VillageCareMAX: Road to Value-Based
Payments Continued from page 32
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Key assumptions on this population included the
following:
• The community-based MLTC population is a
chronically ill population at risk of functional
decline, potentially avoidable hospitalizations and
long term nursing facility placement.
• MLTC Plans bear the risk of the functional decline
and long term nursing home placement, while
Medicaid FFS primarily bears the risk of potentially
avoidable hospitalizations.
• MLTC spending per member per month (PMPM),
Personal Care Assistant (PCA) hours and Nursing
Facility Level of Care (NFLOC) scores all indicate
a 3 percent growth on average for persons with
two consecutive assessments 180 days apart, with
significant variation.
In 2017, VillageCareMAX reached an agreement to
pursue this approach using three years of historical
Medicaid FFS data to create a benchmark for Medicaid
FFS spending on hospital and physician costs.
VillageCareMAX was formally awarded a VBP pilot
project in May of 2018. The care model envisions
working with LHCSAs and using technology in the
home, coupled with enhanced care management to
improve member outcomes and reduce hospitalizations
and concomitant further functional decline.
Expansion to an Integrated Product (MAP) Level 2
VBP Arrangement
Over the last several months, VillageCareMAX’s
Medicare Advantage Plans have focused on expanding
their own proprietary physician and hospital
networks that will be well-suited to the dual-eligible
population that the plans serve. As part of that effort,
VillageCareMAX began to work with several physician
groups interested in a risk-based arrangement to jointly
manage both the Medicare and Medicaid portions of
the spend for the Plan’s members. VillageCareMAX
is working closely with these providers to design the
care model, establish communication protocols, create
benchmarks and craft a financial arrangement to ensure
improved member outcomes on the road to shared
savings on total cost of care.
There are many factors to consider when modeling
for VBP. Such factors include costs associated with
provider contracting, medical management, legal,
technology and more. It is also important to work
closely with provider partners to fully understand the
needs of the member and the most efficient methods
of care and reporting. VillageCareMAX continues to
explore pathways to building the most comprehensive
provider network that aligns with organizational goals
for care and achieves the highest possible outcomes.
Future Work on Value-Based Payments
As an enterprise, VillageCare and its Board of Directors
are committed to its not-for-profit mission and
maintaining its tradition of innovation and leadership.
The organization is focused on improving access to
data and insights provided by analytics to accomplish
all goals.
VillageCareMAX is making significant investments
in key areas such as enhancing member experience,
improving provider information, obtaining data from
the member’s home and collaborating with providers
in deep and meaningful ways. All of these investments
lead to a single goal: to improve the quality of care
provided to all VillageCareMAX members.
Adviser a publication of LeadingAge New York | Fall 2018