HSC's Value-based Payment Newsletter

Updates on value-based payment and health care reform

for the nonprofit human services sector

News and Publications

• New Quality Measure Sets: NYS DOH has released the 2018 VBP Quality Measure Sets for the Total Care for the General Population (TCGP), Integrated Primary Care (IPC), Health and Recovery Plan (HARP) Subpopulation, HIV/AIDs Subpopulation, Maternity Care, and Managed Long Term Care (MLTC) Arrangements.
• Transition Plan: NYS DOH has released its Final Draft Transition Plan for the Children's Medicaid System Transformation.  View
• Guidance: NYS DOH has issued a letter clarifying the guidance guidance released on June 2, 2017 regarding payment of Ambulatory Payment Groups (APGs) and government rates for all behavioral health outpatient programs.  View
• Report: The Citizens Budget Commission (CBC) recently released a report titled The Challenges of Enhancing Effective Engagement of Community Based Organizations in Performing Provider Systems: A Discussion Paper.  Download paper
• Video: On November 13, CBC held the first in a series of symposiums on the challenges of enhancing effective engagement of community based organizations in performing provider systems.  View video

• Presentation: Jason Helgerson's November presentation in response to the CBC report, "Community Based Organizations and DSRIP November 2017," is available here.
• Presentation: "Navigating Partnership Options in New York State: Strategies & Best Practices" from the November 13th MCTAC/OPEN MINDS Partnership Event is available here.

• Videos: The Institute for Community Living (ICL), a behavioral health services organization, is developing a four-part video series about its experience. We sent the first two videos in our first newsletter, and the third was recently posted.

o    Part 1: Finding Our New True North - David Woodlock, President & CEO, shares his perspective on the alignment between health care reform and the behavioral health community. 

o    Part 2: From Volume to Value: Shifting the Paradigm - Chris Copeland, COO, describes the fundamental shift in perspective needed to lead an organization into value-based care.

o    Part 3: Back to Basics: Improving Access - This video describes the key ingredients needed to increase access and improve the experience of care

• New Partnership: As mentioned in my first newsletter, MCTAC+ is a group of partners that diffuse information and assist providers throughout NYS with the transition to Managed Care.

Events

• December 4th from 12:30 p.m. to 2:00 p.m.: webinar on the Final Draft Transition Plan for the Children's Medicaid System Transformation - NYS DOH - register
• December 15th from 9:30 a.m. to 12:30 p.m.: Principles of Revenue Cycle Management and Utilization Management for Children's Providers - MCTAC/CTAC - register

Did you know?

Perhaps you've heard the term "medical loss ratio" (or "MLR") but don't know exactly what it means.  According to the HealthCare.gov glossary, MLR is

A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions. The Affordable Care Act sets minimum medical loss ratios for different markets, as do some state laws.

But what does this mean for CBOs (besides that insurers seem to have a much higher overhead ratio than most CBOs do)?  As the Administration for Community Living (ACL) explains, "CBOs that provide Quality Improvement Activities (QIA) services have an opportunity to provide services to health plans that are now required to meet the MLR standard."  The Aging and Disability Business Institute clarifies that QIA services are "services that an insurer or their partners provide that lead to measurable improvements in patient outcomes or patient safety, prevent hospital readmissions, promote wellness, or enhance health information technology in a way that improves quality, transparency, or outcomes."  To learn more, read the ACL's medical loss ratio tip sheet and the CMS MLR page.

Helpful Links        

NYS DOH Medicaid Redesign Team homepage 

NYS DOH VBP University 

NYS DOH YouTube Channel 

NYS Medicaid Redesign Listserv Registration 

VBP Acronyms and Key Terms List