WASHINGTON - eTradeWire -- The National MLTSS Health Plan Association ("MLTSS Association") is pleased to announce the launch of its new Value-Based Contracting (VBC) Workgroup, a critical initiative aimed at advancing VBC within the managed long-term services and supports (MLTSS) landscape. This strategic effort aligns with the objectives outlined by the Centers for Medicare and Medicaid Services (CMS) Innovation Center to increase the number of individuals in care relationships with accountability for quality and total cost of care. Co-chairs Anna Keith of Centene Corporation and Ashley Bunnell of UPMC Health Plan noted, "through this collaborative effort, we hope to develop actionable recommendations that empower managed care organizations and policymakers to effectively implement value-based contracting initiatives, ultimately improving quality of life and overall health outcomes for individuals enrolled in MLTSS programs."

More and more states are shifting from fee-for-service payment structures to VBC for state Medicaid programs. Instead of paying providers for each service delivered, VBC models link payment to health, quality of care, and cost, among other outcomes. While states are predominantly using VBC for primary and acute care in Medicaid, some are looking to use VBC for long-term services and supports (LTSS).

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The MLTSS Association featured VBC as a key break out session at its 2023 Annual Leadership Summit. Attendees identified a number of unique issues with regard to VBC and LTSS, including:

• Ensuring MLTSS VBC metrics are more enrollee-centric and reflect the person-centered values of LTSS;
• Ensuring that MLTSS metrics placed on plans align with those placed on providers as a means of achieving cohesive alignment between plan, provider, and beneficiary;
• Addressing the gap between acute care and MLTSS measures as a practical gap in the development of MLTSS VBC models;
• Incentivizing the development of provider capacity and capability in managing the LTSS population – particularly the IDD population; and
• Overcoming the attribution of savings to medical spend inherent in many MLTSS VBC models as not necessarily aligning with the goals/intents of LTSS overall.

The aim of the workgroup, comprised of members from the MLTSS Association's Policy Board, will be to develop a set of policy proposals and best practices that advance the uptake of VBC in MLTSS from a plan perspective. Planned deliverables include a white paper that that describes best practices and recommended opportunities for managed care organizations (MCOs), state and federal policy actions to help promote and scale these best practices and opportunities, and what MCOs can do once state and federal policy action is taken.

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The National MLTSS Health Plan Association encourages active participation from industry experts, policymakers, and stakeholders to collectively drive positive change and innovation in MLTSS through value-based contracting.

For more information about the National MLTSS Health Plan Association, please visit www.mltss.org.