Adviser Fall 2018 Vol 1 - Page 33

Applying Experience and Knowledge to Managed Care Value-Based Payments Through knowledge gained in the organization of risk arrangement at VCRN, VillageCareMAX embraced the New York State Department of Health (DOH) Value-Based Payments (VBP) roadmap early on by training leaders, managers and staff in the principles behind the roadmap. Additionally, the Plan established an internal VBP Workgroup when Value-Based Payments became mandated for all MLTCs in the fall of 2017. The workgroup set out to develop a VBP strategy that included: • Limiting contract variation; • Choosing actionable quality measures; • Enabling success through data; • Provider Scorecard on Quality Metrics; • Gaps in Care reporting; • Measuring performance against plan goals; and • Customizing provider outreach. VillageCareMAX identified the need to leverage key relationships with Licensed Home Care Services Agencies (LHCSAs) in the Plan’s network to ensure success while recognizing that significant consolidation of agencies would occur in the process. A team comprised of provider relations, business development, strategy, data/analytics, quality and plan operations conducted provider outreach to select agencies for purposes of gauging appropriate agencies for the Plan to partner with in 2018. Criteria set for LHCSAs to participate included: • Willingness to collaborate; • Infrastructure for training; • Understanding and willingness to work toward performance measures; • Significant level of enrollment; • Size and fiscal health of agency; • Geographic coverage; and • Cultural and language competencies. MLTC Total Cost of Care Pilot with DOH An exciting element in the DOH roadmap was the potential for pilot projects for the Total Cost of Care for the MLTC population. The goal for these pilots was to work toward integration and reduce the rate of decline for MLTC members. VillageCareMAX spent several months exploring options to work with Medicare contractors and ultimately looked to contract with DOH on Medicaid FFS members (approximately 15 percent of membership) of the MLTC. 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. As an enterprise, VillageCare and its Board of Directors are committed to its not-for-profit mission and maintaining its tradition of innovation and leadership. The organization is focused on improving access to data and insights provided by analytics to accomplish all goals. Continued on page 33 32