Last year, the BHT Board made several decisions regarding the allocation of Pay-for-Reporting Project dollars and categorization of Partners based on volume. You can read in detail about those decisions in the Funds Flow for 2019, 2020, & 2021 post.
The model states that Partners will be divided into three volume categories:
Large Providers: serving 20,001+ Medicaid Patients
Medium Providers: serving 1,201-20,000 Medicaid Patients
Small Providers: 1,200 or less Medicaid Patients
The model also states that Pay-for-Reporting funds will be earned based on three categories of work.
40% Transformation Plan Milestones
40% Pay-for-Achievement Measures
20% Equity Activities & Milestones
At the March, 2019 Board meeting, several more decision were made that detail what activities will earn funds, a payment schedule, and minimum achievement. Those decisions are described below.
Earning Pay-for-Reporting Dollars
Over the next three years, a Partner’s earnings from each of the three categories of work and will be based on a combination of selecting measures, then reporting on and meeting those measures. Additionally, Partners will be earning funds based on completing specific activities required by BHT and the HCA.
As a reminder, Pay-for-Reporting and Pay-for-Performance are two different buckets of Project Funds. Pay-for-Performance funds are earned by the region, for meeting the measures created by the Health Care Authority (HCA). These “at-risk” dollars will make up an increasing portion of our total Project Funds over the next three years.
2019 Pay-for-Reporting Payment Schedule - January Cohort
Contract Year 1 will begin on April 1, 2019 for our Partners in our January Cohort. They will earn funds from the above work categories, in three scheduled distributions, based on the following criteria:
Payment 1 (April 2019) for…
selecting Milestones for their Transformation Plans
selecting from menu of BHT Pay-for-Achievement Measures
Payment 2 (October 2019) for…
reporting on selection of Milestones from their Transformation Plans
reporting on selection of BHT Pay-for-Achievement Measures
completing the BHT Equity Assessment and Network Analysis
Payment 3 (April 2020) for…
achievement of selection of Milestones from their Transformation Plans
achievement of selection of BHT Pay-for-Achievement Measures
selecting Equity Milestones based on data from Equity Assessment
Pay-for-Reporting Distribution by Partner
Between 2019 and 2021, approximately $17.6M of the total Pay-for-Reporting funds will be allocated to Collaboratives Partners. The following table shows the potential Pay-for-Reporting earnings (per Partner), over the next three years:
Pay-for-Reporting Payments At-Risk
Partners will earn the majority of these Pay-for-Reporting funds based on timely and complete reporting. However, a portion of funding associated with both Transformation Plan Milestones and Pay-for-Achievement Measures will be “at risk” as the expectation for Partners to earn based on achievement increases (similar to the risk that the region has with the Pay-for-Performance funds described above). Meaning that to earn that portion, Partners must meet the Milestones specified in Addendum 3.01 of their Project Specific Agreement (“Contract”), and achieve the standards set for their selected Pay-for-Achievement Measures specified in Addendum 3.02.
In the event that a Partnering Provider meets some, but not all, of its Milestones and Pay-for-Achievement Measures, BHT will calculate partial payments on the “at-risk” portion. The at-risk payment tiers and criteria are as follows:
Unearned “At-Risk” Pay-for-Reporting Funds
Any at-risk dollars not earned by Partners will be held in an unearned funds pool. The Board will decide how to use those dollars based on recommendations from our Waiver Finance Workgroup.