Value Based Payment Quality Improvement Program (VBP QIP)

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February 28, 2018

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 P4R Updates

VBP QIP P4R – Service Exclusion Waiver

  • Reminder that applications for the Service Exclusion Waiver are being accepted through June 27, 2018.
  • Facilities may find the application for the Service Exclusion Waiver on the VBP QIP website.
  • Waiver adjusts requirement to include only Inpatient & Emergency Department Medicaid Managed Care Dollars:
Original Calculation:
Medicaid Managed Care
dollars in VBP arrangement
Total Medicaid Managed
Care dollars
Calculation with Waiver:
Inpatient & ED Medicaid
Managed Care dollars in VBP arrangement
Total Inpatient & ED Medicaid
Managed Care dollars

VBP QIP P4R – Contract Submission Deadline

DOH will now allow facilities to submit contracts without penalty through June 29, 2018* although facilities are encouraged to submit sooner if possible.

If the June 29, 2018 deadline is missed, the same penalty will apply and will be assessed over the remaining 9 months in the Demonstration Year.

With the revised deadline, contracts should have an anticipated effective date of October 1, 2018.

DOH strongly encourages facilities submitting amended contracts to submit by March 31, 2018 so they can have an effective date of July 1 and avoid any gap between contracts. However, amended contracts will be accepted until the June 29, 2018 deadline.

* Due date is listed as June 29, 2018 since July 1, 2018 falls on a Sunday

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VBP QIP Contracting

Contracting Status

Deliverable Submission/Review Contract Preparation Contract Finalization/Execution
July – Sep 2017 Oct – Dec 2017 Jan– Jun 2018
  • Facilities submitted all LOIs
  • Facilities submitted one Level 1 VBP contract to DOH
  • Facilities received 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

Please include "VBP QIP" in the subject line of your contract submissions so they can be easily identified as VBP QIP contracts.

VBP Contract Review

  • Facilities are required to submit Level 1 (or higher) VBP contracts with the MCOs required to meet the 80% VBP target by June 29, 2018. The facilities should submit information in accordance with the timeline below.
June 29, 2018
  • Contracting MCO must submit new or amended VBP Contract and the following documentation to DOH contracts group for review
    • Contract Statement and Certification Form
    • MCO assigned unique identifier
    • April 1, 2017 Standard Clauses and the contract must contain the April 1, 2017 Standard Clause Incorporation language
    • Off Menu Supplemental Checklist, as required
    • Contract Attestation (sent by facility to DOH and paired MCO)
August 4, 2018
  • DOH will provide feedback to the contracting MCO, the VBP QIP Facility, and the PPS 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.
August 18, 2018
  • Contracting MCO submits updated contract along with the updated contract statement and certification form to DOH contracts group.
September 28, 2018
  • DOH contracts group makes determination if the contract meets requirements.
  • Contracting MCO, VBP QIP Facility, and PPS 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 Penalty Adjustments

VBP QIP Penalty Assessment

For any missed P4R or P4P requirements, penalties will be reflected in the January rate package. However, MCOs have three (3) options when it comes to paying their facilities:

Option 1 Plans may elect to hold (in lump sum) the penalty assessed to the facility from their normal rate payments
Option 2 Plans may elect to keep paying the full funding to the facility and then recover the penalty amount from the facility in knowledge that the State will recover the penalty in a reconciliation of the relative fiscal year.
Option 3 Plans may elect to prorate the penalty over the course of the associated fiscal year.
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VBP QIP Program Reminders

VBP QIP Roles and Responsibilities

PPS Role
  • Provide support (non–financial) and guidance to participating facilities
  • Flow funds from the MCO to the facility
  • Monitor facility´s performance
Facility Role
  • Report quality measure performance to the MCOs
  • Regularly review your FTP to ensure implementation is in accordance with contractual obligations to move towards VBP
  • Improve quality of care
  • Achieve financial sustainability over duration of the program
  • Engage in continuous communication with PPS and MCOs regarding obstacles and successes
DOH Role
  • Provide MCOs with criteria for funds distribution and program administration that aligns with NYS VBP Roadmap
  • Fund the program through MCO Per Member Per Month (PMPM) rate increases inclusive of an administrative fee
  • Provide contracting guidelines and recommendations
  • Monitor the facilities´ sustainability plans and status
  • Communicate facilities´ success/risk with OPCHSM
MCO Role*
  • Validate reporting
  • Communicate with the facility and PPS
  • Collaborate
  • Oversee program
  • Distribute and report on funds

* MCOs are NOT responsible for ensuring that the facilities achieve the goals of VBP QIP

VBP QIP – Penalties

  • 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 by June 29, 2018, 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 facility 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 31, 2018 Facility
Submit QIT Payment report to DOH for DY2Q4 Wednesday, January 31, 2018 MCO
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
Collect and report DY3 Q3 P4P data to MCO Monday, April 30, 2018 Facility
All VBP Contracts with 80% funds in VBP arrangements due to DOH Sunday, July 1, 2018 Facility

Deliverable Submission

Report Submitted by Submitted to Frequency Location
VBP QIP Contracts MCOs DOH As updated
Remaining contracts due Facilities MCOs & DOH July 1, 2018
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 Contracts, Contract Statement and Certification form Contracting MCOs DOH As completed or updated
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Important Information

VBP Support Materials

VBP Resource Library:
VBP Website:

Thank you for your continued support with VBP QIP!

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