Value-Based Payment and Financial Simulations Technical Support Available for State Medicaid Agencies

Expression of Interest Form

The purpose of this expression of interest form is to help the Medicaid Innovation Accelerator Program (IAP)with the selection process by getting a better sense of your state’scurrent and planned efforts to design, develop, and implementValue-Based Payment (VBP) approaches[i.e., payment models that range from rewarding for performance in Fee-For-Service (FFS) to capitation, including Alternative Payment Models (APM) and comprehensive population-based payments]. Details on the technical support available for states are outlined in the Program Overview document.

Overview of Value-Based Payment and Financial Simulations Technical Support

The goal for this IAPopportunity is to support states as they design, develop, and implement Medicaid VBP models and/or enhance and expand existing state Medicaid payment reform efforts. Technical support is offered in one or more of the following areas:

●Strategic design by drilling down into states’ payment approach goals, objectives, and technical support needs.Support is available to help statesassess VBP options that are appropriate for their individual state Medicaid health care delivery and payment environments. This support includes, for example,assessingthe appropriateness of various VBP approaches(e.g., bundled payments, episodes of care, pay-for-performance, per member per month payments,gain- or risk-sharing approaches, advanced Primary Care Medical Home, Accountable Care Organization, global payments, etc.).

  • Development of VBP approaches in Medicaid. Support is available to help states develop their specific VBP approach. This support includes, for example,developing or refining design elements such as attribution methodologies, gain-sharing methodologies, and identification of appropriate quality metrics or other considerations.
  • Implementation of an agreed-upon VBP approach in Medicaid. Support is available to help states implement VBP approaches, includingworking with the state to develop provider-related technicalsupport tools, decision-making tools, and identification of best practices.

●Development of financial simulations of state-developed VBP approaches. This support includesdeveloping a VBP analysis methodology and conducting financial simulation modeling of a specific VBP approach.

Support will be individualized based on each state’s specific needs and an initial goal setting process. In addition to individualized support, states will have access to group technical support and peer-to-peer learning.

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General Information

Name of your state and Medicaid agency: Click here to enter text.

Please indicate the following:

  1. The State Medicaid Director acknowledges that the state is seeking this IAP technical support:

Yes No

  1. The State Medicaid Director acknowledges that the team has or will have sufficient staff time and resources committed to this effort:

Yes No

Please provide contact information for the State Medicaid Agency team’s Project Leadwho will lead this work day-to-day, not including the State Medicaid Director (SMD)[1]:

Information
Name / Click here to enter text. /
Title / Click here to enter text. /
Email Address / Click here to enter text. /
Phone Number / Click here to enter text. /

Provide names, titles, proposed role on the project, and e-mail addresses of your team members: (Enter additional lines if needed)

Name / Organization / Title and Proposed Role on the Project / Email address
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Types of Technical Support Activities

The next set of questions aregeared towards gaining a better understanding ofyour states’ prioritiesrelated to designing, developing, or implementing aVBP approach in FFS or Medicaid managed care program.

  1. With regards to receiving technical support, please use the drop-down boxes below to identify up to three priority activities, ranked as the 1, top priority, 2, second highest, and/or 3, third highest priority.

Priority Selection / VBP or Financial Simulation Modeling Activity
Choose an item. / Development of a VBP options memo or VBP roadmap to provide key considerations and potential VBP approaches that are appropriate for your state’s Medicaid health care delivery and payment environments.
Choose an item. / Identify other payers’ (e.g., Medicare, commercial) VBP approaches to assist with alignment to Medicaid and/or help aligningVBP in FFS and managed care. Example of this includes aligning with the HHS VBP goals, HHS Health Care Payment Learning and Action Network’s APM framework and Medicare Access & CHIP Reauthorization Act’s (MACRA) Quality Payment Program.
Choose an item. / Support examining strategic VBP considerations, such as setting VBP targets, attribution methodologies, and gain-sharing methodologies, around a particular VBP approach or approaches.
Choose an item. / Understanding the types of factors relevant to implementing a VBPwithin Medicaid managed care, including the appropriate levels of risk, prescriptive versus flexible approaches, and contracting examples.
Choose an item. / Understanding the strategic considerations related to measure identification and monitoring VBP outcomes.
Choose an item. / Support to the state in creating provider technical support and training materials, including decision-making tools such as readiness assessments, checklists, or manuals.
Choose an item. / Supportto the state with stakeholder engagement process/activities.
Choose an item. / Developing a VBP analysis methodology and conducting financial simulation modeling of a specific VBP approach, for example:
  • Forecasting the expected payout for participating providers or predicting providers’ response to risk sharing
  • Examining the implications of different options for various Accountable Care Organization elements
  • Identifying the proportion of Medicaid enrollees attributed to Regional Care Organizations and/ or Patient Centered Medical Homes

Choose an item. / Other (Please describe): Click here to enter text.

Description of State Technical Support Needs

  1. Please briefly describewhy the VBPapproaches selected above for IAP technical support are of the highest priority to your state and how IAP can support them:
  2. Top priority:
  3. What programmatic outcome are you hoping to achieve under this activity?Click here to enter text.
  4. What target population, including the expected size of the initial population, will be affected by the VBP approaches supported under this activity?Click here to enter text.
  5. What timeframe would work best for your state for completing this activity?Click here to enter text.
  6. If applicable, is there a specific VBP approach you are interested in focusing on under this activity (e.g., bundled payments, episodes of care, pay-for-performance, per member per month payments,gain- or risk-sharing approaches, advanced Primary Care Medical Home, Accountable Care Organization, global payments, etc.)?Click here to enter text.
  7. Secondpriority:
  8. What programmatic outcome are you hoping to achieve under this activity?Click here to enter text.
  9. What target population, including the expected size of the initial VBP population, will be affected by the VBP approaches supported under activity? Click here to enter text.
  10. What timeframe would work best for your state for completing this activity? Click here to enter text.
  11. If applicable, is there a specific VBP approach you are interested in focusing on under this activity (e.g., bundled payments, episodes of care, pay-for-performance, per member per month payments,gain- or risk-sharing approaches, advanced Primary Care Medical Home, Accountable Care Organization, global payments, etc.)?Click here to enter text.
  12. Thirdpriority:
  13. What programmatic outcome are you hoping to achieve under this activity?Click here to enter text.
  14. What target population, including the expected size of the initial VBP population, will be affected by the VBP approaches supported under activity? Click here to enter text.
  15. What timeframe would work best for your state for completing this activity? Click here to enter text.
  16. If applicable, is there a specific VBP approach you are interested in focusing on under this activity (e.g., bundled payments, episodes of care, pay-for-performance, per member per month payments,gain- or risk-sharing approaches, advanced Primary Care Medical Home, Accountable Care Organization, global payments, etc.)? Click here to enter text.
  1. Are there any current, ongoing or planned VBPactivitiesthat are relevant to these requests? This can include progress todate on the implementation of delivery models (e.g., participation inmodels supported by CMMI) and a description on any relevant authorities related to the model(s).Also include a description of any state involvement in related stakeholder engagement, managed care health plan engagement, and provider readiness activities. Click here to enter text.
  1. Is there ongoing support (technical or financial) for any VBP-related activities in your state (e.g., other federal programs such as a State Innovation Model, foundation support, existing state support)? How will these efforts will synergize?Click here to enter text.
  2. If applicable, please provide a description of any existing VBP approaches for other populations and/or payers to which you plan to align.Click here to enter text.
  3. Please provide any other information your state believes is important for us to understand your proposed VBP interests. Click here to enter text.
  4. If your state indicated it would like to receive technical support for financial simulations (as noted as one of your states’ three priorities), describe your state’s capacity to manage, manipulate, and analyze, Medicaid claim and eligibility FFS or encounter data. Click here to enter text.
  5. Does your state have access to these data or would IAP need to use Alpha-MAX or other data-sets? Click here to enter text.
  6. Does your team have experience conducting financial simulations?Click here to enter text.
  7. If your state indicated it would like to receive technical support for financial simulations (as noted as one of your states’ three priorities), the technical support team may need to receive Medicaid claims data from your state for analysis, and receipt of these data would require a data sharing agreement. Note that these agreements may take extended time to be processed and if a data sharing agreement is necessary, states are expected to prioritize the execution of an agreement as quickly as possible.

Check the boxes that apply to your state project. If you believe that you will require a data sharing agreement, please identify the person responsible for executing this agreement.If you are not sure whether a data sharing agreement will be needed, please answer the following question to the best of your ability.

The Data Sharing Agreement will be reviewed by Click here to enter text.

☐I understand the data sharing requirement, but do not believe an agreement will be required based on my project’s technical support needs.

☐I acknowledge that we will need to execute a data sharing agreementwith the technical supportteam.

☐I have discussed with our legal/privacy/other appropriate contact how to quickly and

effectively execute a data sharing agreementand meet any other legal agreements required by our state.

Form Submission, Conference Call Availability, and Notification

Interested states are asked to complete and email an Expression of Interest form to CMS at y April 13, 2018. All states that submit an Expression of Interest form will be contacted by IAP for a one-on-one conference call to discuss the state’s goals and needs, as well as questions about the program support being offered.

Please indicate your team’s availability for this conference call below by indicating your top three dates and times.

April-May 2018

☐April 20, 10:00-11:00 am ET

☐April 20, 12:00-1:00 pm ET

☐April 20, 1:00-2:00 pm ET

☐April 20, 2:00-3:00 pm ET

☐April 23, 2:00-3:00 pm ET

☐April 24, 12:00-1:00 pm ET

☐April 24, 1:00-2:00 pm ET

☐April 24, 3:00-4:00 pm ET

☐April 24, 4:00-5:00 pm ET

☐April 25, 11:00-12:00 pm ET

☐April 25, 3:00-4:00 pm ET

☐April 25, 4:00-5:00 pm ET

☐April 26, 11:00 am-12:00 pm ET

☐April 26, 1:00-2:00 pm ET

☐April 26, 3:00-4:00 pm ET

☐April 27, 11:00 am-12:00 pm ET

☐April 27, 12:00-1:00 pm ET

☐May 1, 12:00-1:00 pm ET

☐May 1, 1:00-2:00 pm ET

☐May 1, 3:00-4:00 pm ET

☐May 2, 3:00-4:00 pm ET

☐May 2, 4:00-5:00 pm ET

☐May 3, 11:00 am-12:00 pm ET

☐May 3,2:00-3:00 pm ET

☐May 3,3:00-4:00 pm ET

☐May 7, 2:00-3:00 pm ET

☐May 8, 12:00-1:00 pm ET

☐May 8, 1:00-2:00 pm ET

☐May 9, 11:00 am-12:00 pm ET

☐May 9, 2:00-3:00 pm ET

☐May 9, 3:00-4:00 pm ET

☐May 9, 4:00-5:00 pm ET

☐May 10, 11:00 am-12:00 pm ET

☐May 10, 1:00-2:00 pm ET

☐May 10, 3:00-4:00 pm ET

☐May 11, 11:00 am-12:00 pm ET

☐May 11, 12:00-1:00 pm ET

☐May 11, 1:00-2:00 pm ET

☐May 14, 2:00-3:00 pm ET

☐May 15, 1:00-2:00 pm ET

☐May 16, 11:00 am-12:00 pm ET

☐May 16, 3:00-4:00 pm ET

☐May 17, 2:00-3:00 pm ET

☐May 17, 3:00-4:00 pm ET

☐May 18, 10:00-11:00 am ET

☐May 18, 12:00-1:00 pm ET

☐May 18, 1:00-2:00 pm ET

IAP anticipates notifying selected states in July 2018.Additional information about this program support opportunity can be found at Medicaid.gov IAP Value-Based Payment and Financial Simulations webpage. For questions about this Medicaid IAP opportunity, contact with the subject line “VBP and Financial Simulations.”

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[1] Note: It is assumed that the State Medicaid Director will play an important role in this work but will not be responsible for day-to-day management of the work. Another member of the State Medicaid agency’s senior leadership team should be designated as the team lead.