Value-Based Payment in New York State

Using PROMETHEUS Analytics®, our proprietary software tool, we're helping New York's Medicaid program transition to a value-based payment model.

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Overview

Altarum is helping New York state shift $40 billion in yearly Medicaid fee-for-service payments to value-based payments. Using PROMETHEUS Analytics, our health care data analytics tool, Altarum processed hundreds of millions of medical and pharmacy claims covering three years of the Medicaid program, and identified two areas that were ripe for improvement—the management of chronic conditions, and maternity cases.

Our Approach

Altarum worked with professional services firm KPMG to model two value-based payment contracts—a global maternity bundle that includes pregnancy, delivery, newborn costs, and post-discharge care, and an integrated primary care bundle that includes routine preventive and sick care, and all of the chronic medical and behavioral conditions for a Medicaid plan member. The state continues to use PROMETHEUS Analytics to calculate episode costs on an ongoing basis.

Results

The maternity and integrated care value-based payment arrangements are being piloted in contracts between a number of New York’s Medicaid managed care organizations and providers, bringing a consistent approach to risk contracting and moving the state from fee-for-service to value based payments. The maternity bundle model also has been adopted by the National Health Care Payment and Learning Action Network and serves as a model for many payers moving to value-based payment.

Value-Based Payment in New York State Contact

Contact Us

Greg Matthews

Greg Matthews

Deputy Director, Value in Health Care

Areas of Expertise
  • Analytic Tools
  • Applied Research
  • Evaluation

As an expert in statistical science and data analytics, Greg works with public insurers and health systems to achieve better outcomes. He is the lead for PROMETHEUS Analytics®, Altarum’s proprietary software platform that yields insights from claims data. Greg holds a master’s degree in sociology from the University of Washington.