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
leadingageny.org 32