Adviser Fall 2018 Vol 1 - Page 32

VillageCareMAX: Road to Value-Based Payments 31 VILLAGECARE began in 1977 as a project by community volunteers to rescue and reorganize a for-profit nursing home slated for closure. It has developed into a much larger organization that provides post-acute care, community-based services and managed long term care. The organization focused on the geriatric population until the 1980s, when it found itself in the epicenter of the burgeoning AIDS crisis. As a not- for-profit health care organization, the Board and leadership of VillageCare felt it was critical for the organization to develop programs to serve those with HIV and AIDS. With significant progress made in the treatment and prevention of HIV/AIDS, VillageCare shifted its focus by developing additional services to support the frail and chronically ill living in New York City. VillageCare opened a post-acute nursing facility, a Medicaid Assisted Living Program (ALP) and several community programs. Most notably, in 2012, VillageCare established a managed long term care plan, VillageCareMAX MLTC (VCM), and in 2017 added two dual eligible Medicare-Medicaid plans: a dual Special Needs Plan (DSNP) and a Medicaid Advantage Plus (MAP). Today, VillageCare is a community-based nonprofit health care organization that serves over 25,000 people, with over 11,000 members in health plans operated by VillageCareMAX. VillageCare Rehabilitation and Nursing Center (VCRN) undertook a full risk arrangement back in 2015, when the nursing facility joined the Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative as a Model 3 Episode Initiator. This arrangement, which recently concluded due to CMS changes, set a target price based on historical data for an episode of care. As an example, rehabilitation for a total hip replacement lasting 30, 60 or 90 days would have a target price that included total cost of care for an individual with Medicare Fee for Service (FFS) for a certain diagnosis. This price included the cost of care for all days in skilled nursing care as well as home care, durable medical equipment, physician services, diagnostic testing and the cost of hospital stay, if the individual was re-hospitalized. CMS compared the cost of a current episode in the facility to the target price. If the cost was less than the target price, the facility retained the savings. If the cost was greater, however, the facility would owe the difference to CMS. It was a true Level III risk arrangement – weighing potential upside to potential downside. VCRN retains a net savings from participating in this program to date. In addition to the BPCI program, VCRN is at risk for certain managed care payors through case rates which allow for savings if average length of stay is below that implied by the case rates. As evidenced at VCRN, VillageCare has a long history of pursuing innovative payment models. Experience with Innovation and Risk VillageCare has VillageCare has long history history a a long of of being being on on the the leading edge. leading edge. Adviser a publication of LeadingAge New York | Fall 2018