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Wednesday, July 6, 2022 82°F New York

An Interview with Hany Abdelaal, President of VNSNY CHOICE Health Plans

New York State has mandated value-based purchasing for all Medicaid Managed Long Term Care (MLTC) plans by next year. Can you explain how this will work?

The state is requiring that all New York Medicaid MLTC plans convert their provider contracts—that is, their contracts with the licensed home care agencies who care for their members—into Level 1 value-based purchasing arrangements by December 31, 2017. That means the providers will have to meet the state’s MLTC Category 1 quality measures, which cover things like frequency of patient falls and visits to the emergency room, patient satisfaction rates, and avoidable hospitalizations. The details are still being finalized, but they’ll include some sort of bonus for meeting these measures and penalties for failing to meet them.

How is VNSNY CHOICE preparing for this shift?

We’ve developed a quarterly scorecard for the hundred or so licensed home care agencies we contract with, charting their performance on these quality measures, which we rolled out this year. We haven’t set any target benchmarks for our providers yet—we’re still testing the dashboard to get the metrics right—but we think this tool will be a great help in making sure our value-based purchasing agreements go smoothly once they’re all in place.

What other steps are you taking to ensure that these quality measures are being met?

On the member side, VNSNY’s IT team has developed an amazing care management dashboard that monitors all quality metrics for everyone enrolled in any of our plans. This is a real-time dashboard that’s updated daily. At any time, our assessment nurses and care management nurses can view quality measures across our different plans, including the metrics for different vendors, care teams, and individual clinicians and patients. It allows us to immediately spot any areas or individual members where quality metrics appear to be falling off, and move swiftly to address the issue.

Are there any other developments at CHOICE you’d like to share?

This past summer, we also launched an electronic assessment tool that can be used by all of our different vendors. It’s a customized software platform, developed in collaboration with VNSNY’s IT department, that incorporates our 20 years of experience in managed long term care. CHOICE is now using it with all of our Medicaid MLTC members as well as our dual-eligibility FIDA and Medicaid Advantage Plus members, to manage assessments and monitor utilization management more efficiently.

Do you think the number of people in MLTC plans across the U.S. will continue to grow?

I do. Over a dozen states now have MLTC programs similar to New York’s, and other states are following suit as they realize that helping seniors age in place in their own homes is often a better option than placing them in nursing homes. Not only does MLTC cost less than nursing home care, but people prefer it. Whatever happens with health care legislation, the future is all about managing the care of high-risk Medicare and Medicaid members—the 20 percent of seniors who account for 80 percent of medical expenditures. The best way to do this is through the kinds of high-quality, lower-cost home-based interventions that MLTC plans provide. And that’s where VNSNY CHOICE is leading the way.

The Take-Away: VNSNY CHOICE Managed Long Term Care is putting new, technology-supported quality systems in place, as it prepares to switch to value-based agreements with its home care vendors next year.