Town Hall
June 23rd, 2017Tosca Marquee
Bronx, NY
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Topic Speaker
Welcome and Overview • Duane Granston –Project Manager, BHA
PMO Update• Victor Demarco – Chief Financial Officer, BLHC• Dennis Maquiling – Executive Director, BHA • Dr. Parikh – Medical Director, BHA
Value-Based Payment 101• Boris Vilgorin - MCTAC (Managed Care Technical Assistance Center of New York)
VBP and Me Small Group discussionReport-Out/ Q&A
• Roy Wallach - Arms Acres/Conifer Park – Stakeholder Workgroup Co-lead
Next Steps for VBP • Duane Granston –Project Manager, BHA
Wrap-up and Networking
Agenda
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CASH POSITION
Presented by:
Victor Demarco
BHA PPS, Finance Committee Chair
Bronx Lebanon Hospital Center, CFO
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Name Change!
DSRIP Award Letter
3
Equity Programs (EIP and EPP)
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Budgeted Funding by Year
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Net Project Valuation
Equity Infrastructure Program
Equity Performance
Program
Total
DY1 $11,515,003 $7,927,277 $5,284,852 $24,727,132
DY2 $12,271,038 $7,927,277 $5,284,852 $25,483,167
DY3 $19,838,663 $7,927,277 $5,284,852 $33,050,792
DY4 $17,556,017 $7,927,277 $5,284,852 $30,768,146
DY5 $11,515,003 $7,927,277 $5,284,852 $24,727,132
Total $72,695,724 $39,636,387 $26,424,258 $138,756,369
Funding Received – May 31, 2017
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Payment Net Project Valuation
Equity Infrastructure
Payment
Equity Performance
Payment
High Performance Fund (State)
3/31/2015-3/31/2016 $9,005,986
4/1/2016-6/30/2016 $7,883,005
7/1/2016-9/30/2016 $2,302,226 $2,005,116
10/1/2016-12/31/2016 $1,951,946 $688,319
1/1/2017-3/31/2017 $1,994,903 $4,093,406 $1,187,326
4/1/2017-5/31/2017 $5,149,387 $1,771,657 $392,771 $100,270
Total $16,457,599 $15,606,626 $5,174,496 $1,287,596
FUNDING SPENT OR COMMITTED
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Funds Spent or Committed
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Key: Black= Governance expenditure, Green: partner benefit*Offset by Capital Grant
CategoryTotal expected through
May 31, 2017
Administration $7,292,732
Domain 2,3,4 workgroups $4,070,724
Initiatives $397,814
IT* $787,913
PCMH $653,364
Stakeholder $422,054
Workforce $5,094,941
Performance Payments $7,583,933
Sustainability $4,613,207
Contingency $2,841,928
Other $1,672,015
Total $35,430,625
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Funding Overview as of May 31, 2017
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Received versus Spent Amount
Funds Received by PPS$38,526,317
Funds Spent or Committed by PPS $35,430,625
Funds remaining $3,095,692
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Questions?
PMO UPDATE
Presented by:
Dennis Maquiling
BHA PPS, Executive Director
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Statewide Results P4P for MY2
Preliminary statewide results from DOH for all PPS for the MY2 period (July 2015-June 2016):
Average Number of Measures Met Out of 33: 41.2%Best Performing PPS: 56.0%Worst Performing PPS: 26.9%
Number of Measures Met by BHA (BLHC PPS): 42.4%
No PPS Achieved the “Well Care Visit, 5+ in 15 Months”All PPS Achieved the “Asthma in Younger Adults in Admit Rate”
Some Important Notes:1. There is about a 1-Year lag between the reporting period and when results are released.2. PPSs focused on P4R during this period and not P4P.
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CBO Request Summary
CBO Name Request Description
BronxWorksBuild program to identify chronically homeless in Bronx Lebanon ED and connect them to housing resources
CommunilifePeer specialist to support the transition of clients from Safe Havens to permanent housing.
God's Love We DeliverExpansion of medically-tailored food services for the chronically ill
PhippsNeighborhood
Programs to support early childhood development and literacy.
R.A.I.N. Expansion of mobile food kitchen
St. Ann's Cornerof Harm Reduction
Liaison to facilitate communication between clients and social service/medical providers
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CLINICAL UPDATES
Presented by:
Dr. Parikh
BHA PPS, Medical Director
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BHA Clinical Updates
INITIATIVES
– Goal: to better meet P4P measures– Progress: Workgroup established; budgets being approved
(staffing)
DATA
– Goal: To meet P4P measures – Progress: Analyst are mining data and sharing reports; real-
time data reports needed from partners
VBP
– Goal: How do we as a Performing Provider System (PPS) support partners in the shift to VBP and help determine the true “value” of their services to the Triple Aim (reduce health care costs, improve quality, and improve care)?
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Shift from Pay-for-Reporting to Pay-for-Performance
15%
45%
65%
85%
20%
25%
15%
15%
15%
80%
60%
40%
20%
DSRIP Year 1 DSRIP Year 2 DSRIP Year 3 DSRIP Year 4 DSRIP Year 5
Project progress milestones Pay-for-reporting Pay-for-performance
• Note: As part of a December 2015 waiver amendment request to the federal Centers for Medicare and Medicaid Services, New York is seeking to slightly modify these percentages.
• Source: New York State Department of Health, Attachment I—NY DSRIP Program Funding and Mechanics Protocol, April 2014.
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Value Based Payment
Presented by:
Boris Vilgorin
MCTAC (Managed Care Technical Assistance Center of New York)
Agenda
• Introduction
• How Did We Get Here
• Recent Change to Health Care System
• Value Based Payment: An Overview
• What Does this Mean?
Introduction
McSilver Institute
The McSilver Institute for Poverty Policy and Research
at New York University Silver School of Social Work is
committed to creating new knowledge about the root
causes of poverty, developing evidence-based
interventions to address its consequences, and rapidly
translating research findings into action through policy
and practice.
MCTAC Overview
What is MCTAC?
MCTAC is a training, consultation, and educational resource
center that offers resources to all mental health and
substance use disorder providers in New York State.
MCTAC’s Goal
Provide training and intensive support on quality
improvement strategies, including business, organizational
and clinical practices to achieve the overall goal of
preparing and assisting providers with the transition to
Medicaid Managed Care.
How Did We Get
Here
New York State Medicaid Program
• March 2017 Medicaid/CHIP enrollment: 5.9M
individuals (including 2.1M under age 21)
• Total federal FY 2015 expenditures: $59.8B
(11% of US total)
• Public behavioral health system serves
~750,000 Medicaid recipients per year
• Estimated annual behavioral health annual
spend: $7B (~50% for inpatient BH)
Source: NYS OMH Presentation
Medicaid Expenditures: 2013
$49.1 billion
Why Transform?
•New York was spending double the cost per recipient for
healthcare as compared to the national average
•National rankings at best tend to show NYS in the middle of
the pack when it comes to overall health care quality
•NYS Medicaid expenditures were growing at a rate of 10%
per year
•The care delivery system is fragmented, with minimal
incentives and infrastructure to coordinate care across
systems
•The current model incentivizes volume instead of value
MRT Overview
To address underlying health care cost and quality
issues in New York's Medicaid program, within days
of taking office, Governor Andrew M. Cuomo
created the Medicaid Redesign Team to both craft a
first year Medicaid budget proposal as well as
develop a multiyear reform plan. He invited key
Medicaid stakeholders to the table in a spirit of
collaboration to see what could be achieved
collectively to change course and rein in Medicaid
spending, while at the same time improving quality.
Triple Aim
Improve Member
Experience
Improve Quality of
Care
Decrease Costs
Recent Changes To
Health Care System
Transforming Medicaid System
• 2012: Health Homes Goal: Comprehensive care
management services for high-need populations
• 2014: Delivery System Reform Incentive Payment
(DSRIP) Program Goal: Shift locus of care from acute to
community; reduce unnecessary readmissions
• 2015/2016: Medicaid Managed Care: Capitated
Behavioral Health Goal: Fully capitated system with
managed care plans overseeing integrated behavioral and
general medical care. Up to 150,000 members enrolling in
fully integrated special needs plans for individuals with
serious BH conditions (HARPs)
Transforming Medicaid System
Continues
• 2015: Advanced Primary Care (APC)Goal: 80% of
population receives care in APC setting with focus on
prevention and coordinated care as well as through an
alternative payment model
• 2017: Value-Based Payment Models Goal: Shift
reimbursement model from volume to value: by 2020, 80%
of Medicaid Managed Care provider payments will be in
shared savings arrangements, with 35% of those including
downside risk to providers
HARP
• HARP is an managed care product that manages
physical health, mental health, and substance use services
in an integrated way for adults with significant behavioral
health needs (mental health or substance use).
• HARPs manages an enhanced benefit package that
include
• HARPs provide enhanced care management for
members to help them coordinate all their physical health,
behavioral health and non-Medicaid support needs.
Value Based
Payment Overview
Value Based Payment
‣A way of reimbursing providers focusing on value
instead of volume
‣Focus on Quality – Outcome Driven Service
‣Goals (the Triple Aim):
•Improving Quality
•Reducing Costs
•Improving the member’s
experience
Levels from FFS to full
capitation or bundlingSource: NYS DOH VBP
Bootcamp #1
Population Impacted by VBP
‣ VBP discussed today only applies to the
populations covered by Medicaid Managed Care.
‣ Do you know the populations you serve ?
‣ How much of the care you deliver is impacted by
VBP?
Quality Measures
• VBP arrangements are based on meeting quality outcomes or
targets**:
• Pay for Reporting
• Process measures
◦ Some examples include SBIRT Screening and screening for clinical depression
◦ Medication adherence
• Internal and partnership measures
• Outcome measures
Some examples include: reducing preventable inpatient hospitalizations
and readmissions, Follow-up After Hospitalizations for Mental Illnesses
(within 7 and 30 days)
**There is a lack of good BH rehab measures
Level 0 VBP* Level 1 VBP Level 2 VBP Level 3 VBP
(feasible after experiencewith
Level 2; requires mature
contractors)
FFS with bonus
and/or withhold
based on quality
scores
FFS with upside-only shared
savings available when
outcome scores are sufficient
(For PCMH/IPC, FFS may be
complemented with PMPM
subsidy)
FFS with risk sharing
(upside available when
outcome scores are
sufficient)
Prospective capitation PMPM
or Bundle (with outcome-
based component)
FFS Payments FFS Payments FFS Payments Prospective total budget
payments
No Risk Sharing Upside Risk Only Upside & Downside Risk Upside & Downside Risk
*Level 0 is not considered to be a sufficient move away from traditional fee-for-service incentives to be counted
as value based payment in the terms of the NYS VBPRoadmap.Source: VBP Bootcamp #1
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Types of VBP Arrangements
Myths
1. Everyone must eventually contract at Level 3 (capitation,
sub-capitation)
2. A Payer can only reimburse innovative services if provider
is in a Level 3 contract
3. FFS and government rates are incompatible with VBP
4. You are supposed to do more with less
5. VBP is about reducing the Medicaid Global Cap spend
6. Only PPSs can contract VBP arrangements
7. VBP is about reducing services offered to Medicaid
members
Truths
1. MCOs will be penalized if the Roadmap goals are not achieved
(MCOs may pass penalties onto providers)
2. The State will be providing analytical support to the
VBP stakeholders
3. VBP provides flexibility in contracting - it is not a 'one size fits all'
4. The goal of VBP is to improve the quality of care and shift
spending to keep members as healthy as possible and
integrated in their community
5. VBP implementation is an iterative process - the State will
keep learning as the process moves forward (pilots will play
an important role in this learning)
6. VBP is focused on transparency around costs
7. Providers can continue to be paid FFS while participating in
larger VBP arrangements.
What Does This
Mean
What Does This Mean?
• Does it mean a change in focus from volume to
value? Yes
• Does it mean an emphasis on data
demonstrating outcomes? Yes
• Does this mean participating in partnerships
and networks with other providers? Yes
What Does This Mean?
• Does this require communication and
integration across all healthcare and
social determinants of health sectors? Yes
• Are there are opportunities? Yes
• Will this change how I get paid? Maybe
Resources
‣ NYS DOH Value Based Payment Bootcamps:
• Session #1
• Session # 2
• Session #3
‣ NYS DOH VBP Roadmap
‣ September 2016 NYS MCTAC VBP Conference
‣ NYS DOH VBP HARP Subpopulation VBP Recommendations
April 2016 Report:
‣ contains recommended CAG Measures
‣ Care Transitions Network
‣ Please send any additional questions :
THANK YOU!
VBP AND ME
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Presented by:
Roy Wallach - Arms Acres/Conifer Park – Stakeholder Engagement Workgroup Co-lead
NEXT STEPS FOR VBP AT BHA
Presented by:
Duane Granston
BHA PPS, Project Manager
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Next Steps for VBP at BHA
VBP resource page on website
– Link to VBP videos and resources
• Myths and Facts about VBP
• NYSDOH VBP Bootcamp Series
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Next Steps for VBP at BHA
Columbia University Research and Evaluation Training
• August 14th – 9-4 pm**• Target Audience: non-Medicaid billing
agencies*; (2 staff per agency)– Executive Directors, Program Directors, Supervisors,
Evaluators
• Goal: – Increase knowledge of methods to assess and
evaluate programs
– Identify 3 ways to demonstrate the impact of programs on clinical quality outcomes
*Willing to open training to other partners based on interest
** Tentative Date and Time
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Next Steps for VBP at BHA
• Collaboration with fellow PPSs on VBP through GNYHA workgroup
– Curriculum development
• Review evaluations and feedback from Town Hall to assess next steps
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WRAP-UP AND NETWORKING
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