Redesign Update
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Presentation Transcript
Redesign Update Evan Brooksby, MBA Director Policy, Analysis, & Special Projects
Agenda • DSRIP Quick • Department of Health Changes • 1115 Waivers & DSRIP in other states • Sustainability Planning • DSRIP Success – MAX Series • New from CMS
Top Projects 5 high-value projects align with state’s vision reflect about 50% of DSRIP funding
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. “
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. • . . .
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
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
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
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.
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
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;
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
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
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
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
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
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
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
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
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
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
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
Evan Brooksby, MBA 518.431.7736 ebrooksby@hanys.org @ejbrooksby
