Adviser Fall 2018 Vol 1 - Page 34

VillageCareMAX: Road to Value-Based Payments Continued from page 32 33 Key assumptions on this population included the following: • The community-based MLTC population is a chronically ill population at risk of functional decline, potentially avoidable hospitalizations and long term nursing facility placement. • MLTC Plans bear the risk of the functional decline and long term nursing home placement, while Medicaid FFS primarily bears the risk of potentially avoidable hospitalizations. • MLTC spending per member per month (PMPM), Personal Care Assistant (PCA) hours and Nursing Facility Level of Care (NFLOC) scores all indicate a 3 percent growth on average for persons with two consecutive assessments 180 days apart, with significant variation. In 2017, VillageCareMAX reached an agreement to pursue this approach using three years of historical Medicaid FFS data to create a benchmark for Medicaid FFS spending on hospital and physician costs. VillageCareMAX was formally awarded a VBP pilot project in May of 2018. The care model envisions working with LHCSAs and using technology in the home, coupled with enhanced care management to improve member outcomes and reduce hospitalizations and concomitant further functional decline. Expansion to an Integrated Product (MAP) Level 2 VBP Arrangement Over the last several months, VillageCareMAX’s Medicare Advantage Plans have focused on expanding their own proprietary physician and hospital networks that will be well-suited to the dual-eligible population that the plans serve. As part of that effort, VillageCareMAX began to work with several physician groups interested in a risk-based arrangement to jointly manage both the Medicare and Medicaid portions of the spend for the Plan’s members. VillageCareMAX is working closely with these providers to design the care model, establish communication protocols, create benchmarks and craft a financial arrangement to ensure improved member outcomes on the road to shared savings on total cost of care. There are many factors to consider when modeling for VBP. Such factors include costs associated with provider contracting, medical management, legal, technology and more. It is also important to work closely with provider partners to fully understand the needs of the member and the most efficient methods of care and reporting. VillageCareMAX continues to explore pathways to building the most comprehensive provider network that aligns with organizational goals for care and achieves the highest possible outcomes. Future Work on Value-Based Payments 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. VillageCareMAX is making significant investments in key areas such as enhancing member experience, improving provider information, obtaining data from the member’s home and collaborating with providers in deep and meaningful ways. All of these investments lead to a single goal: to improve the quality of care provided to all VillageCareMAX members. Adviser a publication of LeadingAge New York | Fall 2018