State Medicaid director Donna Frescatore
New York State’s innovative set of Medicaid delivery system reforms, launched five years ago and built around a shift to value-based payments, has reduced both preventable hospitalizations and their associated costs, State Medicaid director Donna Frescatore and Gregory Allen, from the NYS Department of Health, told United Hospital Fund’s annual Medicaid conference attendees on July 18. As a result—and with help from UHF—the State is now assessing which reforms show the most promise and the greatest potential for expansion and intends to build on these as it prepares for the launch of the next stage of reforms next year.
In a study released a few days before the conference, UHF reported that four years into full implementation of New York’s groundbreaking Delivery System Reform Incentive Payment (DSRIP) initiative, the program has fostered a number of promising practices that lay the groundwork for improving health care access, quality, and costs well beyond DSRIP’s current conclusion in March 2020. Much of the conference focused on DSRIP 2.0, the anticipated next stage of reform efforts, as New York prepares to seek a renewed federal Medicaid waiver that will allow it to sustain and expand these promising practices.
This year’s conference, entitled Medicaid in New York: A Look Toward the Future, presented with support from The Commonwealth Fund, was attended by nearly 400 people representing every aspect of the health care system in New York. In her keynote, Ms. Frescatore reiterated the UHF report’s conclusion—that Medicaid in New York has made significant progress toward its goal of reimbursing providers for health care outcomes rather than the volume of procedures performed, thanks to its value-based payment initiative (closely aligned with DSRIP). About 63 percent of targeted Medicaid managed care expenditures, or $14 billion, are currently flowing through value-based payment arrangements — in which providers are accountable for achieving both quality and efficiency goals — rather than through payments primarily based on service volume.
New York continues to move closer toward its goal of ensuring that every resident of the state has health insurance, she said, with steady enrollment in Medicaid, growth in other publicly funded sources of coverage, and proactive steps to safeguard the Affordable Care Act’s consumer protections (Ms. Frescatore is also Executive Director of New York State of Health, the State’s online insurance marketplace). Only 4.7 percent of New Yorkers are uninsured, a historic low, she said; nevertheless, that represents about 1 million people who still do not have coverage.
Ensuring the Long-Term Success of DSRIP
During a panel discussion about DSRIP, Mr. Allen, director of the Division of Program Development and Management for the Office of Health Insurance Programs within the NYS Department of Health, said the State feels that more time is needed for value-based payment models to mature in order to support DSRIP’s most promising practices. Strengthening partnerships between managed care organizations, health care providers, and community-based organizations will be another important priority for DSRIP 2.0, and key to sustaining long-term success. Mr. Allen added that the State feels that DSRIP 2.0 should emphasize new flexibility for Performing Provider Systems’ structure and governance, expansion of promising practices to children and other subpopulations, and alignment of DSRIP with other health care transformation initiatives, such as behavioral health and long-term care reforms.
The other DSRIP panel members—Isaac Dapkins, MD, Medical Director, NYU Langone Brooklyn PPS; Ann Monroe, Co-Chair, DSRIP Project Approval and Oversight Panel and former President, Health Foundation for Western & Central New York; and Salvatore Volpe, MD, Chief Medical Officer, Staten Island PPS, with UHF Senior Vice President Chad Shearer moderating—discussed DSRIP’s successes in advancing New York Medicaid’s triple aim of better health, better care, and lower costs. The panelists agreed that partnerships between health systems, community-based organizations (CBOs), and primary care providers were central to many of DSRIP’s achievements—including expanded access to behavioral health services, such as treatment for substance use disorder, and interventions targeting social factors driving health outcomes, such as inadequate housing or food insecurity.
Future of Integration for Medicaid Long-Term Care
The conference presented two additional sessions. A panel discussion of Medicaid long-term care focused on the challenges of, and innovative solutions for, integrating long-term care with other health services and social supports under Medicaid. This discussion considered strategies for supporting consumers and caregivers as they navigate a complex landscape, empowering long-term care providers as partners in improving health outcomes, and overcoming the divide between Medicaid and Medicare. The panel included Randall Klein, CEO of HT Health; Karen Lipson, executive vice president for Innovation Strategies, LeadingAge New York; Adria Powell, president and CEO of Cooperative Home Care Associates; and Frederic Riccardi, president of Medicare Rights Center. Kathryn Haslanger, CEO of JASA, served as moderator.
The Path Forward for Medicaid Managed Care in NY
The third session, a chat about the future of Medicaid managed care with Karen Ignagni, President and CEO of EmblemHealth, and Pat Wang, President and CEO of Healthfirst, was moderated by UHF president Anthony Shih MD, MPH. The two executives said that managed care organizations (MCOs) could be vital partners under DSRIP 2.0 for fully understanding and addressing Medicaid members’ needs and aligning efforts to improve the delivery system across the continuum of care. The executives also identified strengthening the role of primary care and addressing social needs that impede health care access as cornerstones of MCOs’ efforts to improve health outcomes and emphasized simplicity and flexibility as important principles for supporting more effective collaborations between MCOs, health care providers and other partners, and the State.