Below is an announcement from DOH about the launch of NYS’ first Value Based Payment Pilot Program.
We are excited to announce the launch of the State’s first Value Based Payment (VBP) Pilots. The Pilot Program is a first of its kind, two-year program, intended to create momentum in the transition from a fee-for-service to a value based payment environment. VBP Pilots are expected to help the State meet MRT waiver goals by not only establishing early successes, but also through providing invaluable input into the design of VBP in New York State.
Seven (7) provider organizations and eight (8) Managed Care Organizations (MCOs) located throughout the State will be working together as part of the Pilot Program on 13 distinct contracts. These contracts will pilot three (3) types of value based payment arrangements: Health and Recovery Plan (HARP) Subpopulation, Integrated Primary Care (IPC), and Total Care for the General Population (TCGP).
These arrangements are contracted as per the standards outlined in the VBP Roadmap and pilot organizations are required to take on downside risk-sharing VBP responsibilities by the second year of the Program. Pilot organizations will play critical roles in evaluating the validity, feasibility, and reliability of quality measures for their respective arrangements, while also sharing feedback on core aspects of the VBP process (from contracting and financial risk sharing, to use of the Medicaid Analytics Performance Portal (MAPP) analytics).
For their pivotal role as early adopters, VBP pilot organizations will receive support from the Department of Health, and in turn, they will be active participants in providing lessons learned and sharing best practices for statewide VBP implementation.
An additional pilot will be launched in Albany County that will bring together pediatric providers and early childhood stakeholders with MCOs to focus on school readiness.
To learn more about VBP, visit https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform.htm
Participating VBP Pilot Organizations
| Arrangement | Provider | MCO |
| HARP | Maimonides Medical Center | Healthfirst PHSP, Inc. |
| Mount Sinai Health Partners | Healthfirst PHSP, Inc. | |
| IPC | Community Health IPA | Affinity Health Plan, Inc. |
| Hudson Headwaters Health Network | New York State Catholic Health Plan, Inc. | |
| TCGP | Greater Buffalo United ACO | Yourcare Health Plan, Inc. |
| Somos Your Health IPA | Affinity Health Plan, Inc. | |
| Somos Your Health IPA | HealthPlus HP, LLC | |
| Somos Your Health IPA | New York State Catholic Health Plan, Inc. | |
| Somos Your Health IPA | Healthfirst PHSP, Inc. | |
| Somos Your Health IPA | United Healthcare of New York, Inc. | |
| Somos Your Health IPA | Wellcare of New York, Inc. | |
| St. Joseph’s Hospital Health Center | New York State Catholic Health Plan, Inc. | |
| St. Joseph’s Hospital Health Center | TotalCare/Molina Healthcare of New York, Inc. | |
| School Readiness | Albany County Pediatric Providers | Capital District Physicians Health Plan, Inc.
MVP Health Care, Inc. New York State Catholic Health Plan, Inc. United Healthcare of New York, Inc. Wellcare of New York, Inc. |