Town Hall

June 23rd, 2017Tosca Marquee

Bronx, NY

© Bronx Health Access

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 :

‣ MCTAC.info@nyu.edu

THANK YOU!

VBP AND ME

© Bronx Health Access

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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