Class 2

Question 1

Value

Answer 1

Defined as outcomes relative to costs
Value = outcomes/costs
We can increase value by improving outcomes or lowering costs

Question 2

Value-Based Care

Answer 2

High value, cost-conscious care that aims to assess the benefits, harms, and cost of interventions and consequently to provide care that adds value

Question 3

Improved health outcomes

Answer 3

Lower mortality and morbidity

Better experience of care/satisfaction

Question 4

Goal of value based Care

Answer 4

To have people live longer, healthier lives at a sustainable cost

Question 5

Shared Characteristics of Organizations Delivering High Value care

Answer 5

Importance of primary and preventive care
•Focus on keeping people out of hospital
•Emphasis on innovation and change
•Focus on quality measures
•Electronic health record systems

Question 6

Current Payment Model: FFS

Answer 6

More Services = More $$$

Danger for Overuse = Higher spending and unnecessary services

Question 7

Alternative to FFS: Capitation

Answer 7

Provider is paid a fixed amount on a PMPM basis
Less services = more money for provider
Danger for underuse, withholding appropriate care + increased risk for reducing overall quality of care

Question 8

The shift to VBP

Answer 8

• NYS Medicaid: 80-90% VBP by 2020

- Federal Medicare HHS: 90% Medicare FFS to VBP by 2018

Question 9

Medicaid Access and CHIP Reauthorization Act (MACRA)

Answer 9

• Repeals Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians
• Creates new framework for rewarding physicians for providing higher quality of care and incentivizing value over volume
• Streamlines multiple quality program and provides bonus payments by establishing 2 tracks (MIPS and AAPMs)

Question 10

MACRA track: Merit-based Incentive Payment Systems (MIPS)

Answer 10

A single MIPS composite performance score in 4 weighted performance categories:
• Quality
• Meaningful Use
• Resource Use (Cost)
• Clinical Practice Improvement Activities

Question 11

Exclusions to MIPS

Answer 11

• Newly enrolled Medicare clinicians for the first year
• Clinicians who are below the low volume threshold: (1) Medicare Part B allowed charges less or equal to will factor in performance $30K OR (2) 100 or fewer Medicare Part B patients
• Clinicians significantly participating in Advanced APMs

Question 12

MACRA track: Advanced Alternative Payment Models (AAPM)

Answer 12

APM is a payment approach that changes the way CMS pays for care under Medicare. AAPMs are a subset of APMs that offer greater rewards.

Question 13

AAPM characteristics

Answer 13

• Participants must take on two sided risk
• Move from volume to value
• Medicare revenue requirements apply
• Bonus of 5% for 2019-2024

Question 14

Examples of AAPM

Answer 14

• Certain ACOs
• Comprehensive Care Plus (CPC+) Program
• Certain Bundled Payment arrangements

Question 15

Why DSRIP

Answer 15

NYS 2010 Medicaid crisis:

• unsustainable growth rate at > 10% while outcomes lagging
• Costs per patient double national average
• 50th in country for avoidable hospital use
• 21st for overall health system quality

Question 16

NYS 2014 MRT Waiver Amendment

Answer 16

$7.3 mill designated for DSRIP
Waiver will:
-Transform the state’s health care system
-Bend the Medicaid cost curve
-Assure access to quality care for all Medicaid members
-Create a financially sustainable safety net infrastructure

Question 17

DSRIP Payment Reform: Moving to VBP

Answer 17

• MRT Waiver required 5-year roadmap for Medicaid payment reform
• By DSRIP year 5 (2019), all MCOs must use non-FFS models that reward value over volume for for at least 80-90% of provider payments
• If roadmap goals not met, DSRIP $ from CMS to NYS will be significantly reduced