NYAPRS Note: Over the next 5 years, New York will be moving as much of 90% of healthcare payments to a value based payment reimbursement system that rewards consumer outcomes rather than how often and where consumers received care (see https://www.youtube.com/watch?v=9D4M-QsaNfM for the state’s overview of the program).
In order to get broad public input on how the VBP system should be structured, the state convened 5 subcommittees to look at design, regulatory, consumer incentives and education and how we can best position services that address the social determinants of health to make their critical contributions to helping people get and stay well. You can see materials from the workgroups towards the bottom of https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform.htm.
NYAPRS representatives have served on the Steering Committee and all 5 subcommittees, which have met over the past 6 months and wrapped up their work over the past few weeks. Yesterday, the VBP steering committee began hearing the recommendations from those groups. Ultimately, the steering committee and state’s final decisions will become a part of the revised Value Based Payment Roadmap that will be presented to the federal Medicaid agency (CMS) and ultimately guide New York’s plan to implement a value based payment system.
A consistent theme of our advocacy across the groups has been that community based provider organizations receive some measure of the support that has been afforded hospital groups. Most notably, we have been seeking the kinds of financial and technical assistance that will be necessary to help our providers to make the best transition to the Value Based payment environment.
The article below quotes NYAPRS representative Steve Coe on how these recommendations were highlighted by the Social Determinants of Health work group.
We’ll provide an overall summary of what our advocacy priorities have been and where things turn out over the next few weeks.
Medicaid Work Group Weighs in on Value-Based Payments
Crain’s Health Pulse December 18, 2015
The state's roadmap for moving Medicaid to value-based payments calls for 90% of Medicaid managed care reimbursement using the model by 2020. That schedule is sparking significant concern among many nonprofit groups that feel unprepared for the shift.
The state created a VBP Workgroup tasked with working out details of the Roadmap for Medicaid Payment Reform, released in June. On Wednesday, a subcommittee released a draft of 31 recommendations on how the state can address the concerns of community-based groups. The group also looked at how VBP models can address social determinants of health.
"The final product is pretty good and reflects the concerns many of us have," said subcommittee member Steve Coe, chief executive of Community Access, a Manhattan nonprofit that serves people with behavioral-health issues. "How are we going to manage the transition to a different payment and service model that will certainly require an upfront investment and strategic business skills most agencies don't possess?"
Since the launch of DSRIP, some CBO leaders have complained that hospitals leading performing provider systems got state money for planning efforts; CBOs did not. The subcommittee recommends that the state makes available a pool of money for CBOs to tap to help them develop data systems and other infrastructure, and to hire consultants. It also recommended the state develop mechanisms to assist CBOs if cash-flow issues arise.
The group also wants the state provide an array of services to CBOs to help them plan for the VBP shift. Suggestions include the creation of an expert design and consultation team that could advise CBOs on forming partnerships with other health care groups at no cost.
Addressing the social determinants of health from a clinical perspective is tough. From a VBP perspective, that issue is perhaps equally challenging. The work group thinks the state should require managed care companies to give financial incentives, including upfront payments, to providers who tackle one or more social determinants of health….
See http://www.crainsnewyork.com/article/20151218/PULSE/151219840/medicaid-work-group-weighs-in-on-value-based-payments#utm_medium=email&utm_source=cnyb-pulse&utm_campaign=cnyb-pulse-20151218 for the full story