Health Care Reform in New York State Fitting the Pieces Together toward the Triple Aim: Better Care, Lower Costs, and Improved Health for All New York Academy of Medicine Courtney Burke, Deputy Secretary for Health, New York State April 30, 2015

The Vision Healthier New Yorkers (population health) Lower costs 2 The Vision Healthier New Yorkers (population health) Lower costs Engaged consumers Systems, programs, financing, policies that support and value these goals

The Systems, Programs, Policies, Financing 3 The Systems, Programs, Policies, Financing ACA – Affordable Care Act ACO – Accountable Care Organizations APC – Advanced Primary Care APD – All Payer Database DISCO – Developmental Disability Individualized Supports & Care Coordination Organization DSRIP – Delivery System Reform Incentive Payment Program FIDA – Fully Integrated Dual Advantage HARPS – Health and Recovery Plans HH – Health Homes (HH) MLTC – Managed Long-Term Care MRT – Medicaid Redesign Team NYSOH – New York State of Health PA – Prevention Agenda PCMH – Patient Centered Medical Home PHIP – Population Health Improvement Program PPS – Performing Provider System SHINY-NY – Statewide Health Information Network for New York Systems SHIP – New York State Health Innovation Plan SIM – State Innovation Model VAP – Vital Access Provider VBP – Value Based Payment

The Ingredients Vision – ACA/SHIP/PA Resources/incentives – DSRIP/VBP 4 The Ingredients Vision – ACA/SHIP/PA Resources/incentives – DSRIP/VBP Tools/technology/mechanics – SHIN-NY/APD/NYSOH Organization – PPS/ACO/HH/HARP/DISCO/PCMH/MLTC Grass roots buy-in – PHIP/APC/MRT Time and assistance for transition – VAP/Capital

Major Areas of Overlap Primary, preventive care, and population health 5 Major Areas of Overlap Primary, preventive care, and population health Integrated and coordinated care Focus on behavioral health Investments in transforming the workforce Reducing preventable admissions Paying based on value (shared accountability) Consumer engagement and empowerment

The Initiatives State Driven Federally Driven 6 ACA ACOs PCMH HH FIDA Wellness Care Coordination Primary Care & Population Health Collaboration, Cooperation Shared Accountability Attention to Behavioral Health Value-Based Payment MRT HARP, DISCO Prevention Agenda NYSOH APD SHIN-NY SHIP DSRIP (PPS) PHIP State Driven Federally Driven

The Source of Funds (SHIP/DSRIP) 7 The Source of Funds (SHIP/DSRIP) Strong, expert, coordinated state leadership can create value over the next four years DSRIP Advanced Primary Care Capital Restructuring Common Scorecard Prevention Agenda NY State of Health Rate Review SHIN-NY PHIPs SIM Testing Grant Statewide leadership Stakeholder alignment Multi-payer business design and support Workforce strategy NY SHIP value-based purchasing APD Currently funded Planned SIM funding Multi-payer funding

Next Steps SHIP – Workgroups convening 8 Next Steps SHIP – Workgroups convening DSRIP PPSs – Payments begin this year PHIPs – Analyzing data and engaging community stakeholders APD/SHIN-NY – RFP out for APD, SHINY-NY working regionally HARP/DISCOs/FIDA – rollout Payments become value-based Better care management – DISCO/HARP/FIDA/HH/PCMH/ACO Primary care – APC model being developed, practice transformation roll-out Providers become more vested in outcomes – shared risk and savings Workforce importance recognized – joint workforce group convening Consumers more empowered Population health, prevention, primary care at the forefront ALIGNMENT & IMPLEMENTATION

Appendix A: Brief Explanations of Major Initiatives 9 Appendix A: Brief Explanations of Major Initiatives

Prevention Agenda Priorities 10 Prevention Agenda Priorities Prevent chronic diseases Promote a healthy and safe environment Promote healthy women, infants, and children Promote mental health and prevent substance abuse Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases, and health care associated infections

MRT Waiver Amendment: $8 Billion Allocation 11 MRT Waiver Amendment: $8 Billion Allocation $500 Million for the Interim Access Assurance Fund (IAAF) – Time limited funding to ensure current trusted and viable Medicaid safety net providers can fully participate in the DSRIP transformation without unproductive disruption $6.42 Billion for Delivery System Reform Incentive Payments (DSRIP) – Including DSRIP Planning Grants, DSRIP Provider Incentive Payments, and DSRIP Administrative costs and DSRIP related Workforce Transformation. $1.08 Billion for other Medicaid Redesign purposes – This funding will support Health Home development, and investments in long term care workforce and enhanced behavioral health services, (1915i services) 1.2 billion in capital investment enacted in 2014-15 budget Regulatory relief to support provider collaboration on DSRIP projects

12 DSRIP Six Themes: Integrated delivery – creating performing provider systems Project value drives Transformation  # and types of projects # of Medicaid members served (attribution) Application quality – speed and scope of implementation Performance based payments – process and outcome measures Statewide performance matters Regulatory relief and capital funding available Lasting change Long-term transformation Health system sustainability

SHIP/SIM Overarching Goals 13 SHIP/SIM Overarching Goals The SHIP is New York’s overarching vision to integrate and coordinate multiple ongoing initiatives with the goal of optimal health and well-being for all New Yorkers. Population Health Goal of the SHIP: “Improve population health through strengthened capacity and improved screening and prevention through closer linkages between primary care, public health, and community based supports.” 2020 Goal: Achieve top quartile performance among states in prevention and public health 80% of payments risk-based by year 5

SIM Testing Grant Funding was requested to support the following: 14 SIM Testing Grant Funding was requested to support the following: Clinical preventive services that have a demonstrated impact on public health goals and that strengthen linkages between clinical care providers, local public health, and community- based organizations Regionally-based primary care practice transformation Transition to value-based payment Expanding NY’s primary care workforce through innovations in professional education and training Development of a common scorecard, shared quality metrics, and enhanced data/analytics

PHIP Overview and Objectives 15 PHIP Overview and Objectives The Population Health Improvement Program will promote the Triple Aim—better care, better population health, and lower health care costs—by selecting regional contractors to provide a neutral forum for identifying, sharing, disseminating, and helping implement best practices and strategies to promote population health and reduce health care disparities PHIP contractors will, within their regions: Support and advance the Prevention Agenda Support and advance the SHIP Serve as resources to DSRIP performing provider systems in their regions upon request

New York State of Health 16 New York State of Health One of the most successful marketplaces in the nation More than two million New Yorkers have enrolled since 2013 launch Premiums more than 50% lower than they were before the marketplace opened New features for 2015: more plan choices, a Spanish version of the website, key consumer materials in 10 additional languages and a new plan preview tool that allows consumers to shop before they begin their application

HARPs Behavioral health will be managed by: 17 HARPs Behavioral health will be managed by: Special needs health and recovery plans (HARPs) for individuals with significant behavioral health needs Mainstream managed care plans: Plans may operate services directly only if they meet rigorous standards Plans that do not meet rigorous standards must partner with a BHO which meets standards Plans can partner with BHOs to meet the rigorous standards Integration of all Medicaid behavioral health and physical health benefits under managed care will go into effect in spring 2015 in NYC and fall 2015 in the rest of the state

18 DISCOs Managed care designed to meet unique needs of people with developmental disabilities Governed by special statute enacted in 2012 DISCOs will have modified reserve requirements to facilitate start-up DISCOs must be controlled by one or more non-profit organizations with experience providing or coordinating health and long-term care services to people with IID

SHIN-NY Tool to support DSRIP, PCMH, HH, ACOs, and care integration 19 SHIN-NY Tool to support DSRIP, PCMH, HH, ACOs, and care integration Provide support via: Patient record look-up (PRL) Direct messaging Subscribe and notify Hospital admit, discharge, ER visit Value increases as the number of providers connected and sharing PHI in a meaningful way increases

All Payer Database (APD) 20 All Payer Database (APD) New York State enacted legislation in spring 2011 that allowed for the creation of an All Payer Database. APD is envisioned as the repository for a wide variety of health care data that can be integrated to support the evolving information and analytical requirements of stakeholders involved in the management, evaluation, and analysis of the NYS health care system The APD will serve as a key resource for supporting finance policy, quality measurement and improvement, and population health and health care system comparisons and improvements

21 Unfinished Business Changing our view of “health” to include social determinants Transforming long-term care Further empowering consumers Measuring quality of life as a valued outcome