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This overview provides information on various healthcare reform initiatives in New York State, including the implementation of the Affordable Care Act, Medicaid redesign, and efforts to integrate behavioral health and primary care. It also highlights the goals of the Delivery System Reform Incentive Payment (DSRIP) program and the importance of stakeholder and community engagement.
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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
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 essentialelement 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 regionswith 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
