified outcome gaps
Streamlining Quality
- Plans required to have a maximum of tenquality measures within each VBP contract
- Total costs and quality-based process details must be clearly defined and included in the contract
- Plans and providers are encouraged to work together to minimize unnecessary complexity in quality measure selection and ensure that quality measures are chosen to maximize impact on outcome improvement
Data Transparency
- Appendix added for detailed data sharing and transparency requirements to help providers and plans negotiate more well-informed contract terms
- Minimum requirements include (for example) target setting data, claims cost data, and attribution methodology and reporting
- Some data-sharing requirements are more comprehensive for arrangements with higher levels of risk
VBP Level Refinements and Additions
Streamlining VBP Arrangement Types
- On-Menu/Off-Menu language removed, and categories of arrangement types are now used to allow more flexibility between contractors and MCOs and help facilitate innovative arrangements
Level 3B Addition
- Two types of Level 3 arrangements are now available:
- 3A:Financial target-based arrangement (ie. % MLR or claims-based target)
- 3B:the VBP contractor assumes responsibility for a minimum of 90-95%of plan premium, varied based on level of administrative responsibility
- Plans entering 3B arrangements will also have more extensive data sharing requirements to ensure that providers have insight into complex risk-bearing arrangements and performance measurement
Public Comment Process and Ongoing Updates
NYS OHIP intends to update the VBP Roadmap regularly to continue shaping VBP guidance in alignment with evolving delivery system reform and population health goals.
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