0. Overview of Payment and Delivery System Reform Initiatives
June 25, 2015

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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 State Budget requires Community Advisory Boards

7. 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

8. 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 : New York State’s Health Improvement Plan (Prevention Agenda)
Population Health Improvement Plan (PHIP)

9. 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

10. 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

11. 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

12. 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
The State Health Innovation Plan (SHIP)

13. 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

14. 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

15. Conclusion Multiple initiatives restructure health delivery
Shift in focusquality and outcomes vs. volume
Planning and collaboration
Social determinants of health and impact on health outcomes
Hard for everyone to keep pace