By DSRIP Year 5 all Medicaid Managed Care Organizations (MCOs) must transition to value-based payments (VBP) for at least 80–90% of their provider payments.
The state will show benchmarks and give guidance—will not set rates
There are a variety of options outlined in the roadmap—many details to be negotiated between MCOs and providers
The state is committed to ensuring adequate reimbursement aligned with the value provided for the Medicaid population consistent with Federal Statute
Reducing lower-value care (ED admissions/re-admissions and ambulatory sensitive admissions) and increasing higher care value in equal portions = higher margins for providers
MCOs may contract with providers directly or through PPS as it evolves; PPS should be utilized as administrative and best practice support moving forward
Partner Type:
Acute Care, All Other, Behavioral Health, Community-Based Organizations, Developmental Disability Organizations, Home Health Agencies, Obstetrics, Pediatrics, Primary Care, Skilled Nursing Facilities
Posted February 17, 2017 at 11:58 am
the course was very informative for the vna management team