Updates on value-based payment and health care reform
for the nonprofit human services sector
News and Publications
State News: The Office of Health Insurance Programs (OHIP) has established a Bureau of Social Determinants of Health within the Division of Program Development and Management (DPDM). "The Bureau will focus on special SDH initiatives including but not limited to supportive housing, nutrition, and education . . . [and] will work closely with Performing Provider Systems (PPS), VBP contractors, Health Plans, and Providers. It will also continue to enhance the role of Community Based Organizations (CBOs) within the health care sector." The Bureau will be led by Denard Cummings and report to Elizabeth Misa, Deputy Medicaid Director. Source: MRT Email
Federal News: CMS Administrator Seema Verma Highlights Medicaid Policy Goals and New Guidance - View article
Learning Opportunity: Managed Care Technical Assistance Center (MCTAC) is launching Performance Driven Organization Academy, a year-long educational series to prepare agencies for value-based payment. Complete this survey to register.
Public Comments: On November 16, DOH hosted a public comment session in NYC on the State's Section 1115 waiver. The following materials from that session are now available online:
Request for Comments: OPWDD has released a Draft Transition Plan for Home and Community-based Services (HCBS), Health Home Care Management for Individuals with Intellectual and/or Developmental Disabilities (I/DD), and the Development of Specialized Managed Care and is accepting public comments through January 3. View draft
Presentation: The slides from the December 4 presentation of the Final Draft Transition Plan for Children's Medicaid System Transformation are available here.
New Guidance: DOH has released new Long Term Care Workforce Investment Organization (LTC WIO) & Plan guidance and a list of designated LTC WIOs.
Videos: The Institute for Community Living (ICL), a behavioral health services organization, is developing a four-part video series about its experience. We shared the first three videos in our in previous newsletters, and the fourth video was released last week.
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.
Additional Resources: CTAC has also released a bibliography of additional resources to accompany the ICL video series. View bibliography
Events
December 12 - 11:00 a.m. to 1:30 p.m. - Second meeting of the Regulatory Modernization Initiative for Long Term Care Need Methodologies and Innovative Models Workgroup will be - Meeting Room 6, Empire State Plaza in Albany. RSVP at [email protected] with "LTC" in the subject line or view the webcast here.
December 13 - 1:15 p.m. to 2:15 p.m.: The First 1,000 Days on Medicaid: A Conversation with NYS Medicaid Director Jason Helgerson - A Facebook Live event discussing DOH's initiative to generate recommendations to improve health for young children covered by Medicaid - Schuyler Center Facebook page
December 15 - 9:30 am -12:30 pm: MCTAC training on principles of revenue cycle management and utilization management training for children's providers - NYU Kimmel Center - Eisner & Lubin Auditorium (4th floor), 60 Washington Square South, New York, NY 10012 - Register here
January 9 - HOLD THE DATE: Second VBP Bootcamp in NYC (New York Academy of Medicine - 1216 5th Ave, New York, NY 10029). View course overview | View schedule
Did you know?
Did you know that there are multiple levels of value-based payment (VBP)? Participants don't simply jump into a full-fledged VBP arrangements. Rather, they transition through several "levels" that are intended to shift risk incrementally. The table below describes these levels. To learn about the timing of the transition under the Delivery System Reform Incentive Payment program (DSRIP), view this slide.
Acronym
Description
VBP Level 0
This initial level of VBP consists of fee-for-service (FFS) with bonus payments and/or bonus withholding based on quality scores. There is no risk sharing in this arrangement.
VBP Level 1
This level consists of FFS with upside-only shared savings when outcome scores are sufficient.
VBP Level 2
This level consists of FFS with risk sharing (upside available when outcome scores are sufficient; downside is reduced when outcomes scores are high)
VBP Level 3
This type of arrangement is feasible only after experience. As such, it requires a mature performing provider system (PPS). This level consists of global capitation (with an outcome-based component).
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