Value Based Payment Quality Improvement Program (VBP QIP)
Update Webinar
- Webinar also available in Portable Document Format (PDF)
August 17, 2017
Today´s Agenda
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 Awards
- VBP QIP and VAPAP exist to provide temporary State subsidy to financially distressed hospitals, but have different program requirements.
- VBP QIP award amounts are determined annually by OPCHSM
- OPCHSM Transformation plan updates are required for the Department to evaluate performance against the plans.
- OPCHSM requests updates on facility performance against the transformation plans in addition to yearly revised projects to determine the future year budgeted need.
- Preliminary budget and OPCHSM transformation plan updates are due to the Department by August 31, 2017. All documents should be submitted to VAPAP@Health.ny.gov.
VAPAP requirements are separate and distinct from VBP QIP requirements.
VBP QIP Financing – Changes in DY3 Award Amounts
- The April 2017 rates are live as of August 8th. Managed Care Organizations (MCOs) will receive updated dollar amounts on September 6th.
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 once they begin receiving the adjusted rate amount.
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.
- For questions on VBP QIP financing, please contact bmcr@health.ny.gov
VBP QIP Financing – Rate Setting Background
- Rate Setting starts at the beginning of the fiscal year with adjustments made throughout the year
- The initial rates for the fiscal year are based on enrollment projections thus the need to reconcile later in the fiscal year
- Any shortfalls or overages are usually reconciled in the last rate package of the fiscal year unless advised otherwise
- All supplemental programs (VBP QIP, EIP, EPP, AHPP) are sub-components of the rate package, but not the rate package in its entirety
- Timing of supplemental program payments are impacted by non-supplemental related adjustments/revisions within the rate package(s)
VBP QIP P4R Updates
VBP QIP Contracting Updates
- 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.
- DOH contracts group provided feedback to the contracting MCO and the VBP QIP Facility on the status of the contracts
| September 8, 2017 | September 29, 2017 | |
|---|---|---|
|
→ |
|
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|VBP QIP P4P Updates
VBP QIP P4P – Quarterly Improvement Targets
- Facilities have now collected data for the DY2 Q4 measurement period and reported to VBP QIP paired MCOs.
- 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 |
*Due to an unanticipated extended delay of sepsis data, the 3 hour sepsis bundle measure for this quarter will be a P4R deliverable for DY 2 Q4. Facilities should report the 3 hour sepsis bundle measure to the MCO by August 31.
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 21, 2017.
- DY4 AIT baselines for on–menu measures were submitted to DOH for record–keeping by July 31st, 2017.
VBP QIP P4P – Penalties
- DY3 Q4 is the first quarter where payment is driven by the facility´s ability to maintain or improve performance on the quality measures.
- Quarterly P4P payments to facilities will be based on the number of P4P quality measures the facility either maintained or improved on compared to the preceding quarter´s annual rolling results.
- A facility will receive 100% of its quarterly P4P award if at least four of its six P4P quality measures have either maintained or improvement over the rolling annual results from the preceding quarter.
- The P4P award amounts for a quarter will be reduced by 25% for each P4P quality measure that did not maintain or improvement over the rolling annual results from preceding quarter below 4 measures.
| Measures Achieved |
4+ | 3 | 2 | 1 | 0 |
|---|---|---|---|---|---|
| Percentage of Quarterly P4P Award Earned |
100% | 75% | 50% | 25% | 0% |
DY3 Timeline and Q&A
VBP QIP Timeline
| Upcoming Milestone | Date |
|---|---|
| DOH contracts group 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 |
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 September 20th 2017.
- 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.
Follow Us