Value Based Payment Quality Improvement Program (VBP QIP)
Update Webinar
- Webinar also available in Portable Document Format (PDF)
July 19, 2017
Today´s Agenda
- VBP QIP Program Updates
- VBP QIP P4P Updates
- VBP QIP P4P QIT Performance Report Update
- VBP QIP Measure Credits
- VBP QIP P4R Updates
- DY3 Timeline and Q&A
VBP QIP Program Updates
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 |
| 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 | ||
| 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 | $430,645,920 | ||
* VBP QIP funding amounts do not include premium admin, surplus, or taxes
VBP QIP Financing – Changes in DY3 Award Amounts
- Managed Care Organizations (MCOs) will continue to receive DY2 per member per month (PMPM) amounts until the April 2017 rate package is approved.
- If the DY3 award amount is greater than the DY2 award amount, MCOs should continue paying out earned amounts in DY3 based on the DY2 amount.
- MCOs will be able to pay out the difference when the April 2017 rate package is approved.
- If the DY3 award amount is less than the DY2 award amount, MCOs should be paying earned amounts based on the DY3 award amount.
- DOH reached out to partners with lower award amounts in DY3 to discuss adjustments.
- DOH will perform a reconciliation to adjust overpaid funds from MCOs receiving DY2 PMPMs that are larger than the DY3 PMPMs.
- If the DY3 award amount is greater than the DY2 award amount, MCOs should continue paying out earned amounts in DY3 based on the DY2 amount.
- For questions on VBP QIP financing, please contact bmcr@health.ny.gov.
VBP QIP P4P Updates
VBP QIP P4P – Quarterly Improvement Targets
- Although P4P payment does not begin until DY3 Q3, there are P4P activities that should be taking place during the current period.
1 – Facilities will report their initial baseline for DY2 Q4. Therefore, there is no measurement associated with this quarter.
- The table below outlines upcoming activities related to DY2 Q4, DY3 Q1, and DY3 Q2 P4P reporting.
| Measurement Quarter | DY2 Q4 | DY3 Q1 | DY3 Q2 |
|---|---|---|---|
| Measurement Period | April 1, 2016 to March 31, 2017 |
July 1, 2016 to June 30, 2017 |
October 1, 2016 to September 30, 2017 |
| Facility reports measurement information to paired MCO | July 31, 2017* | October 31, 2017 | January 31, 2018 |
| Paired MCO reviews achievement of QIT and prepares payment | September 29, 2017 | December 31, 2017 | March 31, 2018 |
| Paired MCO makes monthly payments to the Facility for achievement of QIT | October, November, and December 2017 | January, February, and March 2018 | April, May, and June 2018 |
| Paired MCO sends P4P Performance Report to DOH | January 31, 2018 | April 30, 2018 | July 31, 2018 |
*Facilities that selected the 3 hour sepsis bundle measure may need additional time to report. Therefore, MCOs should grant facilities an additional 15 days to report on this measure only for DY2 Q4. Therefore, the Facility should report all other measures by July 31, 2017 and the 3 hour sepsis bundle by August 15, 2017.
Annual Improvement Target for DY4
- The Annual Improvement Target (AIT) will be achieved if the Facility meets two metrics:
- The first metric relates to a Facility´s performance on its measures improving over its baseline.
- The second metric relates to a Facility´s performance on its measures are better than the mean NYS results for the specific measure.
- DOH provided the NYS means for measures on the menu for DY4 on June 21st, 2017.
- Facilities and VBP QIP paired MCOs should submit DY4 AIT baselines for on menu measures to DOH for record–keeping by July 31st, 2017.
- AIT baselines for DY4 should be submitted at vbp_qip@health.ny.gov with "AIT DY4 Measure Baselines" in the email title.
VBP QIP P4P – Annual Improvement Targets
- The table below outlines upcoming activities related for DY4 AIT reporting.
| Measurement Year | DY4 |
|---|---|
| Measurement Period | July 1, 2017 to June 30, 2018 |
| Paired MCO reports DY4 AIT baselines for all measures to DOH | July 31, 2017* |
*This submission relates to submitting the baselines for DY4 AIT measures covering the timeframe of January 1, 2016 to December 31, 2016.|top of section| |top of page|
P4P QIT Performance Report Update
Facility to MCO VBP QIP P4P QIT Performance Report
- The first Facility to MCO P4P QIT Performance Report should be submitted to paired MCOs on July 31st, 2017 for the DY2 Q4 period (baseline).
Facility to MCO VBP QIP P4P QIT Performance Report
- The first Facility to MCO P4P QIT Performance Report should be submitted to paired MCOs on July 31st, 2017 for the DY2 Q4 period (baseline).
- Select the performance period being reported on from the drop down menu under the cells labeled "Select Current Period".
- Select the four quarters used to calculate the annual rolling average from the drop down menus under the cells labeled "Select Current Quarter Result".
- Enter the number of events in the numerator column under the appropriate quarter.
- Enter the total potential occurrences (i.e. discharges, device days, etc.) in the denominator column under the appropriate quarter.
- When entering results for the Median Time to ECG, Median Time to Transfer, or 3–hour Sepsis Bundle measures leave the first 3 quarters blank.
- Enter the results for the annual calculation in the numerator column in the last quarter
- Enter NA in the Denominator column in the last quarter.
- The workbook will automatically incorporate any adjustments needed for the calculations.
VBP QIP Measure Credits
P4R Measure Credits
- Facilities that meet certain VBP milestones earlier will be granted a measure credit.
- Measure credits can be used by a facility to help meet their performance targets for VBP QIP P4P quality measures.
- The facility earns a quarterly measure credit in the current quarter the requirement is met and the three subsequent quarters.
- A measure credit will be applied to both the calculation of VBP QIP quarterly and annual measurement achievement by adding an additional measure to the numerator of the calculation.
- Measure credits should be determined based on contract submission date. However, if the contract is not approved as a Level 2 contract by DOH, there may be adjustments to earned award amounts in future periods.
| VBP Contract | By DY3 | By DY4 | By DY5 |
|---|---|---|---|
| Level 2 or Higher qualified VBP Contract | Measure Credit | Measure Credit | Measure Credit |
P4R Measure Credits – QIT
- In the example below, the facility submits a Level 2 VBP contract on August 15, 2017. Therefore, it would receive a measure credit in the current quarter, DY3 Q2, and the three subsequent quarters, DY3 Q3 to DY4 Q1.
- If the Level 2 VBP contract extends through later years, the Facility is required to re–certify that a contract is in place to earn a measure credit the next year.
P4R Measure Credits – AIT
- In the example below, if a facility submits a Level 2 VBP contract during DY3, it can earn a measure credit applied to the DY4 AIT measures. If the facility submits a Level 2 VBP contract in DY4 or DY5, it can earn an additional measure credit applied to the DY5 AIT measures.
- If the Level 2 VBP contract is executed in DY3 and extends through later years, the Facility is required to re–certify that a contract is in place to earn a measure credit for its DY5 AIT.
VBP QIP P4R Updates
VBP QIP P4R DY3 Q2 Deliverables
- Facilities were required to meet the following pay for reporting (P4R) requirements by June 30, 2017* to earn their DY3 Q2 payment**:
| Submit to both DOH & MCO: | Submit to both DOH & MCO: | Submit to DOH: | ||
|---|---|---|---|---|
| One Level 1 VBP contract and provide Contract Attestation | LOIs with the remaining Medicaid MCOs | Updated MCO Contract List | ||
| Facility should have provided its VBP QIP paired MCO and DOH with a Contract Attestation confirming that the parties submitted at least a Level 1 VBP contract*** in accordance with the NYS VBP Roadmap. | + | Facility should have provided copies of Letters of Intent (LOIs) with remaining Medicaid MCOs needed to meet the 80% VBP contracting target**** to their VBP QIP paired MCO and DOH. | + | Facility should have submitted an updated MCO Contract List with calendar year 2016 Medicaid Managed Care revenue and VBP arrangement information outlining a plan to meet the 80% VBP contracting target. The MCO Contract List submitted by June 30 should have been accompanied by an attestation confirming the accuracy of the data by a senior financial manager at the Facility. |
*Due date was June 30, 2017 as July 1, 2017 fell on a Saturday.
**Partial payment may be awarded. Each deliverable should be worth 1/3 of the DY3 Q2 payment.
***The contract submitted to meet the June 30, 2017 is not required to be the same contract from the LOI submitted on April 1, 2017.
****As outlined in the updated July 2017 MCO Contract List the facility submitted on June 30, 2017.
DY3 Q2 Deliverables – Next Steps
- DOH will send out notifications to VBP QIP paired MCOs that MCO Contract Lists and LOIs submitted on June 30th, 2017 were complete and meet the 80% threshold.
- DHPCO is reviewing contract attestations submitted by contracting MCOs and is scheduled to provide feedback by August 11th, 2017.
VBP Contract Review for Contract Attestations
- Facilities were required to have one (1) Level 1 VBP contract to meet the June 30, 2017 P4R requirement. The facilities should submit information in accordance with the timeline below.
| August 11, 2017★ | September 8, 2017 | September 29, 2017 | ||
|---|---|---|---|---|
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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.
|top of section| |top of page|DY3 Timeline and Q&A
VBP QIP Timeline
| Upcoming Milestone | Date |
|---|---|
| Submit DY4 AIT baseline information for on menu measures to DOH | July 31, 2017 |
| Facility to submit DY2 Q4 baseline data* to paired MCO | July 31, 2017 |
| DOH contracts group scheduled to provide feedback to the contracting MCO on Level 1 contract | August 11, 2017 |
| Contracting MCO submits updated contract and required documentation to DOH contracts group | September 8, 2017 |
| DOH contracts group makes determination if the contract meets requirements | September 29, 2017 |
| Paired MCO reviews achievement of QIT for DY2 Q4 and prepares payment | September 29, 2017 |
*MCO should allow 15 additional reporting days for the 3 Hour Sepsis measure.
Deliverable Submission
| Report | Submitted by | Submitted to | Frequency | Location |
|---|---|---|---|---|
| VBP QIP Contracts | MCOs | DOH | As updated | vbp_qip@health.ny.gov |
| Remaining contracts and contract attestations due by April 1, 2018 | Facilities | MCOs & DOH | April 1, 2018 | vbp_qip@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 |
| Paired MCOs submit DY4 AIT baseline information for measures to DOH | MCOs | DOH | July 31, 2017 | vbp_qip@health.ny.gov |
| VBP Contracts, Contract Statement and Certification form | Contracting MCOs | DOH | As completed or updated | contract@health.ny.gov |
Important Information
VBP Support Materials
VBP Resource Library:
- Path: DSRIP Homepage → Value Based Payment Reform → VBP Resource Library
- Link: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library
VBP Website:
- Path: DSRIP Homepage → Value Based Payment Reform
- Link: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform
Thank you for your continued support with VBP QIP!
- The next VBP QIP Update Webinar is scheduled for Thursday, August 17th from 2:00 pm – 3:00 pm.
- 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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