Common use of Value-Based Payment Development Clause in Contracts

Value-Based Payment Development. In partnership with EOHHS and building upon the Contractor’s existing value-based payment (VBP) strategy, the Contractor shall develop a VBP strategy which includes the expansion of existing, successful VBP arrangements to additional membership and with additional provider partnerships for high-risk populations, including those identified below. The Contractor’s VBP strategy shall include meaningful targets to continually increase the amount of the Contractor’s membership in an HCP-LAN Level 3 or 4 VBP arrangement by 2027. The Contractor’s VBP strategy shall include the below populations (P1-P4) with a focus on quality and outcomes measures. The Contractor will earn full incentive payments for each measure outlined below (M1-M4) if the specified requirements are met. If one of the following requirements is not met, or if any of the following requirements are not met by the outlined deadline, the Contractor may be ineligible to earn full incentive payment for that specific measure, as determined by EOHHS. Goal Incentive M1 By May 5, 2023, the Contractor shall submit a review that includes: 1. A baseline analysis of each of the below populations to understand current population cost, care utilization patterns, and outcomes. 2. A market scan to identify the current landscape and evidence for value-based arrangements for each of the below populations. $50,000 M2 By the end of 2023 Q2, the Contractor shall submit a proposal that identifies: 1. Detailed recommendations for opportunities to expand membership in current VBP arrangements for each of the below populations, including high-priority outcome measures, reimbursement structure, provider partnerships and multi-year implementation strategy. 2. Detailed recommendations for novel VBP arrangements for each of the below populations, including high-priority outcome measures, reimbursement structure, provider partnerships and multi-year implementation strategy 3. Collaborate with EOHHS to determine which of the below populations to prioritize for M3 and M4 $50,000 M3 By the end of 2023 Q4, the Contractor will have concrete plans to implement a contract for a new VBP arrangement between the Contractor and a provider organization for one of the below populations for 2024. $250,000 M4 By the end of 2023 Q4, the Contractor will have concrete plans to advance at least one existing HCP-LAN level 1 or 2 VBP arrangement to an HCP-LAN level 3 or 4 for 2024 $150,000 Population High Priority Outcomes P1 Youth (<21 years old) with ASD Pivotal skill development/mastery, caregiver engagement and satisfaction, improved access to care, co-morbidity management, and school retention P2 Teens and young adults (15 to 35 years old) with a new-onset psychotic disorder (within first 3 years of onset) Quality of life, family functioning, symptom severity (including duration of untreated psychosis), participation and progress in work or school, and community tenure/reduction in acute bed days P3 Adults with SMI (3 years beyond first onset) Quality of life, symptoms severity, vocational functioning, social connectedness, medication side- effect management, and community tenure/reduction in acute bed days P4 Care for Opioid Use Disorder- Diversionary Levels of Care and Outpatient MAT induction and maintenance For Diversionary Levels of Care include increased community tenure/reduction of acute care utilization. For Outpatient MAT induction and maintenance include retention in MAT treatment, and increased community tenure/reduction of acute care utilization.

Value-Based Payment Development. In partnership with EOHHS and building upon the Contractor’s existing value-based payment (VBP) strategy, the Contractor shall develop a VBP strategy which includes the expansion of existing, successful VBP arrangements to additional membership and with additional provider partnerships for high-risk populations, including those identified below. The Contractor’s VBP strategy shall include meaningful targets to continually increase the amount of the Contractor’s membership in an HCP-LAN Level 3 or 4 VBP arrangement by 2027. The Contractor’s VBP strategy shall include the below populations (P1-P4) with a focus on quality and outcomes measures. The Contractor will earn full incentive payments for each measure outlined below (M1-M4) if the specified requirements are met. If one of the following requirements is not met, or if any of the following requirements are not met by the outlined deadline, the Contractor may be ineligible to earn full incentive payment for that specific measure, as determined by EOHHS. Goal Incentive M1 By May 5, 2023, the Contractor shall submit a review that includes: 1. A baseline analysis of each of the below populations to understand current population cost, care utilization patterns, and outcomes. $50,000 Goal Incentive 2. A market scan to identify the current landscape and evidence for value-based arrangements for each of the below populations. $50,000 M2 By the end of 2023 Q2, the Contractor shall submit a proposal that identifies: 1. Detailed recommendations for opportunities to expand membership in current VBP arrangements for each of the below populations, including high-priority outcome measures, reimbursement structure, provider partnerships and multi-year implementation strategy. 2. Detailed recommendations for novel VBP arrangements for each of the below populations, including high-priority outcome measures, reimbursement structure, provider partnerships and multi-year implementation strategy 3. Collaborate with EOHHS to determine which of the below populations to prioritize for M3 and M4 $50,000 M3 By the end of 2023 Q4, the Contractor will have concrete plans to implement a contract for a new VBP arrangement between the Contractor and a provider organization for one of the below populations for 2024. $250,000 M4 By the end of 2023 Q4, the Contractor will have concrete plans to advance at least one existing HCP-HCP- LAN level 1 or 2 VBP arrangement to an HCP-LAN level 3 or 4 for 2024 2024, or expand at least one existing HCP-LAN level 3 or 4 VBP arrangement to a new provider organization for one of the below populations for 2024. $150,000 Population High Priority Outcomes P1 Youth (<21 years old) with ASD Pivotal skill development/mastery, caregiver engagement and satisfaction, Population High Priority Outcomes improved access to care, co-morbidity management, and school retention P2 Teens and young adults (15 to 35 years old) with a new-onset psychotic disorder (within first 3 years of onset) Quality of life, family functioning, symptom severity (including duration of untreated psychosis), participation and progress in work or school, and community tenure/reduction in acute bed days P3 Adults with SMI (3 years beyond first onset) Quality of life, symptoms severity, vocational functioning, social connectedness, medication side- side-effect management, and community tenure/reduction in acute bed days P4 Care for Opioid Use Disorder- Diversionary Levels of Care and Outpatient MAT induction and maintenance For Diversionary Levels of Care include increased community tenure/reduction of acute care utilization. For Outpatient MAT induction and maintenance include retention in MAT treatment, and increased community tenure/reduction of acute care utilization.