Many Medicaid programs are adopting value-based payment (VBP) models to reward value over volume, but only a few states have focused these efforts on long-term services and supports (LTSS). This webinar, made possible by the West Health Policy Center, explored opportunities for states seeking to adopt value-based payment models for home-and community-based services (HCBS) in managed long-term services and supports (MLTSS) programs. It featured experiences of two leading states, New York and Tennessee, which have implemented innovative payment models in their MLTSS programs. The webinar examined considerations for selecting quality metrics and payment models for use in these programs. It also described common program and policy challenges that these states have faced in developing these models, and the strategies used to address them.


I. Welcome and Overview

Speakers: Michelle Herman Soper, Director of Integrated Care, CHCS; Amy Herr, Director, Health Policy, West Health Policy Center

Michelle Soper and Amy Herr welcomed participants. Ms. Soper then discussed the MLTSS payment reform landscape, with a focus on program and policy design elements, performance measure selection, and payment models to drive value for HCBS.  

II. New York’s VBP Roadmap and Managed Long-Term Care

Speakers: Khalil Alshaer, MD, Medical Director; Erin Kate Calicchia, Acting Deputy Director; Division of Long Term Care, Office of Health Insurance Programs, New York Department of Health

New York State implemented a major MLTSS payment initiative within the state’s broader Roadmap for Medicaid Payment Reform. Dr. Khalil Alshaer and Erin Kate Calicchia described the goals of the statewide initiative and considerations for adapting new payment models for its MLTSS program. Dr. Alshaer outlined New York’s approach to selecting quality measures, and engaging and supporting stakeholders during design and implementation.

III. Tennessee’s Journey to Value-Based Purchasing in HCBS Programs

Speaker: Patti Killingsworth, Assistant Commissioner and Chief of LTSS, Bureau of TennCare

Patti Killingsworth described payment approaches for certain HCBS in Tennessee’s Quality Improvement in LTSS program. She also examined the state’s efforts to combine targeted investments and VBP strategies to strengthen the linkage between payment, quality measurement, and workforce improvement efforts to address the HCBS workforce crisis.

IV. Expert Reactor

Speaker: Debra Lipson, Senior Fellow, Mathematica Policy Research

Debra Lipson offered commentary on lessons from New York’s and Tennessee’s experiences related to the selection of appropriate quality measures for use in MLTSS VBP programs; phasing in the adoption of VBP models based on HCBS provider and workforce capacity; and other factors that can contribute to program success.

V. Moderated Q&A