1 / 30

Redesign Update

This article provides an overview of the recent changes and updates in the DSRIP program, including the Department of Health changes and DSRIP in other states. It also discusses the barriers to sustainability planning and explores future business models for PPS sustainability.

emiliob
Download Presentation

Redesign Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Redesign Update Evan Brooksby, MBA Director Policy, Analysis, & Special Projects

  2. Agenda • DSRIP Quick • Department of Health Changes • 1115 Waivers & DSRIP in other states • Sustainability Planning • DSRIP Success – MAX Series • New from CMS

  3. DSRIP Basics

  4. 25 DSRIP PPSS Across NYS

  5. Project-Focused

  6. Top Projects 5 high-value projects align with state’s vision reflect about 50% of DSRIP funding

  7. DSRIP in one slide

  8. Department of Health Changes • Helgerson will depart on April 6, 2018 to “pursue opportunities in the private sector” • “I want to make clear that my departure will have NO impact on this important mission. The Department of Health and its leadership remains 100% committed to the causes of MRT, DSRIP and VBP. “

  9. DSRIP in other states • 1115 Medicaid Waiver • Grants state flexibility • NYS 1115 Waiver renewed on January 19, 2017 – 5 year • DSRIP Expiration not aligned • Similarities beyond D.S.R.I.P. • . . .

  10. California • $6.2 Billion • Effective 1/2016 – 12/2020 • Ambulatory and primary care focus through designated public hospitals (DPHs) • Advance alternative payment models(APMs) with Medicaid managed care plans • 60% of all managed care beneficiaries receive all or a portion of their care through APM

  11. Massachusetts • $1.8 Billion • Effective 07/2017 – 06/2022 • Transition to integrated accountable care by: • Launching Medicaid accountable care organizations • Linking ACOs and certified Community Partners for care coordination • Investing in more efficient statewide infrastructure. • Medicaid ACOs, Certified Community Partners, and Managed Care Organizations

  12. Texas • $8.5 Billion • Effective 10/2017 – 9/2021 • Four Categories: • Infrastructure development • Program innovation and redesign • Population-focused improvement • Urgent clinical improvements • Under the terms of the new Waiver, CMS will temporarily continue DSRIP funding. However, funding is phased down to zero over the five years. • Transition from DSRIP to sustainable delivery system reforms that do not require DSRIP funding • 20+ regional health provider groups

  13. Washington • $1.125 Billion • Effective 1/2017 – 12/2021 • Transform Medicaid delivery through Accountable Communities of Health (ACH): • Improve data analytics and workforce development; • 90% of Medicaid care to be purchased via VBP by 2021; • Care delivery redesign with more integration and community linkages; and • Prevention focus. • Partnership with ACH — partnerships will include both traditional Medicaid providers and a variety of other entities and community-based organizations.

  14. New Hampshire • $150 Million • Effective 1/2016 – 12/2020 • Use integrated networks and improve access and quality • Support behavioral health infrastructure through the state's managed care delivery system using APMs • Regional Integrated Delivery Networks (IDNs), led by various entities that meet IDN criteria

  15. New Jersey • $292 Million • Effective 10/2012 – 6/2017 • Improve care delivery around eight chronic diseases — including asthma, HIV/AIDS, substance abuse, and obesity • All acute care hospitals are eligible (total of 63) — 50 have approved DSRIP projects;

  16. Barriers to Sustainability Planning • Uncertaintyoffuturebudgetaryandregulatoryenvironment • ManyPPS werehopingforDSRIP2.0 • Lackofclarityregardingfutureregulatoryrelief • PPS reportdelays in projectimplementationhave impactedevaluationtimelines: currently,thereis limited dataavailabletosupportVBPcontracting • AlmostallPPS citeMCOissuesasa significantbarrier • AccesstoMCOdata,challengesincontractingstrategy,lackofMCOsupportfor DSRIPinitiatives • Localmarketcomplexityandcompetition(particularlydownstate)with multiple participationoptionsofferedtoprovidersbyotherPPS • ContinuedskepticismfromsomepartnersregardingVBPtransition

  17. Future State Business Models January2018 January2018 • PPS are exploring future state structures • IPA • ACO • MSO • PPS are evaluating providing services under a variety of arrangements: • Fee for service • Alternative Payment Models • MSO • Annual membership plus fees for add-on services • PMPM for population health technologies or other services

  18. Vision for PPS Sustainability January2018 • EachPPSneedstodevelopits ownvisionand planfor sustainability, leveragingthenew DSRIP infrastructure • TheDSRIPworkforcewill be neededin thefuturevisionfor sustainability. • Your PPS willplayadifferent role beyond 2020 • VBPoffers flexibilitytoProvidersand MCOs • Theinfrastructuredevelopedin DSRIPwillbeneededto supportVBP. • PerformingProviderSystemsthemselves • NYS PCMHStatus • Connectivityto Qualified Entities andSHIN-NY • CoordinationwithManagedCareOrganizations

  19. Medicaid Accelerated eXchange (MAX) Series Program– Success from DSRIP • MAX Projects were not part of the original 11 projects • Focused on a defined population • Utilized Rapid Cycle Improvement • Quantified results

  20. Southside Hospital • Defined super-utilizers as 4+ admissions in 12 months • Identified an Action Team • 10 people from providers to administrators • Established baseline – Nothing in place

  21. Southside Hospital • Action period 1 • Created a flag to identify super utilizers • Develop a tool to assess the “driver of utilization” • Pilot a response system to a super utilizer presentation

  22. Southside Hospital • Action period 2 • Implement daily huddles to discuss super utilizers and develop a plan of care • Mobilize a point person to coordinate follow up for super utilizers • Link super utilizers consistently to the partnering social service agency

  23. Southside Hospital • Action period 3 • Develop a job description for a resource coordinator • Build community resource relationships • Articulate a business case for ongoing resources to support the super utilizer care team

  24. Southside Hospital

  25. New from CMS: • Expanding Patients Access and Control of Their Data • MyHealthEData • Medicare’s Blue Button 2.0 • Calling on Private Plans to Provide Patients Their Data

  26. New from CMS: • Encouraging Patient Access Through CMS Programs • Streamlining Meaningful Use (MU) and Quality Payment Program (QPP) • Prioritizing Quality Measures That Lead to Interoperability • Preventing Information Blocking

  27. New from CMS: • Modernizing Provider Requirements with a Focus on Value-Based Care • Requiring Providers to Update Their Systems to Ensure Data Sharing • Ensuring Patients Receive Their Data Upon Discharge • Streamlining Documentation and Billing Requirements

  28. Last thoughts

  29. Evan Brooksby, MBA 518.431.7736 ebrooksby@hanys.org @ejbrooksby

More Related