Value Based Payment (VBP)
This webpage provides an overview of relevant information related to NYS's VBP efforts. Questions related to VBP should be directed to vbp@health.ny.gov.
VBP for Managed Long Term Care (MLTC) Plans
Managed Long Term Care (MLTC)
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.
- FAQ: VBP Post-DSRIP for MLTC Plans - November 20, 2020
- MLTC Refresher Webinar on SDH & VBPTR - March 8, 2019 - Updated 4/23/19
- VBP for MLTC Plans: Level 2 Contracting - July 2018
- VBP For MLTC Plans: Level 1 Contracting - July 2017
- Partially Capitated Plan VBP Contract Submission Guidance - December 2017
- FAQs: VBP For Partially Capitated Plans - Updated July 2018
- MLTC VBP Financing Webinar - December 2017
- MLTC VBP Webinar - December 21, 2018 (PDF)
MLTC Clinical Advisory Group (CAG) Report for 2017
DOH is pleased to announce the release of the final MLTC CAG Report for 2017.
- MLTC CAG Report - Value Based Payment Recommendations - September 2017
MLTC CAG Meetings
DOH is pleased to announce the release of the MLTC VBP CAG Meeting Presentation Slides.
VBP MLTC 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.
- MAP VBP Guidance Document - January 2018
- FIDA VBP Guidance Document - January 2018
- PACE VBP Guidance Document - January 2018
- VBP FAQs - MAP, FIDA, and PACE - Updated July 2018
VBP Template Provider Amendments
- Amendment to the Participating Provider Agreement between MLTC Plans and LHCSAs
- Amendment to the Participating Provider Agreement between MLTC Plans and SNF
VBP MLTC Stakeholder Meetings
- MLTC VBP Level 2 Strategy for Partially Capitated Plans - May 25, 2018
- MLTC VBP Level 2 Strategy for Partially Capitated Plans - February 20, 2018
*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.
VBP MLTC Learning Series
- MLTC VBP Learning Series: Part 1 - June 12, 2018 (PDF)
- MLTC VBP Learning Series: Part 1 Video Recording - June 12, 2018 (YouTube)
MLTC VBP Tracking Report (VBPTR)
- MLTC VBP Tracking Report - July 11, 2018
Social Determinants of Health and Community Based Organizations
MACRA Alignment
The Centers for Medicare and Medicaid Services (CMS) has introduced an updated Quality Payment Program (QPP), which was included in the Medicare Access and CHIP Reauthorization Act (MACRA). The final rule posted in November of 2017 effects payments and reporting requirements for approximately 600,000 providers across the U.S. This section will serve as an introduction to the QPP requirements and highlights the alignment between the QPP and the NYS Value Based Payment Program.
MACRA Webinar - March 1, 2019
- Presentation Deck (PDF)
MACRA Webinar - June 13, 2018
VBP Innovator Program
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.
- VBP Innovator Program Webinar Slides - August 2017
- VBP Innovator Program Frequently Asked Questions
Final Innovator Program Application
- Final Innovator Program Overview and Application - June 2017
- C1 - Financial Viability Template (XLSX)
- E - Quarterly Reporting Template (XLSX)
Draft Innovator Program Documents - April 2017
- VBP Innovator Program Overview and Application - April 2017
- C1 - Financial Viability Template (XLSX)
- E - Quarterly Reporting Template (XLSX)
VBP Program Integrity and Patient Confidentiality Workgroups
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:
Integrated Care for Kids CMMI Demonstration
Bronx Equity Integrated Care for Kids (BE-InCK NY) is a child-centered local service delivery and payment model that aims to reduce expenditures and improve the quality of care through prevention, early identification, and treatment of behavioral and physical health needs.
Led by Montefiore Medical Center and implemented in three zip codes in the Bronx, BE-InCK NY established a comprehensive partnership with the New York State Department of Health and an extensive group of stakeholders. The model uses a data-driven approach to reduce preventable inpatient hospitalizations, emergency department visits, and out-of-home placements.
The core features of BE-InCK NY include a comprehensive data sharing platform, Partnership Council, collaborative care navigation, and inclusion of health-related social needs screening and services. The Partnership Council includes more than 50 organizations and programs that provide primary care, specialty care, and behavioral health care, as well as services to those with intellectual disabilities and child welfare, housing, nutritional, social, and data access services to meet the two-generational needs of children, their caregivers, and pregnant people.
BE-InCK NY’s Alternate Payment Model (APM) builds on an established Shared Savings model with the ability to share incentives with providers. This pediatric-specific, New York State Medicaid-approved APM is a model for additional arrangements. Cost sharing and quality elements in the APM will serve to increase care quality for all.
More information can be found on the Centers for Medicare & Medicaid Services (CMS) Integrated Care for Kids (InCK) Model webpage.
VBP Archive
VBP Arrangement Fact Sheets (Measurement Years 2017-2020)
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 2020 Fact Sheets
Measurement Year 2019 Fact Sheets
- HARP - March 14, 2019
- HIV/AIDS - March 14, 2019
- IPC - March 14, 2019
- Maternity Care - March 14, 2019
- TCGP - March 14, 2019
Measurement Year 2018 Fact Sheets
- HARP - February 9, 2018
- HIV/AIDS - February 9, 2018
- IPC - February 9, 2018
- Maternity Care - February 9, 2018
- TCGP - February 9, 2018
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.
- HARP - August 1, 2017
- HIV/AIDS - August 1, 2017
- IPC - August 1, 2017
- Maternity Care Value Based Payment Arrangement - August 1, 2017
- TCGP - August 1, 2017
VBP Outreach and Education
- VBP-U and VBP Bootcamps
- The following videos provide an overview of what value based payments are, their important role in the NYS Medicaid program, how they will help to improve patient outcomes, and how VBP will reshape our healthcare system.
- Value Based Payment for Providers English Version (youtube.com) - August 18, 2016
- Pago basado en valor para proveedores Version en español (youtube.com) - 18 de agosto de 2016
- VBP: An Introduction English Version (youtube.com) - December 7, 2015
- VBP: una introducción Version en español (youtube.com) - 7 de diciembre de 2015
- Value Based Payments White Board Video (youtube.com) - March 27, 2015
VBP Measure Support Task Force
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.
VBP Medicare Alignment
Both the Centers for Medicare & Medicaid Services (CMS) and New York State (NYS) have embarked on an ambitious journey to improve outcomes for patients and populations, reward the delivery of high value care by providers, and increase long-term financial sustainability. The Draft Medicare Alignment Paper presents an approach to maximally align CMS payment reform efforts for Medicare to the NYS Medicaid Payment Reform Roadmap. The proposal will continue to be developed with the input of the Value Based Payment Workgroup and other stakeholders including, but not limited to, NYS health plans, managed care organizations, provider associations, legal firms specializing in health care contracting, other state agencies, community-based providers, patient advocates, Performing Provider Systems and other industry experts.
A draft version of the NYS Medicaid Medicare VBP Alignment Paper was made available for public comment from August 4, 2015 until August 31, 2015. The consolidated list of public comments and the Draft Medicare Alignment Paper are below:
- Draft Medicare Alignment Paper - 8.3.2015
- Public Comments on Draft Medicare Alignment Paper - 8.31.2015
The alignment paper has been revised to include public comments and stakeholder feedback. The Final Draft NYS Medicaid Medicare VBP Alignment Paper has been submitted to CMS for their consideration. The letter to CMS and the revised Alignment Paper are below:
- Letter to CMS - 10.6.2015
- NYS Medicaid Medicare VBP Alignment Paper-final for CMS - 9.28.2015
VBP Pilots
New York State launched its' first Value Based Payment (VBP) Pilot in the fall of 2016 as one initiative to help the State reach the goal of having 80-90% of managed care payments to providers using value based payment methodologies by April 2020. The two-year program was designed to create momentum in the transition from fee-for-service to a value based payment environment, and provide valuable input into the design of VBP in New York State.
Six (6) provider organizations and eight (8) Managed Care Organizations (MCOs) located throughout the State have been working together as part of the Pilot Program on 12 distinct contracts. These contracts 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 have taken on downside risk-sharing VBP responsibilities this year. Pilot organizations have a critical role in evaluating the validity, feasibility, and reliability of quality measures for their respective arrangements, and also share 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 receive support from the Department of Health, and in turn, they will provide early lessons learned and share best practices for statewide VBP implementation.
An additional value driven pilot launched in Albany County brings 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.
- Operated Assisted Call Memorandum - July 11, 2016
Learning Diffusion
- March 2018 VBP Pilot Webinar Slides - March 8, 2018
- October VBP Pilot Webinar Slides - October 26, 2017
- June VBP Pilot Webinar Slides - June 26, 2017
- April VBP Pilot Webinar Slides - April 27, 2017
- March VBP Pilot Webinar Slides - March 16, 2017
- VBP Pilot February Webinar - February 24, 2017
- VBP Pilot Implementation Webinar Slides - November 7, 2016
- VBP Contracting Webinar Slides - September 30, 2016
- VBP Pilot Contracting Webinar FAQs - October 18, 2016
VBP Pilots "Early Lessons Learned" Webinars
- Early Lessons Learned: Data Sharing - July 25, 2018 (PDF)
- Early Lessons Learned: Social Determinants of Health Contracting - October 30, 2018 (PDF)
- Early Lessons Learned in Value Based Payment Contracting (YouTube) - June 27, 2018
VBP Progress (scorecards)
The NY State Department of Health has released the results of an independent assessment of Medicaid payment reform, performed by Catalyst for Payment Reform, a non-profit corporation. The scorecard shows that 80 percent of total Medicaid payments were value-oriented. Funding for the project was provided as part of New York's State Innovation Model (SIM) grant from the Centers for Medicare and Medicaid Services (CMS).
- Report to Accompany the 2018 and 2019 NEW YORK SCORECARDS ON PAYMENT REFORM 2.0 (PDF)
- 2019 NY Scorecard on Medicaid Payment Reform (PDF)
- 2018 NY Scorecard on Medicaid Payment Reform (PDF)
- 2015 NY Scorecard on Medicaid Payment Reform (PDF)
- Medicaid MCOs VBP Baseline Survey Results - June 28, 2016
VBP for Providers
VBP Subcommittees
VBP Workgroup
The VBP Workgroup is a broad stakeholder group that meets regularly to support the development of the VBP Roadmap.
- A complete list of the VBP Workgroup Members
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