Notification of Withholds, Incentive Payments, and Quality Metrics for Healthy Opportunities Pilots VBP Period 3 Implementation

As stated in the Healthy Opportunities Pilot: Standard Plan Value-Based Payment Guide, revised October 25, 2023, the State will provide Standard Plans with formal written notice of CMS approval and the start date of the VBP Period 3 performance period. The VBP Period 3 Performance Period will consist of 3 separate programs each with target metrics and/or goals. The programs are described further below. Within 15 calendar days of receipt of notice from the State, the PHP Standard Plans must notify its Tier 3 AMH and CIN Delegated Pilot Care Management Entities (Delegated Pilot CMEs) of the start date of the VBP Period 3 performance period, the withhold and incentive performance target(s), and the date that the Department will begin withholding funds. In addition, during Period 3, the State will collect quality data for baseline measures from the Pilot regions.

WellCare of North Carolina received formal notification on March 14, 2024 from the Department for the Healthy Opportunities Pilot (HOP) Value-based Payment (VBP) Period performance period of April 1, 2024, to October 31, 2024, with associated performance period for incentives and withholds implemented effective April 1, 2024.

View the Notification (PDF) to learn about the VBP Period 3 Implementation.