Overview of Payment and Delivery System Reform Initiatives June 25, 2015
Significant Activity in Health Systems Implementation of Affordable Care Act (ACA) New York Medicaid Redesign NYS Medicaid Waiver DSRIP Medicaid Managed Care Increased focus on quality and outcomes Patient-Centered Medical Homes, Accountable Care Organizations, Health Homes. Advanced Primary Care Electronic Health Records implementation Efforts to integrate Behavioral Health and Primary Care
Triple AIM Triple Aim is a framework developed by the Institute for Healthcare Improvement Improve patient experience of care (including quality and satisfaction) Improve the health of populations Reduce the per capita cost of health care Guiding principle of NYS payment and delivery system reform initiatives: Move health care delivery system toward triple aim
New York State Department of Health slide NYS Health Initiatives ALIGNMENT: Improve Population Health Transform Health Care Delivery Eliminate Health Disparities PREVENTION AGENDA Priority Areas: - Prevent chronic diseases - Promote a healthy and safe environment - Promote health women, infants, and children - Promote mental health and prevent substance abuse - Prevent HIV, sexually transmitted diseases, vaccine- preventable diseases, health care associated infections STATE HEALTH INNOVATION PLAN (SHIP) Pillars and Enablers: - Improve access to care for all New Yorkers - Integrate care to address patient needs seamlessly - Make the cost and quality of care transparent - Pay for healthcare value, not volume - Promote population health - Develop workforce strategy - Maximize health information technology - Performance measurement & evaluation MEDICAID DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM Key Themes: - Integrate Delivery – create Performing Provider Systems - Performance-based payments - Statewide performance matters - Regulatory relief and capital funding - Long-term transformation & health system sustainability POPULATION HEALTH IMPROVEMENT PROGRAM (PHIP) PHIP Regional Contractors: - Identify, share, disseminate, and help implement best practices and strategies to promote population health - Support and advance the Prevention Agenda - Support and advance the SHIP - Serve as resources to DSRIP Performing Provider Systems
Delivery System Reform Incentive Payment Program (DSRIP) Restructure health care delivery system Delivery System Reform Incentive Payment (DSRIP) program: $7.42 B Interim Access Assurance Fund (IAAF): $500 M Medicaid Redesign Projects: $1.08 B Achieve 25% reduction in avoidable hospitalizations
Goals of DSRIP Transform health care safety net Reduce avoidable hospital use Improve health and public health measures Cost-efficient Medicaid program with better outcomes Leverage payment reform to ensure long-term delivery system reform Financial support for some safety net providers
DSRIP Stakeholder and Community Engagement Community needs assessment was essential element to engage the community Needs assessment shaped and decided DSRIP priorities PPSs need to continue/improve community engagement Enacted 2015-16 State Budget requires Community Advisory Boards
Opportunities to Inform DSRIP Invested Stakeholders can assure broad ongoing community participation: Make meetings accessible (logistically, language and time) Provide education material Capture feedback and incorporate it Facilitate direct interaction with PPSs and community
Also happening…. In addition to DSRIP, the State is also undertaking other comprehensive health improvement and planning initiatives: The State Healthcare Innovation Plan (SHIP) Prevention Agenda 2013-17: New York State’s Health Improvement Plan (Prevention Agenda) Population Health Improvement Plan (PHIP)
State Health Innovation Plan (SHIP) and State Innovation Model (SIM) Five pillars: Improve access to care for all New Yorkers, without disparity Integrate care to meet consumer needs seamlessly Transparent health care cost and quality Value-based payment Promoting population health Three “enablers”: Workforce strategy Health information technology Performance evaluation and measurement
SHIP and SIM Focus: Primary Care Regional practice transformation to deliver advanced primary care (APC model) Improve access to high-quality services Patient and family engagement Care coordination Enhanced reimbursement Address Workforce NY awarded $100 M State Innovation Model (SIM) grant from CMS Center for Innovation
Prevention Agenda 2013-2017: New York State's Health Improvement Plan Roadmap to improve health of New Yorkers; Five priority areas: Prevent Chronic Disease Promote a Healthy and Safe environment Promote Healthy Women, Infants and Children Promote Mental Health and Prevent Substance Abuse Prevent HIV, STDs, Vaccine–Preventable Diseases and Healthcare–Associated Infections Reduce health disparities
Population Health Improvement Programs (PHIPs) Promote Triple Aim: Better care Better population health Lower health care costs Support and advance: The New York State Prevention Agenda 2013-2017 The State Health Innovation Plan (SHIP)
PHIP (cont’d) 11 regions with statewide coverage achieved Serve as neutral convener and resource to: Collect, analyze and utilize data Convene stakeholders Regional needs assessments Facilitate Prevention Agenda Identify and share best practices Enable practice transformation
PHIP Regions Western NY-Allegany, Cattaraugus, Chautauqua, Erie, Niagara, Orleans, Genesee, Wyoming Finger Lakes-Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates Southern Tier-Broome, Chenango, Delaware, Tioga, Tompkins Central NY-Cayuga, Cortland, Madison, Onondaga, Oswego Mohawk Valley-Fulton, Herkimer, Montgomery, Oneida, Otsego, Schoharie North Country-Clinton, Essex, Franklin, Hamilton, Warren, Washington Tug Hill Seaway-Jefferson, Lewis, St. Lawrence Capital Region-Albany, Columbia, Greene, Saratoga, Schenectady, Rensselaer Mid-Hudson-Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester New York City-Bronx, Kings, New York, Richmond, Queens Long Island-Nassau, Suffolk
Conclusion Multiple initiatives restructure health delivery Shift in focusquality and outcomes vs. volume Planning and collaboration Social determinants of health and impact on health outcomes Hard for everyone to keep pace