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Managed Care Organization (MCO) Baseline Survey - Results

Presentation Providing an Overview of the Results from the MCO Baseline Survey

16/28/2016

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MCO Baseline Survey

NYS VBP Baseline

Year 1 Progress

Year 2 Progress

Calendar Year 2014

Calendar Year 2015

Calendar Year 2016

Year 3 Progress

Calendar Year 2017

Year 4 Progress

Calendar Year 2018

Year 5 Progress

Calendar Year 2019

Starting Point for Statewide and Regional VBP Progress

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CMS Reporting Requirements The Baseline Survey was designed to meet the commitments of the VBP Roadmap for reporting progress to CMS on the Statewide Goal:

Reference Reported Information

NYS VBP Roadmap pg. 2 VBP Progress measured in total dollars and outcomes

NYS VBP Roadmap pg. 2 VBP Implementation guidelines, specifications, and changes to the Roadmap

NYS VBP Roadmap pg. 9 Progress and details on the development of any ‘off menu’ VBP arrangements

NYS VBP Roadmap pg. 21 Details on how MCOs reward high or low performing providers, including expenditure trends per VBP arrangement

NYS VBP Roadmap pg. 31 The annual percentage increase of VBP in the state, providers impacted by

alternate payment arrangements, and percentage of provider payments impacted

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Purpose of the MCO Baseline Survey

• The purpose of this survey was to get a ‘baseline’ for measuring statewide

progress towards both the overall 80-90% VBP Goal and the 35% VBP Target

for Levels 2 and 3

• 56 Health Plans Submitted Surveys, including:

16 Mainstream Managed Care

30 Managed Long Term Care

7 Medicaid Advantage Plus

3 HIV Special Needs Plans

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MCO Baseline Survey OutlineThe survey is broken down into the following eight sections:

Section 1: Contact and Organization Information Section 2: Market Position Section 3: Management Contracts by Administrative FunctionSection 4: Medicaid Managed Care Spending by Category & Reimbursement MethodsSection 5: Regional SpendingSection 6: Use of Quality MetricsSection 7: Patient IncentivesSection 8: Potentially Excluded Costs

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Broad Overview of Results

FFS 63.2%

VBP Level 0 11.3%

VBP Level 1 2.5%

VBP Level 2 20.9%

VBP Level 3 2.1%

VBP Level Spending or %Total Spending $ 22,740,721,858

FFS $ 14,362,684,08863.2%

VBP Level 0 $ 2,575,676,354 11.3%

VBP Level 0 Quality $ 2,036,359,972 9%

VBP Level 0 No Quality $ 539,316,383 2.4%

VBP Level 1 $ 567,583,615 2.5%

VBP Level 2 $4,757,327,628 20.9%

VBP Level 3 $477,450,172 2.1%

VBP Baseline of Levels 1 - 3 for CY 2014: 25.5%

*All unallocated plan spending is included under FFS

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Results by Line of Business: Managed Long Term Care (MLTC) and Medicaid Managed Care (MMC)

FFS/Other94.1%

VBP Level 02.6%

VBP Level 23.3%

MLTC

Plan Type Total FFS/Other VBP Level 0 VBP Level 1 VBP Level 2 VBP Level 3

MLTC$ 5,114,452,482 $ 4,813,251,661 $ 132,294,419 $ 1,749,399 $ 167,157,003 $ -

MMC$ 16,595,927,084 $ 8,698,195,942 $ 2,429,094,296 $ 549,827,893 $4,441,358,780 $ 477,450,172

*All unallocated plan spending is included under FFS

FFS Other52.4%

VBP Level 014.6%

VBP Level 13.3%

VBP Level 226.8%

VBP Level 32.9%

MMC

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Results by Line of Business: Medicaid Advantage Plus (MAP) and HIV Special Needs Plans

FFS/Other100%

HIV SNP

FFS Other46.6%

VBP Level 04.3%

VBP Level 14.8%

VBP Level 244.3%

MAP

Plan Type Total FFS/Other VBP Level 0 VBP Level 1 VBP Level 2 VBP Level 3

MAP $ 335,957,318 $ 156,851,511 $ 14,287,639 $ 16,006,323 $ 148,811,845 $ -

HIV SNP$ 694,384,974 $ 694,384,974 $ - $ - $ - $ -

*All unallocated plan spending is included under FFS

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Comparison with the Catalyst for Payment Reform Survey (CPR)

MCO Baseline Survey VBP Level 0 (with quality) and VBP Levels 1,2,3: 34.5%

Catalyst for Payment Reform –Payments made through a reform methodology: 32.9%

• CPR Survey involved 15 MMCs, while the Baseline Survey took information from 56 plans across MMC, MLTC, MAP, and HIV SNP.

• Baseline ties to MMCOR submissions for CY 2014, while CPR was for CY 2013.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

FFS VBP Level 0w/quality

VBP Level 1 VBP Level 2 VBP Level 3

CPR Baseline

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Regional Breakout for Mainstream Managed Care PlansMMC Regional Total Spending FFS % VBP Level 0 % VBP Level 1 % VBP Level 2 % VBP Level 3 %

All Regions $ 16,595,927,084 49.0% 14.4% 3.5% 26.8% 0.6%

Central $ 1,893,793,991 77.9% 21.9% 0.0% 0.0% 0.2%

Finger Lakes $ 490,881,601 81.9% 17.8% 0.0% 0.0% 0.3%

Long Island $ 954,442,498 54.8% 13.6% 2.1% 28.5% 1.0%

Mid-Hudson $ 568,675,021 68.4% 23.1% 6.8% 1.1% 0.6%

New York City $ 9,002,119,262 36.7% 10.9% 5.7% 46.2% 0.5%

Northeast $ 584,248,201 73.7% 24.7% 0.4% 0.0% 1.3%

Northern Metro $ 730,895,887 71.9% 23.5% 1.7% 1.0% 1.9%Utica-Adirondack $ 388,274,491 60.5% 38.3% 0.0% 0.0% 1.1%

Western $ 1,026,019,489 81.6% 17.8% 0.0% 0.0% 0.6%

*Plans significantly underreported for the regional section of the survey. Variances between amounts reported here and in previous sections reflect these unallocated funds

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Regional Breakout for All Other Lines of Business

Other Regional Total Spending FFS % VBP Level 0 % VBP Level 1 % VBP Level 2 % VBP Level 3 %

All Regions $ 6,144,794,774 88.9% 2.6% 0.3% 5.1% 0.0%

New York City $ 5,811,585,780 91.7% 2.6% 0.3% 5.4% 0.0%Long Island /Northern Metro $ 98,591,520 100.0% 0.0% 0.0% 0.0% 0.0%

Rest of State $ 41,215,726 79.1% 20.9% 0.0% 0.0% 0.0%

• Includes an aggregate of the Managed Long Term Care Plans, Medicaid Advantage Plus Plans and HIVSNP that were surveyed

• Regions for those three lines of business were grouped into the regions listed above

*Health Plans significantly underreported for the regional section of the survey. Variances between amounts reported here and in previous sections reflect these unallocated funds

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Thank You!

SC RecommendationsHARP CAG Final Recommendation Report Final 04252016.pdfIntroductionDelivery System Reform Incentive Payment (DSRIP) Program & Value Based Payment (VBP) Overview

Behavioral Health Clinical Advisory Group (CAG)CAG Overview

Recommendation Report Overview & ComponentsPlaybook Overview – Health and Recovery Plan (HARP)Definition of Subpopulation – Health and Recovery Plan (HARP)Attachment A: GlossaryAttachment B: Available Data Impression4FIntroductionHARP Population6FCriteria used to consider relevance:9FNY STATE HARP FOCUSCLINICAL RELEVANCERELIABILITY AND VALIDITYFEASIBILITY

Categorizing and Prioritizing Outcome MeasuresOverview of CAG Outcome Measure DiscussionBH HARP CAG Recommended Outcome Measures – Category 1 and 2CAG Categorization and Discussion of MeasuresAppendix A:Appendix B:

HIVAIDS Final Report 05062016.pdfIntroductionDelivery System Reform Incentive Payment (DSRIP) Program and Value-based Payment (VBP) Overview

HIV/AIDS Clinical Advisory Group (CAG)CAG Overview

Recommendation Report Overview and ComponentsPlaybook Overview – HIV/AIDSDefinition of Subpopulation – HIV/AIDSAttachment A: GlossaryAttachment B: Available Data Impression– Tentative Data, Validation OngoingHIV/AIDS Clinical Advisory Group (CAG) Quality Measure RecommendationsIntroductionHIV/AIDS SubpopulationSelecting Quality Measures: Criteria Used to Consider Relevance6FClinical relevance Focused on key outcomes of integrated care process

Reliability and validity Measure is well established by reputable organization. Outcome measures are adequately risk adjusted

Feasibility Claims-based measures are preferred over non-claims-based measures (clinical data, surveys). When clinical data or surveys are required, existing sources must be available. Data sources must be patient-level data. Data sources must be available without significant delay.

Meaningful and actionable measures for provider improvement in general

Categorizing and Prioritizing Quality MeasuresOverview of CAG Quality Measure DiscussionHIV/AIDS CAG Recommended Quality Measures – Category 1 and 2CAG Categorization and Discussion of MeasuresCAG Categorization and Discussion of Measures - Category 3Appendix A: Meeting Schedule