VBP for Providers

Value Based Payment Roadmap

CMS approved the New York State Roadmap for Medicaid Payment Reform in July of 2015. The Roadmap was conceptualized as a living document that would be updated annually to ensure that best practices and lessons learned throughout implementation would be leveraged and incorporated into the State's overall vision. The primary structure and content of the Roadmap remains consistent, however each year, New York State submits updates needed implementation updates to CMS for approval.

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.

Measurement Year 2017

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.

Value Based Payment Innovator Program

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.