[PPT] - VBP Workgroup Meeting February 22, 2018 February 2018 2 Agenda PowerPoint Presentation

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VBP Workgroup Meeting

February 22, 2018

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I. VBP Bootcamp Takeaways

Risk Adjustments standards & methodologies
Implementation options to encourage data sharing

between MCO and Provider II. MLTC VBP Design Summary III. Children Subcommittee Follow-up IV. Social Determinants of Health and Community Based Organizations Update

SDH CBO Learning Collaboratives
CBO Engagement & Integration
Tracking VBP SDH/CBO COmpliance

V. PPS Sustainability 2 February 2018

Agenda

VI. VBP Roles Document

VII. VBP Evaluation Report
VIII. MCO Data Sharing Readiness

Survey IX. VBP Roadmap Update

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I. VBP Bootcamp Takeaways

3 February 2018

Risk adjustment in VBP
Implementation options for data sharing between MCO and provider

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Risk Adjustment in VBP

Key elements of risk adjustment are summarized below:

1. Pros and cons of prospective, concurrent and hybrid risk adjustment models
2. Availability of different data sources to enable risk adjustment among plans and providers
3. The innovative trend in the healthcare industry to broaden the application of risk adjustment to

address the Social Determinants of Health

VBP Workgroup consideration:

Q. Should additional language be included in the VBP Roadmap, as a standard or guideline, to illustrate

best practices for risk adjustment and govern its application for target budget setting between MCO and provider?

Background: During VBP Bootcamps, stakeholders recognized the need to use and better

understand risk adjustment given its application in VBP Target Budgets

February 2018 4

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Implementation Options to Encourage Data Sharing

The VBP Roadmap has been updated to improve data sharing between MCO and provider:

“For level 2 and 3 arrangements, the State will monitor the data and information exchanged between MCO and

Lead VBP Contractors for the purpose of negotiating target budgets and distribution of shared savings/loss… to help ensure that these financial methodologies are based on timely, frequent and complete data…”

“As a statewide standard, MCOs must include an overview of the data and information the MCO made/will

make available to the VBP Contractor for the purposes of negotiating a target budget and distribution of shared savings/loss, when submitting their (MCO) contracts to the State.”

VBP Workgroup consideration:

Q. Are there additional processes or other options that would support data sharing between MCOs and

contracted providers, and how could the State implement these options?

Background: During VBP Bootcamps, stakeholders identified the need for more frequent and timely

sharing of data between MCOs and providers to establish well-designed target budgets and improve provider performance.

February 2018 5

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Additional VBP Bootcamp Key Takeaways

1. Some PPS have developed data analytics platforms and have identified proxy measures. These tools may be available to providers in VBP to:

Provide them with more frequent, timely and available data
Support them with more real time performance measurement capabilities

~ Providers must continue to engage their PPS as they (PPS) evolve and continue to develop advanced tools and capabilities. ~

2. Recognized need to make rate payment schedules and VBP adjustments more transparent
3. Timely, frequent and complete data sharing between providers and MCOs is critical to

improved performance and well-design target budgets

6 February 2018

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Additional VBP Bootcamp Key Takeaways (Cont’d)

4. There is a need to clarify how the NYS Behavioral Health Value Based Payment (BH VBP)

Readiness Program relates to VBP

The BH VBP program is intended to strengthen behavioral health providers to enable them to

engage in VBP as a VBP Contractor or a provider partner.

The BH VBP is not a substitute for VBP
5. There is a need to clarify how Tier 1 CBOs may be engaged in VBP to fulfill the CBO

requirement for Levels 2 and 3.

CBOs may contract directly with an MCO to support multiple VBP arrangements in a geographic

area

CBOs may also partner with a Lead VBP contractor to support their specific arrangement
MCOs must include the CBO in the 4255 form when submitting the contract to the State

February 2018 7

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II. MLTC VBP Design Summary

8 February 2018

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1. Review of Managed Long Term Care (MLTC) Plan Membership by Product Line
2. Summary of Overall Design, Guidance, and Implementation Support for Level 1
Level 1 Guidance & Implementation Support
Quality Measure Review & Implementation Support
Finance Guidance & Implementation Support
Summary of Stakeholder Engagement
3. Status of Level 1 Implementation
4. Summary of Overall Design of Medicaid Advantage Plus (MAP), Fully Integrated Duals

Advantage (FIDA), and Programs of All-Inclusive Care for the Elderly (PACE)

Review and Recap of MAP, FIDA, and PACE Product Lines
Quality Measure Development & Stakeholder Engagement
VBP Guidance

Agenda

February 2018 9

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February 2018

Section 1: Review of MLTC Plan Membership by Product Line

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199,442 91.2% 9,243 5,733 4,237 19,213 8.8%

Review of MLTC Plan Membership by Product Line

NYS MLTC Plan Enrollment

MLTC Partial Capitation Enrollment Fully Capitated Plan Enrollment

Source: NYS Department of Health, 2018 Monthly Medicaid Managed Care Enrollment, January 2018, https://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/

MAP PACE FIDA February 2018 11

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February 2018

Section 2: Overall Design of MLTC in Level 1

Level 1 Implementation Guidance & Support
Quality Measure Guidance & Support
VBP Finance Implementation Guidance & Support
Summary of Stakeholder Engagement

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Summary Implementation Guidance for Level 1

Posted July 2017

VBP University Video Release

July 2017

Contract Templates for Licensed Home Care Services Agencies (LHCSAs), Certified Home Heath Agencies

(CHHAs) & Skilled Nursing Facilities (SNFs) For LHCSAs/CHHAs – Circulated for Comment in September 2017 & Posted October 2017 For SNFs – Circulated for Comment in October 2017 & Posted in November 2017

Contract Template Submission & DLTC Review

Completed November – December 2017

Frequently Asked Questions (FAQs) Document

Posted December 2017

Individual Plan CEO Outreach

July 2017 – End of Year February 2018

Level 1 Implementation Guidance & Support

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“If the Medicare dollars cannot be (virtually) pooled with the State’s Medicaid dollars, and savings in Medicare cannot be shared with Medicaid providers (or vice versa), the impact of payment reform for this population threatens to be limited, and long term care providers will have difficulty achieving scale in VBP transformation. T

remedy this, the State is

working with CMS to create aligned shared savings possibilities within Medicaid and Medicare. In anticipation, the State aims to treat potentially avoidable hospital use as ‘quality outcomes’ for this subpopulation, improving the quality of life for these members, and rewarding MLTC providers when certain levels of reduced avoidable hospital use are reached. Such arrangements could be treated as Level 1 VBP arrangements, and would be eligible for financial incentives. Improved quality and reduced overall costs can also be realized by delaying or avoiding nursing home admissions through targeted interventions amongst the MLTC population residing at home.”

New York State Department of Health, A Path toward Value Based Payment: New York State Roadmap for Medicaid Payment Reform, Annual Update June 2016: Year 2 (CMS-Approved April 2017), p.18.

Until such time as alignment with Medicare is possible, Level 1 VBP for partially capitated MLTC plans will be a pay-for-performance (P4P) program based on the potentially avoidable hospitalization quality measure.

February 2018

Recap of Level 1 VBP for Partially Capitated MLTC Plans

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Annual Clinical Advisory Group (CAG) Report Published for Measurement Year (MY) 2018

September 2017

Value Based Payment Reporting Requirements Technical Specifications Manual

October 2017

MY 2018 Measure List for Partially Capitated Plans

October 2017

Measures Calculated for Provider Attributions & Disseminated to Plans for Use

October 2017

MLTC Value Based Payment Quality Measure Data Reporting Timeline

January 2018 February 2018

Quality Measure Implementation Guidance & Support

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2016 2017 2018 2019 2020 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Baseline Attribution Period

#1: Attrib. 4/16-12/16 #2: Attrib. 10/16-6/17

VBP QI Measurement Period

7/16-12/16

1/17 - 6/17 Community PAH

7/16-12/16

7/17 - 12/17 Nursing Home PAH 1/17-12/17 Data Releases MY 2018 Attribution Period Attribution 4/17 - 6/18 VBP QI Measurement Period 1/18 - 6/18 Community PAH 7/18 - 12/18 Nursing Home PAH 1/18-12/18 Data Releases MY 2019 Attribution Period Attribution 4/18 - 6/19 VBP QI Measurement Period 1/19 - 6/19 Community PAH 7/19 - 12/19 Nursing Home PAH 1/19-12/19 Data Releases MY 2020 Attribution Period Attribution 4/19 - 6/20 VBP QI Measurement Period 1/20 - 6/20 Community PAH 7/20 - 12/20 Nursing Home PAH 1/20-12/20 Data Releases

Legend

Attribution file due to DOH
Preliminary Community Potentially Avoidable Hospitalizations (PAH) data released
Final VBP Quality Incentive (QI) and PAH data released

February 2018

MLTC VBP Quality Measure Data Reporting Timeline

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$50 million in funds for VBP to provide resources for provider contracts

Formula for MY 2018 to be based on PAH measure Formula for MY 2019 to include PAH and other CAG-recommended measures

$10 million in stimulus funds to provide immediate plan incentives

Immediate disbursement with recoupment for non-compliance Allocated on a per member per month (PMPM) basis

VBP Roadmap penalties adjusted to capture final quarter of fiscal year 2018-19 (January – March 2018) for Level 1

Level 2 penalties will apply as articulated in the VBP Roadmap (5% in Level 2 by April 2019)

MLTC Finance Webinar

December 2017 February 2018

VBP Finance Implementation Guidance & Support

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The funding available for MLTC partial cap plans

and providers is a fixed pool /of $50 million

In the first year of rate adjustments for fiscal year

2020-21, the new $50 million will be based on the PAH measure results

VBP quality funding is for P4P and it is intended

the funds should primarily be passed on to providers

50 100 150 200 250 2017-2018 2020-2021 Recurring MLTC QI Pool MLTC VBP QI Funding $ in Millions

$50 Million $150 Million

Proposed $50M MLTC VBP Quality Weighting Efficiency Measures - PAH (100 Points) Quality Measures (0 Points)

$150 Million

February 2018

MLTC VBP Quality Funding

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Contract Amendment Review

October – December 2017

Individual Question & Answer Sessions by

Request Ongoing February 2018

Summary of Stakeholder Engagement

MLTC CAG Meetings

June 9, 2017 August 17, 2017

VBP Readiness Survey

July – August 2017

Bootcamp 2.0 MLTC Course

Seven Sessions October 2017 (Albany, New York City, Lake Placid) November 2017 (Rochester, Long Island) January 2018 (New York City) February 2018 (Albany) 19

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February 2018

Section 3: Status of Level 1 VBP Implementation

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Plans reported on a weekly basis the number of contracted LHCSAs, CHHAs, and SNFs

how many of these contracts were amended to comply with Level 1

Covered 29 plans

Compliance Survey Overview

77% of total contracts have been amended to meet Level 1 requirements
LHCSAs - 88% of total contracts have been amended
CHHAs - 58% of total contracts have been amended
SNFs - 67% of total contracts have been amended
24 Plans have amended 75% or more of their total contracts
Of these, 12 have amended 100%

Survey Results (as of January 31, 2018)

February 2018

Status of Level 1 Implementation

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February 2018

Section 4: Overall Design for MAP, FIDA, and PACE

Review of MAP, FIDA, and PACE Product Lines
Quality Measure Development & Stakeholder Engagement
VBP Guidance

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Covers managed long-term care services as well as Medicare co-payments and

deductibles, and inpatient and primary care

Enrollees must be at least 18 years of age and eligible for services usually provided

in a nursing home

MAP

Comprehensive benefit package includes all Medicare physical health, behavioral

health, and prescription drug services and Medicaid physical health, behavioral health, and long-term support services

Enrollees must be at least 21 years of age

FIDA

PACE plan is responsible for coordinating and providing all primary, inpatient

hospital, and long-term care services for members

Organizations provide health services for members age 55 and older who are

eligible for nursing home admission

PACE

Source: New York State Department of Health, 2016 Managed Long-term Care Report, 2016, https://www.health.ny.gov/health_care/managed_care/mltc/

February 2018

Review of MAP, FIDA, and PACE Product Lines

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January 2018 Sub-Team Measure Review Period Nov 2017 – Dec 2017 Measure Feasibility Review August 2017 ClinicalAdvisory Group Meeting November 2017 MLTC CAG Sub- Team The MAP & FIDA measure setis aligned with existing measures for IPC/TCGP & HARP . PACE measures were selected from measures currently in development with CMS and Econometrica. The MLTC CAG Sub-Team met twice (11/6 and 11/9) to discuss VBP design and quality measures forMAP , FIDA, and PACE. The MLTC CAG recommended convening Sub-team to focus

n MAP

, FIDA, and PACE VBP design and quality measures. December 2017 Proposed Measure Lists Finalized DOH met with MAP , FIDA, and PACE plans to discuss measure feasibility and consulted with the National PACE Association to verify the CMS measure development timeline for PACE measures. January 31, 2018 VBP Workgoup Webinar February 2018 Final Measure Lists Posted for MAP , FIDA, and PACE Proposed measures disseminated for Sub-Team review, which concluded on 1/19.

February 2018

Quality Measurement Development & Stakeholder Engagement

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Population Included

Total cost of care MLTC Subpopulation Arrangement
Includes members enrolled in MAP and FIDA plans

Defined Services

Inpatient Hospital Services, Laboratory Services, Mental Health & Substance Abuse, Outpatient Hospital/Clinic Services,

Prescription and Non-prescription Drugs, Primary and Specialty Doctor Services, X-Ray and Other Radiology Services, Personal Emergency Response System, Podiatry (Foot care), Private Duty Nursing, Prostheses and Orthotics, Rehabilitation Therapies, Outpatient Respiratory Therapies, Social Day Care, Social/Environmental Supports (chore services or home modifications), Chronic Renal Dialysis, Emergency Transportation, Adult Day Health Care, Audiology/Hearing Aids, Care Management, Consumer Directed Personal Assistance Services, Dental Services, Home Care (Nursing, home health aide, occupational, physical and speech therapies), Home Delivered and/or Meals in a Group Setting (such as a day center), Durable Medical Equipment, Medical Supplies, Medical Social Services, Non-emergency Transportation to Receive Medically Necessary Services, Nursing Home Care, Nutrition, Optometry/Eyeglasses, Personal Care (assistance with bathing, eating, dressing, etc.)

VBP Levels

Equivalent to VBP Roadmap Levels 1, 2, and 3 for Mainstream ManagedCare

VBP Contractor

Independent PracticeAssociation (IPA),Accountable Care Organization (ACO), Provider Responsible for Total

Cost of Care

February 2018

Recap of MAP and FIDA Arrangement

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Population Included

Total cost of care MLTC Subpopulation Arrangement
Includes members enrolled in PACE plans

Defined Services

PACE provides a comprehensive range of services for participants, serving as plan and provider, employing care providers in its primarily

center-based model and receiving a global capitation payment at full risk

VBP Levels

T
reflect the differences in the PACE model the VBP approach is as follows:
Global capitation payments from NYS to PACE qualify as a Level 3 VBP with the addition of a VBP quality component and a social

determinants of health intervention (SDH) with a community based organization (CBO)

PACE can pursue VBP Roadmap Levels 1, 2, or 3 with independent providers under contract

VBP Contractor

PACE
Individual Providers with whom PACE pursues VBP Contracts

February 2018

Recap of PACE VBP Arrangement

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Implementation Guidance for MAP & FIDA

Posted January 2018

Implementation Guidance for PACE

Posted January 2018

FAQs Document for Fully Capitated Plans

Posted February 2018

MY 2018 Measure List for Fully Capitated Plans

Posted February 2018

PACE Social Determinants of Health Intervention Survey

Underway

February 2018

Summary of Implementation Guidance & Support

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III. Children Subcommittee Follow-up

February 2018 28

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Background:

Children’s Subcommittee presented recommendations for a VBP arrangement focused on pediatric

care. DOH is exploring how to move forward while keeping in mind key considerations:
Improved outcomes and cost savings may not be realized until well into the future
Cross government sector savings as a result of quality pediatric care
Appropriate and feasible quality measures
Pediatric care in existing VBP arrangements
Technical design that rewards certain quality outcomes in an upside only model

Report: VBP Report from Children’s Health Subcommittee and Clinical Advisory Group from Sept. 2017 is posted in the VBP Resource Library

February 2018

Children’s Sub-Committee Recommendation Update

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Next Steps:

DOH is working with UHF on the proposed Pediatric Primary Care Capitation Plan to make it Roadmap compliant DOH is analyzing data to explore:

Volume of Medicaid members in IPC who are children
Percentage of costs that might be attributable to children in an IPC-like arrangement for

children

Ability to identify high risk families

30 February 2018

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IV. Social Determinants of Health and Community Based Organizations Update

31 February 2018

SDH CBO Learning Collaboratives
CBO Engagement and Integration
Tracking VBP SDH/CBO Compliance

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New Bureau of Social Determinants of Health

February 2018 32

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Bureau of SDH: 2018 Goals

February 2018

Review VBP Level 2 and 3 Contracts and Amendments
Track SDH Interventions and CBO
Provide support and technical assistance

Implement the VBP Roadmap Requirements Related to SDH and CBOs

Regional meetings with MCOs, VBP contractors, CBOs, & health

care providers

Maximize CBO and SDH interventions in the health care system.

Begin CBO SDH Regional Meetings

Increase data collection on SDHs (i.e. electronic health records)
Standardize SDH Quality Measures and incorporating into QARR
Risk Adjustment MMC Plans for SDH

Improve SDH Measures in Population Health and Payment Reform

Integrate MRT SH with PPSs, VBP Contractors, and Health Systems
Create a plan to expand to families to align with the First 1,000

Days

Create a New Housing Referral Process

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Upcoming MRT Capital Projects

Greenport – 33 Units

Population Served: Single adults with a mental health diagnosis.
TCO Completion- April 1, 2018. Hudson Valley Region (Columbia)

Webster Green – 41 Units

Population Served: Homeless single adults living with HIV/AIDS and who suffer from a co-occurring serious

and persistent mental illness, and/or a substance abuse disorder.

TCO Completion- April 26, 2018. NYC (Bronx)

294 East 162nd St. Court – 37 Units

Population Served: Formerly homeless families
TCO Completion- May 1, 2018. NYC (Bronx)

Marion Avenue – 65 Units

Population Served: Homeless single adults living with a serious mental illness exiting state psychiatric

facilities and programs

TCO Completion- June 4, 2018. NYC (Bronx)
St. Augustine Apartments – 35 Units
Population Served: Chronically homeless single adults who suffer from a serious and persistent mental

illness (SPMI) or who are diagnosed as mentally ill and chemically addicted (MICA)

TCO Completion- August 1, 2018. NYC (Bronx)

February 2018

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Learning Collaboratives

February 2018

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Goal for the SDH CBO Learning Collaboratives

The focus of these regional sessions will be to increase the number of CBOs and SDH interventions within the health care system by bringing together MCOs, CBOs, PPSs, VBP contractors, and Stakeholders. These sessions will also be used to provide support to CBOs through education/training activities and sharing best practices.

Overall Purpose/Goal:

February 2018

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CBO and MCO Outreach Related to SDH

February 2018

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CBO Engagement and Integration

CBO Survey was released earlier this year. The survey is used to understand CBO integration with the NYS VBP program and use information provided to build a public inventory of Tier 1, 2 and 3 CBOs that can be used to facilitate VBP contracting.

Total Responses:
369 Respondents to date
CBO Tier Designation:
Tier 1: 29%
Tier 2: 14%
Tier 3: 48%
Have you met with a MCO/VBP Contractor to determine your role in VBP?
45%- Have met with an MCO and VBP Contractor
12%- Currently participating in an SDH Intervention to support a VBP arrangement
CBO Directory is posted on the VBP Resource Library under Social Determinants of Health and Community Based
Organizations. Directory is updated bi-weekly.

February 2018

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Nine major MCOs responded and have had discussions with over 200 CBOs as part of VBP contracting MCOs are asked to submit monthly status updates on CBO contracting progress and the SDH interventions being implemented

MCO Contracting Compliance Tracker

To track progress towards compliance for VBP Level 2 and 3 contracts, DOH developed SDH-CBO Contracting Tracker MCOs have executed contracts with CBOs in NYC, Suffolk, Nassau, and Erie counties to implement SDH interventions.

Interventions include: Transportation; Isolation and Lack of Community Support; Health Education on Asthma Management; Home Environment Assessment; Nutritional Case Management; Food Insecurity (food farmacy initiative, fresh box program); Access to Health Care.

February 2018

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Other Goals

VBP Prevention Agenda Pilots

Asthma Diabetes

Public/Private Partnerships for SDH Interventions

$44 million in 19-20 Executive Proposed Budget February 2018

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Questions?

February 2018

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Contact Us: SDH@health.ny.gov

Thank you! !

February 2018

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VBP Pilots SDH/CBO Survey Results

43 February 2018

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February 2018

Current State

Type Provider Managed Care Organization Level (Y1) Status HARP Maimonides Medical Center Healthfirst PHSP, Inc. 1 Approved Mount Sinai Health Partners Healthfirst PHSP, Inc. 1 Approved IPC Community Health IPA Affinity Health Plan, Inc. 1 Approved TCGP Greater Buffalo United ACO Yourcare Health Plan, Inc. 1 Approved Somos Your Health IPA Affinity Health Plan, Inc. 2 Approved Somos Your Health IPA HealthPlus HP, LLC 2 Approved Somos Your Health IPA New York State Catholic Health Plan, Inc. 2 Approved Somos Your Health IPA Healthfirst PHSP, Inc.* 1 Approved Somos Your Health IPA United Healthcare of New York, Inc. 2 Pending Somos Your Health IPA Wellcare of New York, Inc. 2 Approved

St. Joseph’s Hospital Health Center

New York State Catholic Health Plan, Inc. 1 Approved**

St. Joseph’s Hospital Health Center

Molina Healthcare of New York, Inc. 1 Approved**

**Waiting on commitment for

St. Joseph’s Year 2

contracts *Need to align with year 2 Pilot measures, moving into a Level 2 in year 2

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SDH Survey Results

Metrics used to determine need for Intervention:

Medical Records including admission data,

medication ratio, claims data to isolate diagnoses that can be targeted by SDH partnerships

Community Needs Assessment
IPA Input/Analysis
DSRIP Hotspot Analysis

17% 17% 33% 50% 67% 0% 10% 20% 30% 40% 50% 60% 70% Neighborhood & Environment Education Social, Family & Community Context Economic Stability Health & Healthcare

SDH Domains Addressed

February 2018

Four (4) survey respondents identified a total of six (6) SDH interventions. Based on survey responses, respondents are in the early implementation phase of their interventions and are still in the process of understanding each intervention’s full impact.

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VBP Pilots and SDH Interventions

VBP Pilots were surveyed to collect insights into SDH interventions. The survey is still ongoing, however, initial feedback is provided below: Case Management Support Services to Improve Economic Stability

Utilizes a “total person approach” for high-utilizers
Includes interventions such as case management support services, financial incentives

for medication adherence, legal services, housing related issues, and assistance with dietary and nutritional issues. Social Services for Refugees

Provides language and health care system navigation support for refugees
Provides interpretation services for case management home visits

Priscilla Project

Provides pregnancy support for refugees’ first pregnancy in the United States

AIR

Provides baseline and follow up visits that include home environmental assessments for

asthma management

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February 2018

Next Steps

Schedule Lessons Learned webinars
Quality Measure Test Project
Work with Testing Participants to develop a project plan
Work with Testing Participants to develop Current State Snapshot of the various

activities supporting VBP quality measurement

Formal Kickoff with all Testing Participants in late March to share relevant findings

and provide additional project requirements

VBP Pilots will be assessed for compliance with the VBP Pilot Program

requirements (entering Level 2 in year 2, CBO contracting, SDH interventions, quality measures, etc.

Failure to comply with the VBP Pilot Program requirements may result in recoupment
f funds made available to VBP Pilots.

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V. PPS Sustainability

48 February 2018

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DSRIP represents a $7.3 billion dollar investment. Communities large and

small through New York have received an unprecedented influx of dollars to transform their regional health systems.

The future of healthcare is now. We have an opportunity to build on the

infrastructure we have built during the DSRIP period to make the lives of millions of New Yorkers better.

Though challenges exist, there are ways to collaborate and continue to build
n the successes that we have already achieved.

Purpose of the Survey

February 2018 49

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PPS Sustainability Survey Update

PPS were surveyed to garner insights into:

Where are PPS in determining their sustainability plan?
How is that planning being done?
How are partners being engaged in this process?
What barriers are impeding plan development?
What organizational structures and capabilities are PPS likely to adopt in the future?

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Key Findings

Nearly all PPS expect to provide some type of service following DSRIP. The most frequently cited services are:

population health technology / analytics
performance improvement services
network management
ther administrative services
Most PPS are still considering all options for future state organizational models
Most have engaged partners in planning, to some degree, though mostly focused on

understanding capacity

February 2018 51

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Sustainability Planning Progress: Initial Assessment by DSRIP Support Team

PPS identifies themselves as in the

“early stages”

Survey response is generally less

developed than the Advanced group

Sustainability and/or post-DSRIP

transition planning appears to have started relatively recently

Relatively fewer resources appear to

be devoted to sustainability planning

Multiple options still under

consideration

Extensive level of planning relative to
ther PPS
Planning has been underway for a

year or more

Significant resources (internal and/or

external) have been devoted to sustainability planning

Planning activities have been

integrated into committee structures

PPS has eliminated some options;

may have a formal plan in draft form

Underway Advanced

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Partner/Stakeholder Engagement

All PPS’ are doing some level of partner/stakeholder engagement
PPS activities generally consistent with overall PPS progress towards sustainability plan
PPS with low engagement currently have plans to do more in the future
Commonly reported engagement activities
Assessing partner interest and capabilities
Including sustainability as a topic at PAC meetings and Town Halls
Requiring Innovation Fund awardees to develop sustainability plans
Integrating sustainability planning in existing PPS governance structures/committees
More advanced PPS have created separate Sustainability Workgroup/Committee, usually reporting to

Finance February 2018 53

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Barriers to Sustainability Planning

Uncertainty of future budgetary and regulatory environment
Many PPS were hoping for DSRIP 2.0
Lack of clarity regarding future regulatory relief
PPS report delays in project implementation have impacted evaluation timelines: currently, there is

limited data available to support VBP contracting

Almost all PPS cite MCO issues as a significant barrier
Access to MCO data, challenges in contracting strategy, lack of MCO support for DSRIP initiatives
Local market complexity and competition (particularly downstate) with multiple participation options
ffered to providers by other PPS
Continued skepticism from some partners regarding VBP transition

February 2018 54

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Future State Business Models

Some PPS are exploring how an “IPA-like” structure could be developed for CBOs
PPS are evaluating the pros/cons of providing services under a variety of arrangements:
Fee for service
Annual membership plus fees for add-on services
PMPM for population health technologies or other services

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Each PPS needs to develop its own vision and plan for sustaining the positive impacts of DSRIP, and for

leveraging the infrastructure built under DSRIP.

The DSRIP workforce that will be needed in the future vision for sustainability.
PPS will play a different but critical role in 2020 and beyond.
VBP offers tremendous flexibility to Providers and Managed Care Organizations.
The infrastructure developed in DSRIP will be needed to support VBP.
Performing Provider Systems themselves
PCMH/APC Status
Connectivity to Qualified Entities and SHIN-NY
Coordination with Managed Care Organizations

Vision for PPS Sustainability

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VII. Medicaid Redesign Team Structural

Roadmap

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Roles and Responsibilities in a Value Based Payment World

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Medicaid Redesign Team Structural Roadmap

Background: DOH has developed a roles and responsibilities document which seeks to more clearly define the various roles that critical “middle layer” actors play in a reformed system that is more responsive to patient and provider needs. The document will cover the following stakeholders:

VBP Work Group Consideration

Medicaid Managed Care Organizations (MCOs) &

Managed Long Term Care (MLTC)

Health Homes
Performing Provider Systems
ACOs & IPAs
Behavioral Health Care Collaboratives (BHCCs)
Patient Centered Medical Homes (PCMH)
Statewide-Health Information Exchange Network for NY

(SHIN-NY) Support for DSRIP & VBP

DOH is accepting VBP Work Group feedback on the roles blueprint document. Please submit your feedback by March 8th, to jdeem@kpmg.com

February 2018 58

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Medicaid Managed Care Organizations (MCOs) & Managed Long Term Care (MLTC)

Mainstream MCOs, Managed Long Term Care (MLTC) Plans, Health and Recovery Plans (HARPs) and other specialty plans are key players in contracting and quality management relative to VBP. Many functions will continue to be carried out by the MCOs while other functions may become delegated to provider networks.

February 2018 59