New York State's Medicaid program is in the midst of a radical re-engineering, as it shifts the focus of provider payments to rewarding the health outcomes of patients rather than the quantity of care delivered. This change is leading hospitals, other health care providers, and community-based organizations to collaborate, often for the first time, to advance delivery system reform and address the economic and social drivers of avoidable health care utilization.
Those collaborations are working, State Medicaid Director Donna Frescatore told United Hospital Fund's annual Medicaid conference in her keynote address. For example, preventable readmissions have dropped more than 15 percent in the first three measurement years of the Delivery System Reform Incentive Payment (DSRIP) program, a five-year state initiative launched in 2014 to bring down avoidable hospital use by 25 percent.
New York State Medicaid Director Donna Frescatore
(credit: Ellen Wallop)
The conference was held July 18 at the New York Academy of Medicine, with some 375 providers, policy makers, and health care experts attending.
DSRIP encouraged provider collaborations to pursue health system transformation, clinical improvement, and population health goals, while also laying the foundation for New York's value-based payment (VBP) reforms, under which Medicaid providers increasingly receive managed care payments tied to value rather than volume of services. Requirements and incentives embedded in VBP encourage health providers to address social determinants of health, such as poor housing, inadequate nutrition, and exposure to violence. As the move to VBP continues, additional partnerships between health care providers and community-based social service organizations, similar to those encouraged by UHF's Partnerships for Early Childhood Development initiative, are being formed across the city and state. As a result, Ms. Frescatore said, organizations that never really talked to each other before are talking now, “creating a new fabric of community in caring for residents.”
Next on the agenda? “How do we take what we've learned here and make it more broadly available, maybe even outside the Medicaid program?" she asked the attendees. In one effort to broaden DSRIP's and VBP's impacts on population health, the New York State Department of Health issued a call in June for innovative new approaches to address social determinants of health. “We were overwhelmed with the response. We received more than 200 innovation applications,” Ms. Frescatore said.
The proposals came from community-based organizations, technology solutions companies, and health care providers. Their number and variety are a sign that New York Medicaid's message—that health outcomes can be improved through innovation and collaboration—is being heard, she said.
To keep the momentum going, the New York State Department of Health is compiling stories on how DSRIP has changed the lives of New Yorkers, because stories can change minds. “We want to collectively identify what has been most successful through these DSRIP reforms, assess what works best for patients, and then share the stories of those successes broadly across the state,” she said, “and even beyond the Medicaid program to the individual market.”
The meeting continued with a second keynote speech by Matt Salo, executive director of National Association of Medicaid Directors, and two panels: New York Medicaid's Children's Agenda with Dodi Meyer MD, professor of pediatrics and director of community pediatrics at Columbia University Medical Center, Jennifer March, PhD, executive director of Citizens' Committee for Children of New York, and Joe Stankaitis, MD, MPH, chief medical officer of Monroe Plan and YourCare Plan, and moderated by Suzanne Brundage, director of UHF's Children's Health Initiative and Patricia S. Levinson Fellow; and Leveraging Value-Based Payments to Address Social Determinants, with Theresa Soriano, MD, senior vice president for care transitions and population health at Mount Sinai St. Luke's, Ricardo A. Rivera-Cardona, chief business development officer of SOMOS Community Care, and Shoshanah Brown, chief executive officer of AIRnyc, and moderated by Chad Shearer, UHF's vice president for policy and director of the UHF Medicaid Institute.
PDFs of several presentations are below:
Ricardo A. Rivera-Cardona