1. True Population Health in the Context of VBP
Ryan P. Ashe, Director of Medicaid Payment Reform
New York State Department of Health
September, 2018

2. Agenda Update on Value Based Payment progress
NYS VBP Model and Population Health
SDH / CBO VBP Roadmap Requirements
Considerations as VBP Moves Forward
VBP Roadmap requirements
SDH Intervention Examples

3. Update on Value Based Payment Progress
VBP Roadmap requirements
Update on Value Based Payment Progress
SDH Intervention Examples

4. VBP Progress & Key Milestones
Meeting DSRIP year 3 VBP statewide goals
Reviewing provider progress in VBP
Conducting Pilot Lesson Learned Webinars
NYS Payment Reform
Bootcamps
Clinical Advisory Groups
VBP Pilots
2016
2017
2018
2019
2020
DSRIP Goals
April 2017
April 2018
April 2019
April 2020
Performing Provider Systems (PPS) requested to submit growth plan outlining path to 80-90% VBP
> 10% of total MCO expenditure in Level 1 VBP or above
> 50% of total MCO expenditure in Level 1 VBP or above.
> 15% of total payments contracted in Level 2 or higher
80-90% of total MCO expenditure in Level 1 VBP or above
> 35% of total payments contracted in Level 2 or higher

5. NYS VBP Model & Population Health
VBP Roadmap requirements
NYS VBP Model & Population Health
SDH Intervention Examples

6. requires population health capabilities
New York State Value Based Payment Framework
Support a model that:
Requires a broad network of provider partners that spans the complete care spectrum
requires population health capabilities
VBP Roadmap requirements
SDH Intervention Examples

7. New York State Value Based Payment Design of the Model
Core Components of VBP Model
3 Levels of risk
Quality measures
Attribution
Finance and target budget setting
VBP Arrangements
Population based (total care for a population)
Episodic (primary care and chronic condition)
Social Determinants of Health Interventions & Community Based Organizations
VBP Roadmap requirements
SDH Intervention Examples

8. VBP Arrangements: Population Based & Episodic
General Population Approach
Specialty Population Approach
Behavioral Health
HIV/AIDS
Managed Long Term Care
Intellectually & Developmentally Disabled
Integrated Primary Care
(Preventive Care, Sick Care, 14 chronic Conditions)
Maternity
( Pregnancy, Delivery, Post Delivery (Mom & Baby)
Behavioral Health
Physical Health
Diabetes, Depression, Anxiety, Trauma, Substance Use Disorder, bi-polar disorder, Lower back pain, hypertension
SDH Intervention Examples

9. Evolving provider networks
Develop and build partnerships to include:
Behavioral health providers
Substance use providers
Hospitals
PPS
Community based organizations
Investors
VBP Roadmap requirements
SDH Intervention Examples

10. Population Health Capabilities
Investment in:
primary care infrastructure
care coordination
referral pattern and discharge management activities
care integration… partner primary, acute, home and community based care, physical and behavioral health
Population health data and analytics
Reduce health inequities or disparities among different population groups and address social determinants of health.
VBP Roadmap requirements
SDH Intervention Examples

11. SDH/CBO VBP Requirements
VBP Roadmap requirements
SDH/CBO VBP Requirements
SDH Intervention Examples

12. VBP Roadmap Requirements for CBO & SDH Interventions
Social Determinants of Health Interventions & Community Based Organizations are critical components to the NYS VBP model
Level 2 & 3 arrangements must include at least one CBO and one SDH intervention.
MCOs will provide upfront funding (seed money) to providers which implement SDH interventions in level 2 and 3 arrangements
SDH interventions must address one of five key social determinant of health domains
Economic Stability
Education
Health and Healthcare
Neighborhood and Environment
Social, Family, and Community Context
VBP Roadmap requirements
SDH Intervention Examples

13. How is DOH operationalizing CBO & SDH inclusion?
As part of internal contract review process:
Internal contract review to ensure compliance with VBP Roadmap requirements
SDH/CBO Template to support SDH/CBO requirements
On Menu/ Off Menu Checklist
Ongoing efforts to strengthen and support CBO engagement
Outreach to private investment & philanthropic organizations
Continuing VBP Bootcamps 10/10
Planning SDH & CBO Collaboratives
CBO Directory
SDH Summit 9/26
VBP Roadmap requirements
SDH Intervention Examples

14. SDH Intervention Menu April 2018
The SDH intervention menu provides examples of evidence-based interventions to address SDH
For more information, access the VBP Resource Library on the DOH website

15. SDH Template The Social Determinants of Health (SDH) Template will:
April 2018
SDH Template
The SDH template was created to assist CBOs and MCOs with contracting for SDH
The Social Determinants of Health (SDH) Template will:
identify the contracted CBO
identify the SDH intervention
explain why the SDH intervention was selected
illustrate how the intervention will be measured
understand funds utilization
For more information, access the VBP Resource Library on the DOH website

16. Considerations as VBP moves forward
VBP Roadmap requirements
Considerations as VBP moves forward
SDH Intervention Examples

17. Key considerations as MCOs, providers and CBOs move forward in VBP
Streamline contracting between parties, MCOs, providers and CBOs
Consider CBO hub “concept”
Explore opportunity for third party investment in shared savings arrangements
Engage partners early and often
Keep in mind the VBP milestones
50% Level 1 & 15% Level 2 by April 2019
80% Level 1 & 35% Level 2 by April 2020
VBP Roadmap requirements
SDH Intervention Examples

18. CBOs: Determine the pathway forward
General Guidelines:
Your organization’s proposal may be different depending on your partner
Define your proposal, cost, timeline, impact, outcomes (health & financial)
Streamline contracting
Keep in mind 5 main buckets
Identify the intervention:
Align intervention to your potential partners
Regional considerations (rural – access to care, opioids)
Global, national or local recognition that intervention is successful
Define the concept
Start w/ manageable size, then expand
Is it a Food security initiative or food security that combines wellness visit for seniors?
VBP Roadmap requirements
SDH Intervention Examples

19. CBOs: Determine the pathway forward
2. Identify your contracting mechanism & support:
MCO or provider contract
Philanthropy (local)
Private equity
Combination of approaches:; contract with MCO and include philanthropy)
VBP Roadmap requirements
3. Build the value proposition
Necessary upfront investment
Determine ROI (health outcomes and financial)
Metrics
Timeline
Scalability
Impact
SDH Intervention Examples

20. CBOs: Engaging in value based payment
4. Engage your partners:
Engage early and often
Understand the members MCOs and/or providers serve (overlap)
Providers are an option
Be flexible
Build relationships!!
VBP Roadmap requirements
5. Make the pitch
Prepare
Build support (foundations, government, MCOs, providers, philanthropy, advocates, etc.)
Stay connected to your partners
SDH Intervention Examples