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Value Based Payment — Key Resources

Overview:

BPHC has aggregated Value Based Payment (VBP) materials for PPS Members. This page will be updated as additional resources become available.

Introductory Information:

VBP Introduction Video: On overview of what value based payment (VBP) is, its important role in the NYS Medicaid program, and its role in improving patient outcomes. Link

GNYHA: Value-Based Payment Fundamentals: A Guide to New York State Medicaid VBP: Includes:

  • Defining VBP and the policy context for this shift
  • New York State’s VBP program and the role of partners
  • Integrated delivery systems in VBP
  • Capabilities, benefits, and challenges to VBP Link

Value Based Payment for Providers Video: Highlights how VBP will reshape our health care system and the important role providers play within VBP. Link

Myths and Facts of Value Based Payment: New York State’s former Medicaid Director, Jason Helgerson, talks about common myths and facts about the Value Based Payment (VBP) initiative. He debunks common misunderstandings about the program and highlights what VBP actually means to those who are and will be participating in it Link

The VBP Roadmap: A comprehensive outlines of the direction NYS DOH is moving toward for contracts between Managed Care organizations and providers. Link

VBP Arrangements: Materials discussing the various service specific VBP arrangements. Link

  • Total Cost General Population (TCGP) Arrangement 102 Video Link
  • Subpopulation Arrangement 102 Video Link
  • Maternity Care Arrangement 102 Video Link
  • Integrated Primary Care (IPC) Arrangement 102 Video Link
  • Health and Recovery Plan (HARP) Arrangement 102 Video Link
  • HIV/AIDS Arrangement 102 Video Link
  • Managed Long Term Care (MLTC) Arrangement 102 Video Link

Topic-Specific Videos:

       All organizations:

  • VBP Governance 101 Video Link
  • VBP Stakeholder Engagement 101 Video Link
  • VBP Business Strategy 101 Video Link
  • VBP Finance 101 Video Link
  • VBP Data 101 Video Link
  • VBP Contracting Lessons Learned 101 Video Link

      CBOs:

  • VBP CBO Contracting Strategy Guidance 103 Document Link
  • Social Determinants of Health 101 Video Link
  • Role of CBOs in Addressing SDH 101 Video Link
  • SDH Intervention: Gods´ Love We Deliver 101 Video Link
  • SDH Intervention: Empire Blue Cross Blue Shield HealthPlus (NYC) 101 Video Link
  • SDH and CBO Webinar 101 Video Link
  • VBP SDH Intervention Visual 102 Document Link

MLTC VBP Learning Series: Part 1 Link

VBP Bootcamps:

The DOH released a series of materials walking organizations through Value Based Payment. These materials are comprehensive, covering the basics of VBP through the advanced stages of contracting with Managed Care Organizations:

Bootcamp 1 — Introduction to VBP: This introductory session provides a clear foundational understanding of VBP, the implementation work that has been done to date, and where implementation is heading in the coming years. The below topics are addressed in the materials Link:

  1. Introduction to Value-Based Payments
  2. High-level overview of VBP Readiness Assessment
  3. New VBP Design Standards:
    1. Technical Design
    2. Patient Engagement
    3. Social Determinants of Health

Bootcamp 2 — Contracting and Risk Management: The second installment of the VBP Bootcamp series familiarizes participants with VBP contracting as well as risk management techniques. It provides real life experience and examples of strategizing and contracting value-based arrangements. These topics are addressed: Link:

  1. VBP Contracting Overview:
    1. VBP Contracting Entities
    2. Presentation on two types of contracts:
      1. Contract between a plan and a provider network (IPA/ACO)
      2. Contract between IPA/ACO and downstream providers
    3. Contracting considerations
    4. Contract necessities vs. optional items
    5. Contracting with Community Based Organizations
  2. Risk management mechanisms (stop loss provisions, risk corridors, etc.) and their importance in VBP contracting
  3. Leveraging analytics tools
  4. Advancement in risk levels

Bootcamp 3 — Performance Measurement: The final VBP Bootcamp session is devoted to performance measurement and how performance results will impact the adjustment (upward or downward) in target budgets and shared savings/losses. These topics are addressed:

  1. Overview or Performance Measurement in VBP:
    1. Data
    2. IT guidance / considerations
    3. Rapid Cycle Evaluation
    4. Overview of the Process (Start to Finish)
    5. Provider / MCO / State expectations

The following link contains the materials: Link

Additional Resources:

Value Based Payment (VBP) Baseline Survey was administered by NYS gathering details of current state payment arrangements between MCOs and providers: Medicaid MCOs VBP Baseline Survey Results

VBP Quality Measurement Sets:  As outlined in the VBP Roadmap, the State has established a common set of quality measures for each VBP arrangement based on national standards and the recommendations from the Clinical Advisory Groups, Technical Design Subcommittees, and approved by the VBP Workgroup.

  • TCGP/IPC Quality Measure Set Link
  • HARP Quality Measures Set Link
  • HIV/AIDS Quality Measures Set Link
  • Maternity Quality Measures Set Link
  • Managed Long Term Care (MLTC) Quality Measures Set Link

VBP and MACRA: The Centers for Medicare and Medicaid Services (CMS) has introduced an updated Quality Payment Program (QPP), which was included in the Medicare Access and CHIP Reauthorization Act (MACRA). The final rule posted in November of 2017 affects payments and reporting requirements for approximately 600,000 providers across the U.S. This section will serve as an introduction to the QPP requirements and highlights the alignment between the QPP and the NYS Value Based Payment Program. PDF     Video