Transcript Slide 1

Health Care Reform in New York State
Fitting the Pieces Together toward the Triple Aim:
Better Care, Lower Costs, and Improved Health for All
New York Academy of Medicine
Courtney Burke, Deputy Secretary for Health, New York State
April 30, 2015
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The Vision
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Healthier New Yorkers (population health)
Lower costs
Engaged consumers
Systems, programs, financing, policies that support
and value these goals
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The Systems, Programs, Policies, Financing
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ACA – Affordable Care Act
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ACO – Accountable Care
Organizations
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APC – Advanced Primary Care
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APD – All Payer Database
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DISCO – Developmental Disability
Individualized Supports & Care
Coordination Organization
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DSRIP – Delivery System Reform
Incentive Payment Program
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FIDA – Fully Integrated Dual
Advantage
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HARPS – Health and Recovery Plans
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HH – Health Homes (HH)
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MLTC – Managed Long-Term Care
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MRT – Medicaid Redesign Team
NYSOH – New York State of Health
PA – Prevention Agenda
PCMH – Patient Centered Medical
Home
PHIP – Population Health
Improvement Program
PPS – Performing Provider System
SHINY-NY – Statewide Health
Information Network for New York
Systems
SHIP – New York State Health
Innovation Plan
SIM – State Innovation Model
VAP – Vital Access Provider
VBP – Value Based Payment
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The Ingredients
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Vision – ACA/SHIP/PA
Resources/incentives – DSRIP/VBP
Tools/technology/mechanics – SHIN-NY/APD/NYSOH
Organization – PPS/ACO/HH/HARP/DISCO/PCMH/MLTC
Grass roots buy-in – PHIP/APC/MRT
Time and assistance for transition – VAP/Capital
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Major Areas of Overlap
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Primary, preventive care, and population health
Integrated and coordinated care
Focus on behavioral health
Investments in transforming the workforce
Reducing preventable admissions
Paying based on value (shared accountability)
Consumer engagement and empowerment
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The Initiatives
Federally Driven
State Driven
Wellness
Care Coordination
ACA
ACOs
PCMH
HH
FIDA
Primary Care &
Population Health
Collaboration,
Cooperation
Shared
Accountability
Attention to
Behavioral Health
Value-Based
Payment
MRT
HARP, DISCO
Prevention
Agenda
NYSOH
APD
SHIN-NY
SHIP
DSRIP (PPS)
PHIP
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The Source of Funds (SHIP/DSRIP)
Strong, expert, coordinated state leadership can create value over the next four years
Advanced Primary Care
DSRIP
Capital
Restructuring
Common
Scorecard
Prevention
Agenda
SHIN-NY
Currently funded
NY SHIP
value-based
purchasing
Planned SIM funding
Multi-payer funding
Rate Review
SIM Testing Grant
▪ Statewide
leadership
▪ Stakeholder
alignment
▪ Multi-payer
business design
and support
NY State of
Health
PHIPs
Workforce
strategy
APD
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Next Steps
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SHIP – Workgroups convening
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DSRIP PPSs – Payments begin this year
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PHIPs – Analyzing data and engaging community stakeholders
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APD/SHIN-NY – RFP out for APD, SHINY-NY working regionally
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HARP/DISCOs/FIDA – rollout
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Payments become value-based
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Better care management – DISCO/HARP/FIDA/HH/PCMH/ACO
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Primary care – APC model being developed, practice transformation roll-out
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Providers become more vested in outcomes – shared risk and savings
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Workforce importance recognized – joint workforce group convening
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Consumers more empowered
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Population health, prevention, primary care at the forefront
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ALIGNMENT & IMPLEMENTATION
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Appendix A:
Brief Explanations of Major Initiatives
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Prevention Agenda Priorities
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Prevent chronic diseases
Promote a healthy and safe environment
Promote healthy women, infants, and children
Promote mental health and prevent substance abuse
Prevent HIV, sexually transmitted diseases,
vaccine-preventable diseases, and health care
associated infections
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MRT Waiver Amendment:
$8 Billion Allocation
• $500 Million for the Interim Access Assurance Fund (IAAF) – Time limited
funding to ensure current trusted and viable Medicaid safety net providers
can fully participate in the DSRIP transformation without unproductive
disruption
• $6.42 Billion for Delivery System Reform Incentive Payments (DSRIP) –
Including DSRIP Planning Grants, DSRIP Provider Incentive Payments, and
DSRIP Administrative costs and DSRIP related Workforce Transformation.
• $1.08 Billion for other Medicaid Redesign purposes – This funding will
support Health Home development, and investments in long term care
workforce and enhanced behavioral health services, (1915i services)
• 1.2 billion in capital investment enacted in 2014-15 budget
• Regulatory relief to support provider collaboration on DSRIP projects
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DSRIP
Six Themes:
1. Integrated delivery – creating performing provider systems
2. Project value drives
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Transformation  # and types of projects
# of Medicaid members served (attribution)
Application quality – speed and scope of implementation
Performance based payments – process and outcome measures
Statewide performance matters
Regulatory relief and capital funding available
Lasting change
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b.
Long-term transformation
Health system sustainability
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SHIP/SIM Overarching Goals
The SHIP is New York’s overarching vision to integrate and
coordinate multiple ongoing initiatives with the goal of optimal
health and well-being for all New Yorkers.
Population Health Goal of the SHIP:
• “Improve population health through strengthened capacity and
improved screening and prevention through closer linkages
between primary care, public health, and community based
supports.”
• 2020 Goal: Achieve top quartile performance among states in
prevention and public health
• 80% of payments risk-based by year 5
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SIM Testing Grant
Funding was requested to support the following:
• Clinical preventive services that have a demonstrated impact
on public health goals and that strengthen linkages between
clinical care providers, local public health, and communitybased organizations
• Regionally-based primary care practice transformation
• Transition to value-based payment
• Expanding NY’s primary care workforce through innovations in
professional education and training
• Development of a common scorecard, shared quality metrics,
and enhanced data/analytics
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PHIP Overview and Objectives
The Population Health Improvement Program will promote the
Triple Aim—better care, better population health, and lower
health care costs—by selecting regional contractors to provide a
neutral forum for identifying, sharing, disseminating, and helping
implement best practices and strategies to promote population
health and reduce health care disparities
PHIP contractors will, within their regions:
– Support and advance the Prevention Agenda
– Support and advance the SHIP
– Serve as resources to DSRIP performing provider systems in their
regions upon request
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New York State of Health
• One of the most successful marketplaces in the nation
• More than two million New Yorkers have enrolled since 2013
launch
• Premiums more than 50% lower than they were before the
marketplace opened
• New features for 2015: more plan choices, a Spanish version
of the website, key consumer materials in 10 additional
languages and a new plan preview tool that allows consumers
to shop before they begin their application
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HARPs
• Behavioral health will be managed by:
o Special needs health and recovery plans (HARPs) for individuals
with significant behavioral health needs
o Mainstream managed care plans:
— Plans may operate services directly only if they meet rigorous
standards
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Plans that do not meet rigorous standards must partner with a BHO
which meets standards
— Plans can partner with BHOs to meet the rigorous standards
• Integration of all Medicaid behavioral health and physical
health benefits under managed care will go into effect in
spring 2015 in NYC and fall 2015 in the rest of the state
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DISCOs
• Managed care designed to meet unique needs of
people with developmental disabilities
• Governed by special statute enacted in 2012
• DISCOs will have modified reserve requirements to
facilitate start-up
• DISCOs must be controlled by one or more non-profit
organizations with experience providing or
coordinating health and long-term care services to
people with IID
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SHIN-NY
• Tool to support DSRIP, PCMH, HH, ACOs, and care
integration
• Provide support via:
– Patient record look-up (PRL)
– Direct messaging
– Subscribe and notify
• Hospital admit, discharge, ER visit
• Value increases as the number of providers connected
and sharing PHI in a meaningful way increases
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All Payer Database (APD)
• New York State enacted legislation in spring 2011 that allowed
for the creation of an All Payer Database.
• APD is envisioned as the repository for a wide variety of health
care data that can be integrated to support the evolving
information and analytical requirements of stakeholders
involved in the management, evaluation, and analysis of the NYS
health care system
• The APD will serve as a key resource for supporting finance
policy, quality measurement and improvement, and population
health and health care system comparisons and improvements
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Unfinished Business
• Changing our view of “health” to include
social determinants
• Transforming long-term care
• Further empowering consumers
• Measuring quality of life as a valued outcome