Value Based Payment Quality Improvement Program (VBP QIP)

Update Webinar

  • Webinar also available in Portable Document Format (PDF)

December 20, 2017

Today´s Agenda

VBP QIP Financing

VBP QIP Financing – Demonstration Year 3 (DY3) Pairings

VBP QIP SFY 17–18 Pairings & Funding

MCO PPS Facility Gross Funding
Affinity Maimonides Medical Center Brookdale Hospital $31,000,000
Montefiore Hudson Valley Collaborative St. Joseph´s Hospital $7,800,000
Amerigroup Nassau Queens Performing Provider System, LLC Nassau University Medical Center TBD
Advocate Community Partners Jamaica Hospital $16,000,000
Emblem Health (HIP) Health and Hospitals Corp. Health and Hospitals Corp. TBD
Excellus Central New York Collaborative, Inc. Lewis County General Hospital $2,036,000
Finger Lakes Performing Provider Systems, Inc. Orleans Community Hospital $1,434,039
St. James Mercy Hospital $1,844,635
Wyoming County Community Health $1,000,000
Mohawk Valley PPS A O Fox Memorial Hospital $1,000,000
Fidelis Maimonides Medical Center Interfaith Medical Center $50,000,000
Kingsbrook Jewish Medical Center $50,000,000
Montefiore Hudson Valley Collaborative Montefiore–Mount Vernon $11,096,728
Nyack Hospital $17,747,861
Nassau Queens Performing Provider System, LLC St. John´s Episcopal $27,650,000
Westchester Medical Center Bon Secours Charity Health $2,898,070
Good Samaritan Hospital Suffern $2,000,000
Advocate Community Partners Jamaica Hospital $9,000,000
HealthFirst Maimonides Medical Center Brookdale Hospital $109,000,000
MetroPlus Health and Hospitals Corp. Health and Hospitals Corp. TBD
MVP Montefiore Hudson Valley Collaborative Montefiore – New Rochelle $20,837,141
Westchester Medical Center Health Alliance (Benedictine) $2,999,926
United Health Plan Central New York Care Collaborative, Inc. Rome Memorial Hospital $1,000,000
Maimonides Medical Center Wyckoff Heights Medical Center $70,000,000
WellCare Montefiore Hudson Valley Collaborative St. Luke´s Cornwall $19,301,520
Total VBP QIP Funding $455,645,920

* VBP QIP funding amounts do not include premium admin, surplus, or taxes

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VBP QIP Contracting

VBP QIP Contracting

  • In reviewing the LOIs submitted in DY3, the Division of Health Plan Contracting and Oversight (DHPCO) raised the issue that there were many MCO (plan) names that are not regulated by DOH.
    • This may occur if a facility attempting to enter a VBP arrangement with an IPA or if the plan has a subcontract
  • In order for a contract to be counted towards the VBP QIP milestone of 80% of Medicaid managed care payments in a VBP arrangement, DHPCO must be able to easily identify the DOH–regulated MCO and the VBP QIP facility that the contract is between.
The following is a comprehensive list of plans that are regulated by DOH:
  • Affinity Health Plan, Inc.
  • Amida Care Inc.
  • Capital District Physicians´ Health Plan, Inc.
  • Crystal Run Health Plan, LLC
  • Excellus Health Plan, Inc.
  • Health Insurance Plan of Greater New York, Inc. (Emblem)
  • Healthfirst PHSP, Inc.
  • HealthNow of New York, Inc.
  • HealthPlus HP, LLC (fka Amerigroup)
  • Independent Health Association, Inc.
  • MetroPlus Health Plan, Inc.
  • Molina Healthcare of New York, Inc.
  • MVP Health Plan, Inc.
  • New York State Catholic Health Plan, Inc (Fidelis)
  • UnitedHealthcare of New York, Inc.
  • VNS (d/b/a VNSNY Choice) and Subsidiary
  • WellCare of New York, Inc.
  • YourCare Health Plan, Inc.

Contracting Status

Deliverable Submission/Review Contract Preparation Contract Finalization/Execution
July – Sep 2017 Oct – Dec 2017 Jan– Mar 2018
  • Facilities submitted all LOIs
  • Facilities submitted one Level 1 VBP contract to DOH
  • Facilities will receive determination on whether contract meets requirements on Sep 29
  • Facilities to begin engaging with MCOs with whom they have an LOI
  • Facilities and MCOs expected to have agreed on risk/shared savings, quality metrics
  • Facilities and paired MCOs should finalize details of contract including data collection methods and physician network
  • Contracts must be nearing readiness for submission*
*While contracts are due on April 1, 2018, contracts should not have effective dates of April 1, 2018. The contracts should contain effective dates of July 1, 2018 for VBP contracts submitted on April 1, 2018 to allow time for review by DHPCO.

VBP Contract Review for Contract Attestations

Facilities are required to have Level 1 (or higher) VBP contracts with the MCOs required to meet the 80% VBP target by April 1, 2018. The facilities should submit information in accordance with the timeline below.

October 2, 2017 –March 30, 2018
  • Contracting MCO must submit new or amended VBP Contract and the following documentation to DOH contracts group for review contract@health.ny.gov:
    • Contract Statement and Certification Form
    • MCO assigned unique identifier (if amended)
    • Standard Clauses, as needed
    • Off Menu Supplemental Checklist, as required
    • Contract Attestation (sent by facility to DOH and paired MCO)
 ⇒ May 4, 2018
  • DOH contracts group will provide feedback to the contracting MCO and the VBP QIP Facility that either:
    1. Contract is in alignment with the NYS Roadmap and no further updates are needed.
    2. Updates are needed and provide feedback on elements that should be updated to meet roadmap requirements.
 ⇒ May 18, 2018
  • Contracting MCO submits updated contract along with the updated contract statement and certification form to DOH contracts group.
 ⇒ July 1, 2018
  • DOH contracts group makes determination if the contract meets requirements.
  • Contracting MCO and VBP QIP Facility are notified of DOH determination.
  • VBP QIP paired MCO is also notified of DOH determination.

Off–menu contracts may take DOH additional time to review. Therefore, if there are delays in DOH feedback, paired MCOs should continue paying out funds for attestation. The paired MCO can perform a reconciliation in the future if the requirement is not met.

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VBP QIP Program Reminders

Sepsis Reporting

For the facilities that selected the 3–Hour Sepsis Bundle

  • Facilities only received one quarterly report this year, January – March
  • The data from that report was not forwarded to the PFP due to revisions in the measure specifications
  • The next reports are scheduled to be released approximately 3–weeks after the data deadline of December 22. Those reports will include Q1, Q2, and Q3 results

VBP QIP P4P – Retiring Measures

  • In the event a facility has selected a measure that has been identified to be retired:
    • The facility must select a substitute measure from the same measure focus area/domain (i.e., timely and effective care)
  • The process once a substitute measure is selected:
    • Facility submits a measure selection form prior to the expiration of the retiring measure
    • Upon DOH approval, the facility notifies the MCO of the new measure selected
    • Facility submits the baseline and quarterly performance retroactively to 6/2017*
    *All activities originally performed in 6/2017 will need to be completed for the new substitute measure

VBP QIP P4P – Penalty

  • The table below outlines the allocation of P4R and P4P funds in years DY3 through DY5
  DY3 DY4 DY5
VBP Contracting Progress (P4R) % 50% (Paid in Q1 and Q2) 20% 0%
Performance Improvement (P4P) % 50% (Paid in Q3 and Q4) 80% 100%
  • If the facility is unable to meet the DY4 P4R requirement of 80% of total Medicaid MCO contracted payments tied to at least a Level 1 VBP arrangement, the facility will forfeit 20% of their available award in DY4.
  • If the facility remains unable to reach this milestone by April 1, 2019, the PPS will forfeit 50% of the DY5 P4P award.

Key Deliverable Deadlines

  • Beginning DY3 Q4, quality measure performance will drive payment.
  • Quarterly Improvement will be considered achieved for a measure if the most recently completed quarter´s annual rolling results indicate maintaining or improving the level of quality over the preceding quarter´s annual rolling results regardless of the magnitude of improvement.
Measurement Quarter DY2 Q4 DY3 Q1
Measurement Period 4/1/2016 – 3/31/2017 7/1/2017 – 6/30/2017
MCO Reviews Achievement, Prepares Payment 9/30/2017 12/31/2017
MCO Releases Monthly Payments for QIT Achievement Oct – Dec (2017) Jan – Mar (2018)
MCO Sends P4P Performance Report to DOH 1/31/2018 4/30/2018

VBP QIP Timeline

Description of Event/Task Deadline/Date Completed Responsible Party
Review and approve DY3 Q1 QITs and begin preparing payment Friday, December 29, 2017 MCO
DY3 Q3 measurement period ends Sunday, December 31, 2017 N/A
Collect and report DY3 Q2 P4P data to MCO Wednesday, January 21, 2018 Facility
Review and approve DY3 Q2 QITs and begin preparing payment Friday, March 30, 2018 MCO
DY3 Q4 measurement period ends Saturday, March 31, 2018 N/A
All VBP Contracts with 80% funds in VBP arrangements due to DOH Sunday, April 1, 2018 Facility
Collect and report DY3 Q3 P4P data to MCO Monday, April 30, 2018 Facility

Deliverable Submission

Report Submitted by Submitted to Frequency Location
VBP QIP Contracts MCOs DOH As updated contract@health.ny.gov
Remaining contracts due Facilities MCOs & DOH April 1, 2018 vbp_qip@health.ny.gov
Documentation of achievement of P4P metrics Facilities MCOs Quarterly VBP QIP paired MCO
Documentation of approval of P4P deliverables, supporting documentation, and payment date MCOs DOH One month after payment quarter vbp_qip@health.ny.gov
VBP Contracts, Contract Statement and Certification form Contracting MCOs DOH As completed or updated contract@health.ny.gov
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VBP QIP Survey Follow–up

Survey Feedback and Escalation

  • Main Feedback
    1. Deadline extension beyond 4/1/18
    2. Contract dates not aligning with the program

The State remains committed to enabling facilities to move into meaningful VBP contracts as a means to long–term sustainability, and is working to remove administrative roadblocks.

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Important Information

VBP Support Materials

VBP Resource Library:
VBP Website:

Thank you for your continued support with VBP QIP!

  • The next VBP QIP Update Webinar is scheduled for January 24th 2018.
  • For questions on VBP QIP quality measures, please email the SPARCS BML at sparcs.submissions@health.ny.gov with "VBP QIP Measures" in the title.
  • For questions on VBP QIP financing, please contact bmcr@health.ny.gov.
  • For other questions on VBP QIP, please contact the VBP QIP inbox at vbp_qip@health.ny.gov.
  • For questions regarding VAP or VAPAP, please contact vapap@health.ny.gov.
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