DSRIP - Value Based Payment (VBP) Resource Library

To ensure the long term sustainability of the DSRIP investments in the waiver, the Terms and Conditions (§ 39) state that NYS must submit a multi–year roadmap for comprehensive payment reform. The Roadmap was submitted to CMS and received approval on July 22, 2015. This Roadmap was developed with broad stakeholder input, the VBP Workgroup, and a public comment period. The final Roadmap and approval letter and a consolidated list of public comments are below:

2016

2015

The Fact Sheets below provide an overview of each of the New York State Medicaid Value Based Payment Arrangements, including a high–level description of:

  • Types of care included in the arrangement,
  • Method used to define the attributed population for the arrangement,
  • Calculation of associated costs under the arrangement, and
  • Quality measures recommended for use in the arrangement.

Measurement Year 2018 Fact Sheets

Measurement Year 2017 Fact Sheets

Update 8/1/17: The Maternity Care Value Based Payment Fact Sheet has been updated to adhere to a new format.

The VBP Workgroup is a broad stakeholder group that meets regularly to support the development of the VBP Roadmap.

The VBP Bootcamp regional learning series was provided by the Department of Health to plan and provider communities throughout the State between June and October of 2016, in order to fill payment reform knowledge gaps and ensure successful transition to VBP implementation. The series was completed over the course of three all-day sessions in each of five Bootcamp regions throughout the State.

These Bootcamp sessions aimed to give an in-depth look at Value Based Contracting in New York State Medicaid. They provided an overview of VBP arrangements, focusing on what it means to be a VBP contractor and how to make a VBP contract successful. The sessions also highlighted the data and analytical capabilities that the State will make available, how Medicaid providers can move responsibly into accepting downside risk, what health plans are expected to do, and what the financial incentives in the VBP world will look like for both payers and providers.

The sessions covered the following topics, respectively:

  • Session 1: Intro to VBP
  • Session 2: Contracting and Risk Management
  • Session 3: Performance Measurement

Session Materials

  • Session Recordings
    All three sessions from Region 1 were recorded and can be played back at any time. While recorded in Region 1, the content is applicable statewide.
  • Session Presentations
    The accompanying PowerPoint presentation materials for each session are provided below:
  • Session Content Description
    Session 1 Presentation 6.2.16 (PDF, 1.2MB) Region 1: Capital Region, Mid-Hudson, Southern Tier

    Session 1 Presentation 9.31.16 (PDF, 1.3MB) Region 4: Central, Finger Lakes, Western (minor updates)

    Introduction to VBP
    VBP Arrangement Types
    VBP Incentives
    VBP Standards
    Session 2 Presentation 6.15.16 (PDF, 1.7MB) Region 1: Capital Region, Mid-Hudson, Southern Tier

    Session 2 Presentation 08.17.16 (PDF, 1.7MB) Region 3: New York City (Bronx, Brooklyn, Manhattan, Staten Island) (minor updates)

    VBP Contracting
    Contract Review Process
    Target Budget Setting Methodology
    Financial Risk Management
    Session 3 Presentation 7.7.16 (PDF, 1.3MB) Region 1: Capital Region, Mid-Hudson, Southern Tier

    Session 3 Presentation 9.12.16 (PDF, 1.3MB) Region 3: New York City (Bronx, Brooklyn, Manhattan, Staten Island) (minor updates)

    Quality Measures
    Performance Data Overview
    VBP Dashboards Walkthrough

What are Clinical Advisory Groups (CAG)?

In addition to the subcommittees, Clinical Advisory Groups (CAG) were created to review the care bundle design and subpopulation definitions most relevant to NYS Medicaid. The CAG made recommendations to the State on quality measures, data and support required for providers to be successful, and addressed other implementation details related to specific VBP arrangements, including bundles and subpopulations. For CAG participation, VBP Workgroup members nominated individuals with specific skillsets including: clinical experience and knowledge focused on the care or condition being discussed; industry knowledge and experience; geographic diversity knowledge; and total care spectrum experience as it relates to the specific care or condition. The following CAGs convened in 2016-2017 to discuss key aspects of each respective VBP arrangement:

  • Maternity
  • Chronic Heart / Diabetes
  • Behavioral Health
  • HIV / AIDS
  • Managed Long Term Care (MLTC)
  • Intellectually/Developmentally Disabled (I/DD)
  • Children´s Health (This Series is being conducted as a combination of a Clinical Advisory Group and Subcommittee.)

Please note that the Pulmonary, Chronic Heart Disease, and Diabetes CAGs that convened in 2015–2016 have been combined to form the "Chronic Pulmonary, Heart, Diabetes and Primary Care" CAG.

CAG Members

Clinical Advisory Group Meeting Materials

Final CAG Reports

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.

Measurement Year 2018

2018 VBP Quality Measure Sets

The following Quality Measure Sets provide the listing of measures for the 2018 VBP contracting year including all Category 1 and Category 2 measures.

Public Comment for 2018 VBP/QARR Measure Specifications [Comment Period Closed]

The New York State Department of Health is pleased to announce the draft technical specifications for newly proposed quality measures for both the 2018 Value Based Payment (VBP) Quality Measure Set and the 2018 Quality Assurance Reporting Requirements (QARR). The public comment period will occur for the next 30 days. We welcome your feedback on the proposed new measures. We are seeking specific comments to targeted questions per measure, as well as comments on whether you support, support with modifications, or do not support the use of this quality measure. Comments related to the measure intent and measure feasibility are also encouraged. The draft technical specifications, the New York State Value Sets, and the Public Comment Submission Form are posted below. Comments and questions specifically relating to the measures should be submitted in writing via the Public Comment Submission Form to vbp@health.ny.gov by September 11, 2017.

Measurement Year 2017

Managed Long Term Care Value Based Payment Quality Measure Data Reporting Timeline

The Managed Long Term Care (MLTC) Value Based Payment (VBP) Quality Measure Data Reporting Timeline is a supplement to the 2018 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual. The purpose of this document is to provide Partially Capitated MLTC Plans with a visual tool that outlines the timing of the data elements and information flow for VBP quality measurement.

Managed Long Term Care – Use of the Potentially Avoidable Hospitalization (PAH) Measure for VBP Schematic

For MLTC plans and VBP Contractors, PAH measures help to assess whether a reduction in potentially avoidable hospital admissions among attributed members in VBP arrangements has occurred. The information depicted in below schematic explains how the PAH measures will be used in VBP.

Reporting Guidance

2018 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual. The purpose of this document is to make stakeholders aware of the quality measure reporting requirements for Medicaid Managed Care Organizations (MCOs) participating in the New York State Medicaid VBP program. The contents of this document include an overview of the specific reporting requirements for Category 1 measures for each VBP arrangement, a description of the changes to the measure sets from Measurement Year 2017 to 2018, and detailed instructions regarding additional file specifications required for the VBP program. All questions can be sent to the New York State Department of Health at vbp@health.ny.gov.

2018 Quality Assurance Reporting Requirements (QARR) Technical Specifications Manual. The 2018 QARR Technical Specifications Manual can be found at the link below. This document contains the reporting requirements, listing of quality measures, and New York State–specific measure specifications as part of New York State´s QARR program. Comments and questions relating to the manual should be submitted to nysqarr@health.ny.gov.

VBP Quality Measure 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.

The following Quality Measure Sets provide the listing of measures for the 2017 VBP contracting year include all Category 1 and Category 2 measures.

Update 3/16/17: The links below include updates to the HARP and HIV/AIDS Quality Measure Sets due to the inclusion of measures from the Total Care for the General Population (TCGP)/Integrated Primary Care (IPC) Measure Set appropriate for these subpopulations. The Maternity Quality Measure Set also includes changes to the Category 2 measure list. Details for these changes are outlined in the Maternity Quality Measure Set document.

Update 5/9/17: The links below include updates to the TCGP/IPC, HARP and HIV/AIDS Quality Measure Sets. The change relates to the measure Statin therapy for those with diabetes. The changes are redlined within the documents.

Update 6/15/17: The links below include updates to the TCGP/IPC, HARP and HIV/AIDS Quality Measure Sets. This update reflects a modification to five measures addressing the initiation and utilization of medication-assisted treatment for alcohol and opioid dependence as well as the Continuity of Care Measure. The updated measure titles are redlined in the documents below.

Update 7/14/17: The links below include updates to the TCGP/IPC, HARP and HIV/AIDS Quality Measure Sets. All updates are redlined within the documents.

We are excited to announce the launch of the State´s first Value Based Payment (VBP) Pilots. The Pilot Program is a first of its kind, two-year program, intended to create momentum in the transition from a fee-for-service to a value based payment environment. VBP Pilots are expected to help the State meet MRT waiver goals by not only establishing early successes, but also through providing invaluable input into the design of VBP in New York State.

Seven (7) provider organizations and eight (8) Managed Care Organizations (MCOs) located throughout the State will be working together as part of the Pilot Program on 13 distinct contracts. These contracts will pilot three (3) types of value based payment arrangements: Health and Recovery Plan (HARP) Subpopulation, Integrated Primary Care (IPC), and Total Care for the General Population (TCGP).

These arrangements are contracted as per the standards outlined in the VBP Roadmap and pilot organizations are required to take on downside risk-sharing VBP responsibilities by the second year of the Program. Pilot organizations will play critical roles in evaluating the validity, feasibility, and reliability of quality measures for their respective arrangements, while also sharing feedback on core aspects of the VBP process (from contracting and financial risk sharing, to use of the Medicaid Analytics Performance Portal (MAPP) analytics).

For their pivotal role as early adopters, VBP pilot organizations will receive support from the Department of Health, and in turn, they will be active participants in providing lessons learned and sharing best practices for statewide VBP implementation.

An additional pilot will be launched in Albany County that will bring together pediatric providers and early childhood stakeholders with MCOs to focus on school readiness.

Participating VBP Pilot Organizations

Arrangement Provider MCO
HARP Maimonides Medical Center Healthfirst PHSP, Inc.
Mount Sinai Health Partners Healthfirst PHSP, Inc.
IPC Community Health IPA Affinity Health Plan, Inc.
TCGP Greater Buffalo United ACO Yourcare Health Plan, Inc.
Somos Your Health IPA Affinity Health Plan, Inc.
Somos Your Health IPA HealthPlus HP, LLC
Somos Your Health IPA New York State Catholic Health Plan, Inc.
Somos Your Health IPA Healthfirst PHSP, Inc.
Somos Your Health IPA United Healthcare of New York, Inc.
Somos Your Health IPA Wellcare of New York, Inc.
St. Joseph´s Hospital Health Center New York State Catholic Health Plan, Inc.
St. Joseph´s Hospital Health Center TotalCare/Molina Healthcare of New York, Inc.
School Readiness Albany County Pediatric Providers Capital District Physicians Health Plan, Inc.
MVP Health Care, Inc.
New York State Catholic Health Plan, Inc.
United Healthcare of New York, Inc.
Wellcare of New York, Inc.

Learning Diffusion

In order to fully develop aspects of the Payment Reform and transition to VBP in NYS according to the vision laid out in the VBP Roadmap, two Workgroups were created to dive deeper into issues of Program Integrity and Patient Confidentiality. These workgroups functioned between September 2016 and December 2016.

What were Workgroups?

  • Workgroups play a crucial role in defining VBP implication details
  • Each workgroup was comprised of stakeholders who have direct interest in, and knowledge of, Program Integrity and/or Patient Confidentiality
  • Each workgroup had co–chairs charged with managing the workgroup´s progress toward the development of a final Workgroup Recommendation Report

Workgroup Meeting Materials

Final Workgroup Recommendations

Through their efforts, each workgroup developed a list of recommendations to aid in the design and implementation of VBP in NYS. These recommendations are documented in full in the Recommendations Reports:

After public review and comment, the Value Based Payment (VBP) Innovator Application Package has been finalized and posted to the VBP website. Applications for Innovator designation are now being accepted at any time on an ongoing basis. Please refer to the application and instructions in the below document titled: Final Innovator Program Overview and Application-June 2017.

The VBP Innovator Program will support experienced VBP contractors who are continuing to chart the path into value based payments. It is a voluntary program for VBP contractors prepared to participate in VBP Level 2 (full risk or near full risk) or Level 3 Total Care for General Population and/or Subpopulation arrangements. By taking on further management and administrative functions, contractors approved as Innovators will be eligible for an increased premium pass through. To become an Innovator, VBP contractors must provide all the information and documentation required in the application and explained in the instructions.

Final Innovator Program Application

Draft Innovator Program Documents – April 2017

Managed Long Term Care

The Managed Long Term Care, or MLTC, VBP Resources page houses content specifically related to the implementation of VBP in managed long term care. Information posted on the MLTC VBP Resources page will include guidance on VBP implementation for MLTC plans and providers, use of quality measures specific to MLTC, and contracting materials developed for public input such as measure specifications, Clinical Advisory Group publications, and surveys will also be posted on the MLTC VBP Resources page.

MLTC Clinical Advisory Group (CAG) Report for 2017

DOH is pleased to announce the release of the final Managed Long Term Care Clinical Advisory Group Report for 2017.

MLTC VBP Guidance Documents for Fully Capitated Plans

The overall goal of the movement toward value based payment (VBP) in New York State´s Medicaid program is to improve individual and population health outcomes by providing more integrated care, care coordination, and incentives for high quality care in a financially sustainable delivery system. The guidance documents below aim to support the understanding of VBP implementation for Medicaid Advantage Plus (MAP) Plans, Fully Integrated Duals Advantage (FIDA) Plans, and Program of All–Inclusive Care for the Elderly (PACE).

Comments and questions relating to the guidance documents should be submitted to MLTCVBP@health.ny.gov.

VBP Template Provider Amendments

MLTC VBP Stakeholder Meetings

*Feedback and comments relating to the proposed options for MLTC VBP Level 2 for partially capitated plans should be submitted to MLTCVBP@health.ny.gov no later than COB Friday, March 2, 2018 for consideration in strategy development.

The New York State (NYS) Department of Health (DOH) established the VBP Quality Measure Support Task Force, formerly known as the VBP Quality Measure Feasibility Task Force, to assist with assessment of quality measure data capture, calculation mechanisms, and reporting feasibility for the NYS VBP program. Task Force members represent Managed Care Organizations (MCOs), VBP Pilot Participants and Contractors, NYS DOH agencies, and other stakeholders with expertise in quality measurement and health information technology (HIT).

The Task Force is charged with soliciting and distilling feedback from VBP Contractors, MCOs, and VBP Pilots as it relates to quality measure feasibility, reporting, calculation and utility. Efforts also focus on developing strategies to assist with testing of new measures that require clinical data for calculation, aiding the NYS Department of Health in implementing best practices and further aligning quality measurement efforts statewide.

The Social Determinants of Health (SDH) and Community Based Organization (CBO) content below provides information for the implementation of the VBP requirement for level 2 and 3 arrangements to have a minimum of one SDH intervention and contract with a Tier 1 CBO.

SDH and CBO Webinars

VBP Subcommittee Documents

SDH and CBO Contracting Documents for Managed Care Organizations and Providers

Community Based Organizations