Value-Based Payment Reform
As part of the requirements for NYS receiving DSRIP investments from the federal government, a multi-year roadmap for comprehensive payment reform needed to be developed. This Roadmap was submitted to CMS and received approval on July 22, 2015.
An annual update to the Roadmap is provided to CMS. The latest information is listed here.
- Final Approved New York State Roadmap for Medicaid Payment Reform – April 2017 (PDF, 1MB)
- 2016 Annual Update to the New York State Roadmap for Medicaid Payment Reform – Submitted to CMS For Approval – June 2016 Draft
- Reader´s Guide: A Path toward Value Based Payment: Annual Update – March 2016
- VBP Sub Committee Recommendations Report – February 2016 (PDF, 1MB)
The NYS Council is a member of the NYS Value-Based Payment (VBP) Workgroup that helped to develop the Roadmap and continues to work with the State on Annual Updates. With our members, we have submitted numerous comment letters along the way.
- September 12, 2017 – NYS Council Comments on Technical Specifications for the 2018 Value Based Payment (VBP) Quality Measures Set and the 2018 Quality Assurance Reporting Requirements
- April 8, 2016 – NYS Council Comments on VBP Roadmap Annual Update
- January 27, 2016: NYS Council Comments on VBP Recommendations
- November 4, 2015: NYS Council Comments on Early Draft Subcommittee Recommendations
- October 30, 2015: NYS Council Comments on VBP Sub Recommendations
- March 27, 2015: NYS Council Comments on VBP
In September 2015, the NYS Council offered two webinars presented by Health Management Associates on VBP and Community Behavioral Health. These webinar are available on the Archived Events page of our site.
DOH has also held webinars related to VBP:
VBP University and Bootcamp Information:
The NYS Department of Health has completed six Value Based Payment Bootcamps with over 2,500 participants statewide! The webcast recording of the Albany Bootcamp session, all course presentations, and supplemental materials are now posted on the DOH website here: https://www.health.ny.gov/heal
Additional VBP University semesters will be released in the near future. Staff may continue to complete semesters 1-3, and quizzes for the semesters to receive a certificate of completion. Certificates will be sent via email on a quarterly basis.
For more information on VBP University please visit https://www.health.ny.gov/heal
Remember to keep the conversation going online around VBP by following @NewYorkMRT on Twitter and using the hashtag #NYSLearnsVBP. Please send any questions to VBP@health.ny.gov.
The VBP University is designed to be an academic resource to raise awareness, knowledge and expertise in the move to VBP. In order to obtain a VBP Certificate of Completion, students must complete and pass* the quiz at the end of each semester and attend a VBP Bootcamp.
Details about the archived and upcoming VBP University sessions is available here.
The VBP Bootcamp regional learning series was provided by the Department of Health to plan and provider communities throughout the State between June and October of 2016, in order to fill payment reform knowledge gaps and ensure successful transition to VBP implementation. The series was completed over the course of three all-day sessions in each of five Bootcamp regions throughout the State.
The archive of the VBP Bootcamp is available here from the Resource Library.
January 3, 2019 – The 2019 VBP Quality Measure Sets and the 2019 VBP Reporting Requirements Technical Specifications Manual for Measurement Year (MY) 2018 are now available on the Value Based Payment (VBP) Resource Library website.
The 2019 VBP Quality Measure Sets were reviewed and approved by the VBP Workgroup in 2018 as part of the Annual Measure Review Cycle. Measure sets were compiled in collaboration with State agency partners, including the Office of Mental Health and the Office of Alcoholism and Substance Abuse Services. The following 2019 measure sets are now available on the VBP website:
- HARP Measure Set (special needs population type arrangement)
- HIV /AIDS Measure Set (special needs population type arrangement)
- Maternity Measure Set
- Total Care for the General Population (TCGP) & Integrated Primary Care (IPC) Measure Sets
The 2019 quality measure sets can be found by clicking on the following link and looking under the VBP Quality Measures subheading tab: https://health.ny.gov/health_
Additionally, the 2019 VBP Reporting Requirements Technical Specifications Manual for MY 2018 has also been posted. The purpose of this document is to make stakeholders aware of the quality measure reporting requirements for Medicaid Managed Care Organizations (MCOs) participating in the New York State Medicaid VBP program. The contents of this document include an overview of the specific reporting requirements for Category 1 measures for each VBP arrangement, a description of the changes to the measure sets from MY 2018 to MY 2019, and detailed instructions regarding additional file specifications required for the VBP program.
The changes added to reporting requirement include a field that identifies the Contractor ‘DBA’ Name and Contractor Type. The document can be found on the VBP Resource Library website here: https://health.ny.gov/health_
February 16, 2018 – DOH has announced the release of the 2018 Value Based Payment (VBP) Arrangement Fact Sheets for the Total Care for the General Population (TCGP), Integrated Primary Care (IPC), Health and Recovery Plan (HARP) Subpopulation, HIV/AIDs Subpopulation and Maternity Care Arrangements.
The Measurement Year 2018 Fact Sheets provide an overview of the New York State Medicaid Value Based Payment Arrangements, including a high-level description of:
- Types of care included in the arrangement,
- Method used to define the attributed population for the arrangement,
- Calculation of associated costs under the arrangement, and
- Quality measures recommended for use in the arrangement.
The documents can be found on the VBP Resource Library under the VBP Arrangement Fact Sheets tab; Measurement Year 2018 Fact Sheets.
January 29, 2018 – The state’s VBP ‘Off Menu’ section is now available online. Off-Menu VBP arrangements (OMA) is intended to provide flexibility for entities who wish to address market specific needs. However the Off-Menu option is not built to support changes to VBP arrangements defined in the NYS VBP Roadmap (the “Roadmap”). VBP arrangements (whether ‘off menu’ or not) require approval by the state and must conform with certain elements and criteria discussed at the link below and in the state’s VBP Roadmap – Updated Version 2.
September 30, 2017 – DOH has released another video in the whiteboard series titled, “What CBOs Need to Know to Be Successful in VBP.” In the video, NYS Medicaid Director, Jason Helgerson, describes the top 5 things that Community Based Organizations (CBOs) need to know in order to be successful in the move to Value Based Payment (VBP). He also discusses how CBOs can get involved in the transition to VBP.
August 25, 2017 – DOH hosted a webinar discussing the role of CBOs and Social Determinants of Health in New York’s Value Based Payment initiative. NYS Council notes are available here. Power Point slides and a recording from the presentation will be available soon.
May 10, 2017 – State Medicaid Director Jason Helgerson has developed a new (May 3) video Whiteboard presentation on VBP.
October 28, 2016 - The state’s Value Based Payment Behavioral Health Clinical Advisory Group (CAG) released recommendations for how to structure value-based payments for chronic behavioral health conditions.
October 20, 2016 – NYS stakeholders with a specific interest in children’s healthcare came together for the first of three meetings of a newly minted Value Based Payment sub-committee, the Children’s Health VBP Subcommitte/Clinical Advisory Group (CAG).
NYS Council member agency representatives at the NYS Children’s Health VBP Subcommittee/Clinical Advisory Group (CAG) table include:
- John Kastan, Chief Program Officer, The Jewish Board (NYS Council Board President) https://jewishboard.org
- Fern Zagor President & CEO, Staten Island Mental Health Society http://simhs.org
- William (Bill) Gettman Jr., CEO, Northern Rivers Family of Services http://www.northernrivers.org
- Audrey LaFrenier, President/Chief Operating Officer, Northern Rivers Family of Services http://www.northernrivers.org
- Lauri Cole, Executive Director, NYS Council for Community Behavioral Healthcare (appointed member of NYS Value Based Payment Main Workgroup) www.nyscouncil.org
*Northern Rivers Family of Services (members Northeast Parent & Child Society, Parsons Child & Family Center)
- VBP Roadmap (2017 Update)
- VBP Roadmap (2016 update)
- Value-Based Payment Models for Medicaid Child Health Services (Bailit Health)
- Poverty and Child Health in the United States
- Effects of Social Needs Screening and In-Person Service Navigation on Child Health
- You Get What You Pay For: Measuring Quality in Value-Based Payment for Children’s Health Care
- Understanding Medicaid Utilization for Children in New York State: Data Brief and Chartbook
- Shifting the Care and Payment Paradigm for Vulnerable Children
For more details on Value-Based Payment Reform, you can go to the NYS Web site.