NY Value-Based Payments Proposal Needs Workforce Measures, Says PHI

January 17, 2017

In December, New York’s Managed Long-Term Care Clinical Advisory Group issued a recommendation report on the quality measures that should be used to calculate value-based payment (VBP) allocations.

New York Medicaid Spending Moving to Value-Based Payments (VBP)

Over the coming years, New York plans to transition 80 to 90 percent of its Medicaid spending to VBP, where payment is based on outcomes as determined by quality measures rather than solely on enrollment numbers or enrollee acuity.

Among the report’s proposals are measures recommended to determine VBP for home health care and nursing home care. While many important quality measures are included, the report largely omits substantive measures related to the direct care workforce.

PHI Recommends Workforce Quality Measures

PHI submitted comments (pdf) on the report and made the following recommendations to the state:

    • Include measures relating to turnover or retention of direct care workers, which has been shown to correlate with quality of care;
    • Consider measures outlined in the workforce section of a National Quality Forum report, such as the difficulty a client has in finding a qualified direct care worker or the amount of training an aide receives; and
    • Include a measure on how often aides are assigned to the same residents in nursing homes, a scheduling practice called “consistent assignment,” which has been shown to correlate with quality of care.

The direct care workforce provides a majority of the hands-on care that long-term care clients receive and, therefore, greatly impacts quality of care. A VBP system would be remiss if it did not include measures related to ensuring access to a stable and skilled direct care workforce.

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