Download New York State of Health –PowerPoint

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TRANSFORMING HEALTH CARE
IN NEW YORK STATE:
WHAT’S NEW
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Contents
• Key Themes of Transformation
• Delivery System Reform Incentive Payment (DSRIP) Program
• Statewide Health Innovation Program (SHIP)
• Supporting Sustainability
• Workforce Support Programs
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Key Themes of Transformation
Driven by Triple Aim: Improved Population Health, Better
Quality, Efficient Spending
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Key Themes:
• Integrated delivery of care
• Performance-based payment
• System sustainability
• Effective & trained workforce
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NYS Medicaid in 2010: the crisis
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2009 Commonwealth State Scorecard
on Health System Performance
> 13% anticipated growth rate had
become unsustainable, while quality
outcomes were lagging
CARE MEASURE
Avoidable Hospital Use and Cost
• Costs per recipient were double the
national average
• NY ranks 50th in country for avoidable
hospital use
• 21st for overall Health System Quality
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Attempts to address situation had failed
due to divisive political culture around
Medicaid and lack of clear strategy
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Percent home health patients with a hospital admission
Percent nursing home residents with a hospital
admission
Hospital admissions for pediatric asthma
Medicare ambulatory sensitive condition admissions
Medicare hospital length of stay
NATIONAL
RANKING
50th
49th
34th
35th
40th
50th
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The DSRIP Challenge – Transforming the Delivery System
• Largest effort to transform the NYS Medicaid Healthcare Delivery
System to date
– From fragmented and overly focused on inpatient care towards integrated and community focused
– From a re-active, provider-focused system to a pro-active, patient-focused system
– Allow providers to invest in changing their business models
Patient-Centered
Transparent
• Improving patient care & experience through a more
efficient, patient-centered and coordinated system.
• Decision making process takes place in the public eye and
that processes are clear and aligned across providers.
Collaborative
• Collaborative process reflects the needs of the communities
and inputs of stakeholders.
Accountable
• Providers are held to common performance standards and
timelines; funding is directly tied to reaching program goals.
Value Driven
• Focus on increasing value to patients, community, payers and
other stakeholders.
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New York State Health Innovation Plan (SHIP)
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Supporting Transformation
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Providing Regulatory Flexibility
• Goal: waive regulatory requirements that may prevent / delay
transformation
• Criteria:
• Consistent with a federal requirement?
• Consistent with state statute?
• Consistent with patient safety considerations?
• Consistent with important public policy principle(s)?
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Providing Regulatory Flexibility
• 250 requests approved in the following categories:
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Integrated Services
Public Need and Financial Feasibility
Admission, Transfer, Discharge
Offsite Services
Revenue Sharing
Bed Capacity
Transfer and Affiliation agreements
Tele-health
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Integration Models and Approaches
• Goal: streamline processes to integrate service
• Licensure Thresholds
• DSRIP Project 3.a.i Licensure Threshold
• Collaborative Care Model
• Integrated Outpatient Services (IOS) Regulations
• Multiple Licenses
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Capital Restructuring Financing Program
(CRFP)
• $1.2 billion for capital projects to enhance the quality, financial viability & efficiency
of NYS’s health care delivery system, embracing DSRIP goals.
• Eligible applicants: general hospitals, NH’s, diagnostic & treatment centers,
substance abuse / mental health clinics, assisted living providers, home care
providers, & primary care providers.
• 135 Awards announced March 2016; 671 applications requested $3.5 billion.
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Essential Health Care Provider Support Program
(EHCPSP)
• $355 million in discretionary grants to essential licensed
general hospitals or hospital systems
• Goal: preserve essential services & facilitate provider
transformation to create financially sustainable systems
• 27 awards; 111 applications requesting $1.64 billion
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EHCPSP – Desired Outcomes
• Measurable Managed Care Health Improvement
• Reduction of Hospital Readmissions & Inpatient Admissions
• Increase in the number of Medicaid beneficiaries served
• Attaining Highest level of Patient Centered Medical Home (PCMH) Status
• Working with the DOH toward a shared Medicaid Savings Program
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The Statewide Health Care Facility Transformation Program
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$195 million discretionary funding available to fulfill a health care need for
acute inpatient, outpatient, primary, home care or residential health care.
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Supports projects that strengthen & protect access to services & are part of
an overall transformation plan to a sustainable system of care.
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At least $30m for community-based health care providers
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Priority given to projects not funded by the CRFP or EHCPSP grants
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RFA posted July 20. Applications due September 16. Awards
anticipated December 2016.
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Protecting Safety Net Essential
Providers
July 28, 2016
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Protecting Essential Safety Net Providers
• Interim Access Assurance Fund (IAAF)
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$500 million to support safety net hospitals in SFY 14-15 until a DSRIP transformation
application could be submitted, approved and funded
• Vital Access Provider Assurance Program
Value-Based Payment—Quality Improvement Program
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Support eligible providers while they work toward longer-term sustainability, improved
quality, & alignment with Value Based Payment (VBP) initiatives.
– SFY 2015-16: Over $332 million
– Projected SFY 2016-17: Over $450 million
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Vital Access Provider Program (VAP)
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Supports restructuring plans for essential providers
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Workforce Support Programs
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Workforce Support Programs
• Doctors Across New York (DANY): improve access to physicians
• Loan Repayment & Practice Support Programs: $9 million annually to place &
retain physicians in underserved area
• Ambulatory Care Training Program: $4 million annually to medical schools,
hospitals & clinics to train residents & medical students in free-standing ambulatory
care sites
• Health Workforce Retraining Initiative (HWRI)
• $24.2M grant RFA released May 11, 2016 to support training & retraining of health care &
public health workers
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Workforce Programs
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$1 million annual funding loan repayment to non-physician health
care practitioners who agree to practice in underserved areas
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$3.7 million annual funding to assist underrepresented & financially
disadvantaged students in entering medicine & health care fields
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$1 million annually for 3 years through Rural Residency Program to
support the development of rural-based GME programs to help
alleviate regional and primary care physician shortages.
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Questions?
Thank You!