Value Based Payment Quality Improvement Program (VBP QIP)

Update Webinar

  • Webinar also available in Portable Document Format (PDF)

October 25, 2017

Today´s Agenda

VBP QIP Financing

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
Advocate Community Partners Jamaica Hospital $16,000,000
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
Advocate Community Partners Jamaica Hospital $9,000,000
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 $455,645,920

* VBP QIP funding amounts do not include premium admin, surplus, or taxes

VBP QIP Financing

  • The DY3 rates were loaded on September 6 therefore MCOs should be paying at the DY3 rate.
  • The January 2017 rates are loaded on eMedNY.
  • A reconciliation will be performed at a later date and eliminate all DY3 variances.
  • For questions on VBP QIP financing, please contact bmcr@health.ny.gov
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VBP QIP Survey

Survey Overview

  • Survey was distributed to all VBP QIP facilities on Friday, September 29th
  • The survey was used to assess the progress of VBP QIP Facilities in developing VBP contracts with MCOs required to meet 80% VBP by April 1, 2018
  • DOH will survey again in November and January to monitor VBP QIP Facility efforts and progress

Survey Results Summary

Survey Results Summary

Primary Takeaways

  • Insufficient attribution presents a major roadblock for facilities trying to enter into VBP arrangements
  • Facilities request additional guidance/flexibility from DOH on the VBP arrangements offered
  • Facilities need more support and availability from their MCO partner

Survey Feedback

Respondents Requests of DOH   DOH Response to Requests
  • Can the April 1 date to submit contracts be extended?
  • Can DOH facilitate conversations between the facility and the MCO?
  • Can DOH develop VBP models for small providers?
  • Can DOH persuade MCOs to engage VBP contracts other than TCGP?
  • Can DOH provide more guidance on contract review requirements?
  • Can DOH influence the MCO actuarial model and/or number of VBP arrangements offered?
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  • All QIP participants are expected to have contracts submitted by March 30, 2018
  • DOH cannot facilitate or engage in contract discussions between providers and MCOs
  • DOH recommends small providers work together to form larger entities for contracting
  • DOH cannot intervene in the MCO business practice
  • DOH developed the On–Menu Checklist to provide information on contract requirements
  • DOH cannot intervene in the MCO business practice
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VBP QIP Contracting

Contracting Status

Deliverable Submission/Review Contract Preparation Contract Finalization/Execution
July – Sep Oct – Dec Jan– Mar
  • Facilities submitted all LOIs
  • Facilities submitted one Level 1 VBP contract to DOH
  • Facilities will receive determination on whether contract meets requirements on Sep 29
  • Facilities to begin engaging with MCOs with whom they have an LOI
  • Facilities and MCOs expected to have agreed on risk/shared savings, quality metrics
  • Facilities and paired MCOs should finalize details of contract including data collection methods and physician network
  • Contracts should be nearing readiness for execution

VBP Contract Review for Contract Attestations

Facilities are required to have Level 1 (or higher) VBP contracts with the MCOs required to meet the 80% VBP target by March 30, 2018. The facilities should submit information in accordance with the timeline below.

October 2, 2017 –March 30, 2018
  • Contracting MCO must submit new or amended VBP Contract and the following documentation to DOH contracts group for review contract@health.ny.gov:
    • Contract Statement and Certification Form
    • MCO assigned unique identifier (if amended)
    • Standard Clauses, as needed
    • Off Menu Supplemental Checklist, as required
    • Contract Attestation (sent by facility to DOH and paired MCO)
 ⇒ May 4, 2018
  • DOH contracts group will provide feedback to the contracting MCO and the VBP QIP Facility that either:
    1. Contract is in alignment with the NYS Roadmap and no further updates are needed.
    2. Updates are needed and provide feedback on elements that should be updated to meet roadmap requirements.
 ⇒ May 18, 2018
  • Contracting MCO submits updated contract along with the updated contract statement and certification form to DOH contracts group.
 ⇒ June 29, 2018
  • DOH contracts group makes determination if the contract meets requirements.
  • Contracting MCO and VBP QIP Facility are notified of DOH determination.
  • VBP QIP paired MCO is also notified of DOH determination.

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.

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Contracting Checklist

On Menu VBP Arrangement Checklist

The following questions must be addressed to meet the VBP contracting requirements outlined in the VBP Roadmap.
VBP Contracting Element Relevant Question
Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition?
Definition and Scope of Services Does the contract either state that it matches the VBP Roadmap definition or list all of the services included in the arrangement?
Quality Measures/Reporting Does the contract commit to reporting on all reportable Category 1 quality measures approved by the State? OR Does the contract list all of the reportable Category 1 quality measures that the MCO will report?

On Menu VBP Arrangement Checklist (cont.)

The following questions must be addressed to meet the VBP contracting requirements outlined in the VBP Roadmap.
VBP Contracting Element Relevant Question
Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition?
Definition and Scope of Services Does the contract either state that it matches the VBP Roadmap definition or list all of the services included in the arrangement?
Quality Measures/Reporting Does the contract commit to reporting on all reportable Category 1 quality measures approved by the State? OR Does the contract list all of the reportable Category 1 quality measures that the MCO will report?
Risk Level Does the contract describe the level of risk chosen by the contracting parties?
Shared Savings/Losses Does the risk level correspond with the shared savings/losses minimums? AND Does the contract list at least one (1) Category 1 P4P quality measure to be used for calculating shared savings and losses?
Attribution Does the contract describe the attributed population?

On Menu VBP Arrangement Checklist (cont.)

The following questions must be addressed to meet the VBP contracting requirements outlined in the VBP Roadmap.
VBP Contracting Element Relevant Question
Type of Arrangement (as per the Roadmap) Does the contract match the Roadmap arrangement definition?
Definition and Scope of Services Does the contract either state that it matches the VBP Roadmap definition or list all of the services included in the arrangement?
Quality Measures/Reporting Does the contract commit to reporting on all reportable Category 1 quality measures approved by the State? OR Does the contract list all of the reportable Category 1 quality measures that the MCO will report?
Risk Level Does the contract describe the level of risk chosen by the contracting parties?
Shared Savings/Losses Does the risk level correspond with the shared savings/losses minimums? AND Does the contract list at least one (1) Category 1 P4P quality measure to be used for calculating shared savings and losses?
Attribution Does the contract describe the attributed population?
Target Budget Does the contract describe the Target Budget in this arrangement?
Social Determinants of Health If this is a Level 2 or higher contract, does it commit to implementing at least one intervention to address Social Determinant(s) of Health?
Contracting with CBOs (starting Jan 2018) If this is a Level 2 or higher contract, does it commit to contract with at least one Tier 1 Community Based Organization?

Off Menu Arrangements

MCOs and providers may agree to contract off–menu arrangements*. The following criteria need to be fulfilled to count as VBP arrangements:

  1. Reflect the underlying goals of payment reform as outlined in the Roadmap and sustain the transparency of costs versus outcomes
  2. Focus on conditions and subpopulations that address community needs but that are not otherwise addressed by VBP arrangement in the Roadmap
  3. Patient rather than provider centric
  4. Through sharing savings and/or losses, off–menu VBP arrangements include a focus on both components of ´value´: outcomes and cost of the care delivered
  5. ´Off–Menu´ VBP arrangements should utilize standard definitions and quality measures from the Roadmap where possible

*For detailed information please refer to Appendix II of the Roadmap

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VBP QIP Program Reminders

VBP QIP P4P – Quarterly Improvement Targets

  • 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

Key Deliverable Deadlines

  • Beginning DY3 Q3, Pay for Performance payments begin. Payment will be tied to reporting baselines to the MCO in DY2 Q4.
  • Quality measure performance will drive payment beginning in DY3 Q4 (with the exception of sepsis)
Measurement Quarter DY2 Q4 DY3 Q1
Measurement Period 4/1/2016 – 3/31/2017 7/1/2017 – 6/30/2017
MCO Reviews Achievement, Prepares Payment 9/30/2017 12/31/2017
MCO Releases Monthly Payments for QIT Achievement Oct – Dec (2017) Jan – Mar (2018)
MCO Sends P4P Performance Report to DOH 1/31/2018 4/30/2018

VBP QIP Timeline

Description of Event/Task Deadline/Date Completed Responsible Party
Collect and report DY3 Q1 P4P data to MCO Tuesday, October 31, 2017 Facility
Review and approve DY3 Q1 QITs and begin preparing payment Friday, December 29, 2017 MCO
DY3 Q3 measurement period ends Sunday, December 31, 2017 NA
Collect and report DY3 Q2 P4P data to MCO Wednesday, January 21, 2018 Facility
Review and approve DY3 Q2 QITs and begin preparing payment Friday, March 30, 2018 MCO
DY3 Q4 measurement period ends Saturday, March 31, 2018 NA
Collect and report DY3 Q3 P4P data to MCO Monday, April 30, 2018 Facility

Deliverable Submission

Report Submitted by Submitted to Frequency Location
VBP QIP Contracts MCOs DOH As updated contract@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
VBP Contracts, Contract Statement and Certification form Contracting MCOs DOH As completed or updated contract@health.ny.gov

Remaining VBP Bootcamps

Date Region Location Address
November 3, 2017 Central New York Rochester Radisson Riverside 120 E Main St, Rochester, NY 14604
November 15, 2017 Long Island The Long Island Marriott 101 James Doolittle Blvd, Uniondale, NY 11553

As a reminder, VBP bootcamps are being considered the ´4th semester´ of VBP University. If you attend a VBP bootcamp, and have completed all 3 semester quizzes of VBP University with a passing grade of 80% or higher, you will receive a printed copy of your ´VBP University diploma´ at the session you attend. To learn more and participate in VBP University visit, www.health.ny.gov/VBP.

Please send any questions to VBP@health.ny.gov.

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Important Information

VBP Support Materials

VBP Resource Library:
VBP Website:

Thank you for your continued support with VBP QIP!

  • The next VBP QIP Update Webinar is scheduled for November 16th 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.
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