As the national leader in serving the needs of health and human service providers, MediSked understands the importance to our clients of staying on top of the most recent national trends in payment reform. One such recent regulatory change seen in a number of states is the move towards a Value-Based Purchasing model, also known as Value Based Payment reform (VBP).
Under this payment model, which actually consists of 5+ overarching models from the Centers for Medicare and Medicaid Services (CMS), state Medicaid systems will move away from fee-for-service (FFS) payments and towards a model which rewards provider performance. There are many ways in which a state can design their VBP system. One state leading the way is MediSked’s home state of New York. As part of the Delivery System Reform Incentive Payment Program (DSRIP), a 5-year CMS demonstration, New York will move 80-90% of all Medicaid payments to a value-based model by the end of 2019.
The design of New York’s VBP system differentiates between two different VBP arrangements which providers can enter into with payers: (1) population-based, and (2) episode-based. Episode-based includes paying for value for episodic health conditions, including integrated primary care and chronic care, as well as maternity care. The specific populations to be included in population-based VBP arrangements includes:
- Total Care for the General Population (TCGP)
- Individuals with HIV/AIDS
- Health and Recovery Plan (HARP)
- Individuals in Managed Long-Term Care (MLTC)
- Intellectually/Developmentally Disabled (I/DD)
In New York, providers will be responsible for entering into VBP contracts with payers. These contracts will determine the quality and outcome metrics to be measured, for which the provider can be paid for based on the performance under those metrics. In an effort to recognize the differences in provider preparedness for VBP, providers can enter into VBP contracts that range from upside-risk only (participating in shared-savings), all the way to a fully prospective payment arrangement. There are many ways in which a provider can enter into a VBP contract; by forming an Independent Provider Association (IPA) with other similar providers, by contracting with an Accountable Care Organization (ACO), or by the provider individually entering into a VBP contract themselves, among others. The overall goal is that the better a provider performs, the more they will be financially rewarded.
The only population in New York yet to enter into VBP arrangements is the I/DD population. Currently, the state I/DD Clinical Advisory Group (CAG) is still determining the Quality Measure Set for I/DD providers to use in their VBP contracts with payers. I/DD providers will need to begin planning and self-evaluating, in order to determine which kind of VBP contract arrangement will work best for them as the state moves I/DD to a VBP model throughout 2018 and 2019.
As a Compliance Policy Analyst here at MediSked, I had the opportunity to attend and “graduate” from a VBP intensive put on by New York State, the ‘Value-Based Payment University.’ This intensive was designed to prepare the wider industry for the upcoming changes. As part of our commitment to being the leading brand in holistic solutions that improve lives, drive efficiencies, and generate innovations for human services organizations, MediSked is here and ready to aid providers in our ever-changing regulatory environment.
Tyler Blake is a Compliance Policy Analyst with MediSked, focusing on compliance and regulatory research. He is a graduate of Albany Law School where he received his joint JD/MBA in healthcare management.