DSRIP: What You Need To Know! Jason Helgerson, Medicaid Director Office of Health Insurance Programs NYS Department of Health.

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Presentation transcript:

DSRIP: What You Need To Know! Jason Helgerson, Medicaid Director Office of Health Insurance Programs NYS Department of Health

1.Integrated Delivery—Creating Performing Provider Systems 2.Project Value drives a)Transformation  # and types of projects b)# of Medicaid members served (attribution) c)Application Quality – Speed and Scope of Implementation 3.Performance Based Payments – Process and Outcome Measures 4.Statewide Performance Matters 5.Regulatory Relief and Capital Funding Available 6.Lasting Change a)Long-Term Transformation b)Health System Sustainability SIX KEY THEMES OF DSRIP

MCO* HH #1HH #2 Other PPS Providers Other Providers PPSs ROLE: -Insurance Risk Management -Payment Reform -Hold PPS/Other Providers Accountable -Data Analysis -Member Communication -Out of PPS Network Payments -Manage Pharmacy Benefit -Enrollment Assistance -Utilization Management for Non-PPS Providers -DISCO and Possibly FIDA/MLTCP Maintains Care Coordination ROLE: -Care Management for Health Home Eligibles -Participation in Alternative Payment Systems ROLE: -Be Held Accountable for Patient Outcomes and Overall Health Care Cost -Accept/Distribute Payments -Share Data -Provider Performance Data to Plans/State -Explore Ways to Improve Public Health -Capable to Accept Bundled and Risk-Based Payments How The Pieces Fit Together: MCO, PPS & HH Five Years in the Future *Mainstream, MLTC, FIDA, HARP & DISCO

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