The Delivery System Reform Incentive Payment (DSRIP) initiative aims to reform more than the health care delivery system. For improvements afforded by DSRIP to remain sustainable beyond the 5-year DSRIP timeframe, the payment system must reform concurrently toward a Value Based Payment (VBP) model from the existing Fee-For-Service (FFS) model.
FFS model is a payment system where payment to providers is based upon volume of services as specified rates regardless of quality or patient outcomes. VBP is a payment system that rewards quality, outcomes and improved patient care with the intent to reduce overall health care costs while improving outcomes.
New York State Department of Health (DOH) created a short video that provides an overview of what value-based payments are, its important role in the Medicaid program, and how it will help to improve patient outcomes.
VBP is not a completely new concept; various levels of participation already exist among health care providers and payers. The various levels of participation in the VBP system are generally categorized in the following way:
• Level 0: FFS with bonus based upon quality score
• Level 1: Shared Savings – FFS with upside shared savings based upon performance
• Level 2: Shared Risk – FFS with both upside and downside shared savings/risk based upon performance
• Level 3: Full Risk – Capitation per member per month (PMPM) for an episode of care (bundle or total cost) with performance
Under DSRIP, the State Department of Health (DOH) has established the goal to be achieved over the 5-year program (through April 2020) as to have 80-90% of Medicaid Managed Care Organization (MCO) payments at VBP Level 1 or higher and at least 50-70% at Level 2 or higher. Minimally, 35% of MCO payments must be at a Level 2 or higher.
VBP: Value Based Payment is a system that rewards quality outcomes and improved health versus paying for a specific service performed.
FFS: Fee For Service is a payment system where payment is for a specific service provided and is volume based, regardless of health outcomes.
MCO: Managed Care Organization is an insurance organization paid generally a premium to provide care to the enrolled patient. This organization generally then negotiates the payment to a provider when services are delivered.
CBO: Community Based Organization is a public or private nonprofit (including a church or religious entity) that is representative of a community or a significant segment of a community, and is engaged in meeting human, educational, environmental, or public safety of the community.
VAP: Vital Access Provider is a provider of health care services in a community that is a hospital, nursing home, diagnostic and treatment center, home care providers and denotes the state’s determination to ensure patient access to a provider’s services otherwise jeopardized by the provider’s payer mix or geographic isolation. A VAP designation is a threshold determination that will qualify providers for some level of supplemental financial assistance to support their longer-term financial viability.
Shared Savings is a payment strategy that offers incentives for provider entities to reduce health care spending for a defined patient population by offering them a percentage of any net savings realized as a result of their efforts.
Integrated Primary Care (IPC) including behavioral health primary care, effective management of chronic disease, medication management, community based prevention activities and clear alignments with community based, home, and social services agencies (Patient Centered Medical Home (PCMH)/Advanced Primary Care (APC) models). This type of care is continuous in nature, strongly population-focused, based in the community, culturally sensitive, oriented towards primary and secondary prevention, and aims to act as the primary source of care for the majority of everyday care need.
Bundles of Care is where MCO’s and providers contract for a bundle of services and is generally thought of in two categories, Acute and Chronic bundles of service. Acute examples might be maternity care episodes or stroke, while Chronic examples might be Asthma or Diabetes where bundles would be looked at over an entire continuous year of care.
Value-Based Payment (VBP) Webinar Series
CCN and COPE Health Solutions hosted a series of educational VBP webinars to inform partner organizations about the upcoming transition from traditional fee-for-service payments to a new, pay-for-performance approach or Value-Based Payment (VBP) program. The webinars are available on the HWApps website for partners to view. For information on how to register for a course on HWApps, click here to view the guide.
Integration of Behavioral Health and Primary Care
United Healthcare Payer Forum
Care Compass Network (CCN) recently partnered with United Healthcare to offer a payer forum to help partners and stakeholders learn how their organizations can participate in Value-based payment arrangements like those being pursued by United Health Care. This information is intended to help partner organizations understand how to plan for Value Based Payment arrangements in 2017.
Items of interest on the following link are:
1. Value Based Payment Introduction Waiver
2. VBP Final Roadmap
3. Public Comments on VBP Roadmap
4. Medicare Alignment with Medicaid proposal
5. Value Based Payment for Providers
Value Based Payment (VBP) Bootcamps
The NYSDOH VBP Bootcamps are a regional learning series created by the Department of Health with the goal to equip future VBP contractors with the knowledge necessary to implement NYS Payment Reform.
The website will provide you with the Bootcamps schedule, content outlines and ability to register for sessions in your region. Registrations will open 3 weeks in advance and close 1 week before the event. These events are free and open to the public.
For those who are unable to attend the Bootcamps, sessions 1, 2, and 3 of Region 1 (Capital region, Mid-Hudson, and the Southern Tier) will be webcast live. The link will be sent out when it becomes available.