VillageCareMAX: Road to Value-Based
Payments
31
VILLAGECARE
began in 1977 as a project by community volunteers
to rescue and reorganize a for-profit nursing home
slated for closure. It has developed into a much
larger organization that provides post-acute care,
community-based services and managed long term
care. The organization focused on the geriatric
population until the 1980s, when it found itself in the
epicenter of the burgeoning AIDS crisis. As a not-
for-profit health care organization, the Board and
leadership of VillageCare felt it was critical for the
organization to develop programs to serve those with
HIV and AIDS.
With significant progress made in the treatment
and prevention of HIV/AIDS, VillageCare shifted its
focus by developing additional services to support
the frail and chronically ill living in New York City.
VillageCare opened a post-acute nursing facility,
a Medicaid Assisted Living Program (ALP) and
several community programs. Most notably, in 2012,
VillageCare established a managed long term care
plan, VillageCareMAX MLTC (VCM), and in 2017 added
two dual eligible Medicare-Medicaid plans: a dual
Special Needs Plan (DSNP) and a Medicaid Advantage
Plus (MAP).
Today, VillageCare is a community-based nonprofit
health care organization that serves over 25,000
people, with over 11,000 members in health plans
operated by VillageCareMAX.
VillageCare Rehabilitation and Nursing Center (VCRN)
undertook a full risk arrangement back in 2015, when
the nursing facility joined the Centers for Medicare and
Medicaid Services (CMS) Bundled Payments for Care
Improvement (BPCI) initiative as a Model 3 Episode
Initiator. This arrangement, which recently concluded
due to CMS changes, set a target price based on
historical data for an episode of care. As an example,
rehabilitation for a total hip replacement lasting 30,
60 or 90 days would have a target price that included
total cost of care for an individual with Medicare Fee
for Service (FFS) for a certain diagnosis. This price
included the cost of care for all days in skilled nursing
care as well as home care, durable medical equipment,
physician services, diagnostic testing and the cost of
hospital stay, if the individual was re-hospitalized. CMS
compared the cost of a current episode in the facility
to the target price. If the cost was less than the target
price, the facility retained the savings. If the cost was
greater, however, the facility would owe the difference
to CMS. It was a true Level III risk arrangement –
weighing potential upside to potential downside.
VCRN retains a net savings from participating in this
program to date.
In addition to the BPCI program, VCRN is at risk for
certain managed care payors through case rates which
allow for savings if average length of stay is below
that implied by the case rates. As evidenced at VCRN,
VillageCare has a long history of pursuing innovative
payment models.
Experience with Innovation and Risk
VillageCare has
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Adviser a publication of LeadingAge New York | Fall 2018