While we wait for the final details to be worked out on the New York State budget, a general re-statement of the Department of Health’s (DOH’s) intentions on the move to value-based payment (VBP) may be of interest. The Medicaid Redesign Team recently released a draft clarification to the VBP Roadmap, outlining the proposed future roles and responsibilities of intermediary or “middle-layer” organizations that lie between the State and front line providers.
These intermediaries assist in DOH’s efforts to move the Medicaid program from fee for service (FFS) to VBP payment methodologies in order to improve population health, quality of care and efficiency of care. The kinds of organizations include, but are not limited to:
- Mainstream and specialized Managed Care Organizations (MCOs);
- Performing Provider Systems (PPSs);
- Independent Practice Associations (IPAs);
- Accountable Care Organizations (ACOs);
- Behavioral Health Care Collaboratives (BHCCs);
- Health Homes (HHs);
- Qualified Entities (QEs); and
- Patient Centered Medical Homes (PCMHs).
Noteworthy in the document are statements reflecting DOH’s policies and intentions regarding:
- The shift of care management and population health management responsibilities from MCOs towards provider-led organizations;
- The long term focus of PPS on population health coordination and the requirement for a transition plan of PPS functions if a PPS will not continue;
- The full delegation of complex care management to HHs funded by an MCO capitation pass-through, while acknowledging the need for process improvement at some HHs; and
- Elimination of PCMH add-on payments for PCMHs that do not engage in VBP contracts of Level 1 or higher.
Stakeholder feedback is invited, and should be sent to VBP@health.ny.gov. The full draft of the Structural Roadmap is attached.