Overview of Payment and Delivery
System Reform Initiatives
June 25, 2015
Significant Activity in Health Systems
 Implementation of Affordable Care Act (ACA)
 New York Medicaid Redesign
 NYS Medicaid Waiver  DSRIP
 Medicaid Managed Care
 Increased focus on quality and outcomes
 Patient-Centered Medical Homes, Accountable Care
Organizations, Health Homes. Advanced Primary Care
 Electronic Health Records implementation
 Efforts to integrate Behavioral Health and Primary Care
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Triple AIM
 Triple Aim is a framework developed by the
Institute for Healthcare Improvement
 Improve patient experience of care (including
quality and satisfaction)
 Improve the health of populations
 Reduce the per capita cost of health care
 Guiding principle of NYS payment and delivery
system reform initiatives: Move health care
delivery system toward triple aim
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New York State Department of Health slide  NYS Health Initiatives
STATE HEALTH INNOVATION PLAN (SHIP)
PREVENTION AGENDA
Priority Areas:
- Prevent chronic diseases
- Promote a healthy and safe environment
- Promote health women, infants, and children
- Promote mental health and prevent substance abuse
- Prevent HIV, sexually transmitted diseases, vaccinepreventable diseases, health care associated infections
Pillars and Enablers:
- Improve access to care for all New Yorkers
- Integrate care to address patient needs seamlessly
- Make the cost and quality of care transparent
- Pay for healthcare value, not volume
- Promote population health
- Develop workforce strategy
- Maximize health information technology
- Performance measurement & evaluation
ALIGNMENT:
Improve Population Health
Transform Health Care Delivery
Eliminate Health Disparities
MEDICAID DELIVERY SYSTEM REFORM
INCENTIVE PAYMENT (DSRIP) PROGRAM
Key Themes:
- Integrate Delivery – create Performing Provider Systems
- Performance-based payments
- Statewide performance matters
- Regulatory relief and capital funding
- Long-term transformation & health system sustainability
POPULATION HEALTH IMPROVEMENT
PROGRAM (PHIP)
PHIP Regional Contractors:
- Identify, share, disseminate, and help implement best
practices and strategies to promote population health
- Support and advance the Prevention Agenda
- Support and advance the SHIP
- Serve as resources to DSRIP Performing Provider
Systems
Delivery System Reform Incentive
Payment Program (DSRIP)
 Restructure health care delivery system
 Delivery System Reform Incentive Payment (DSRIP)
program: $7.42 B
 Interim Access Assurance Fund (IAAF): $500 M
 Medicaid Redesign Projects: $1.08 B
 Achieve 25% reduction in avoidable
hospitalizations
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Goals of DSRIP
 Transform health care safety net
 Reduce avoidable hospital use
 Improve health and public health measures
 Cost-efficient Medicaid program with better
outcomes
 Leverage payment reform to ensure long-term
delivery system reform
 Financial support for some safety net providers
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DSRIP Stakeholder and Community
Engagement
 Community needs assessment was essential
element to engage the community
 Needs assessment shaped and decided DSRIP
priorities
 PPSs need to continue/improve community
engagement
 Enacted 2015-16 State Budget requires
Community Advisory Boards
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Opportunities to Inform DSRIP
 Invested Stakeholders can assure broad
ongoing community participation:
 Make meetings accessible (logistically, language
and time)
 Provide education material
 Capture feedback and incorporate it
 Facilitate direct interaction with PPSs and
community
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Also happening….
In addition to DSRIP, the State is also undertaking
other comprehensive health improvement and
planning initiatives:
 The State Healthcare Innovation Plan (SHIP)
 Prevention Agenda 2013-17: New York State’s
Health Improvement Plan (Prevention Agenda)
 Population Health Improvement Plan (PHIP)
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State Health Innovation Plan (SHIP) and
State Innovation Model (SIM)
 Five pillars:
 Improve access to care for all New Yorkers, without
disparity
 Integrate care to meet consumer needs seamlessly
 Transparent health care cost and quality
 Value-based payment
 Promoting population health
 Three “enablers”:
 Workforce strategy
 Health information technology
 Performance evaluation and measurement
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SHIP and SIM
 Focus: Primary Care
 Regional practice transformation to deliver
advanced primary care (APC model)
 Improve access to high-quality services
 Patient and family engagement
 Care coordination
 Enhanced reimbursement
 Address Workforce
 NY awarded $100 M State Innovation Model
(SIM) grant from CMS Center for Innovation
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Prevention Agenda 2013-2017: New York
State's Health Improvement Plan
 Roadmap to improve health of New Yorkers;
Five priority areas:
 Prevent Chronic Disease
 Promote a Healthy and Safe environment
 Promote Healthy Women, Infants and Children
 Promote Mental Health and Prevent Substance
Abuse
 Prevent HIV, STDs, Vaccine–Preventable Diseases
and Healthcare–Associated Infections
 Reduce health disparities
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Population Health Improvement Programs
(PHIPs)
 Promote Triple Aim:
 Better care
 Better population health
 Lower health care costs
 Support and advance:
 The New York State Prevention Agenda 2013-2017
 The State Health Innovation Plan (SHIP)
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PHIP (cont’d)
 11 regions with statewide coverage achieved
 Serve as neutral convener and resource to:
 Collect, analyze and utilize data
 Convene stakeholders
 Regional needs assessments
 Facilitate Prevention Agenda
 Identify and share best practices
 Enable practice transformation
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PHIP Regions
 Western NY-Allegany, Cattaraugus, Chautauqua, Erie, Niagara, Orleans,
Genesee, Wyoming
 Finger Lakes-Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca,
Steuben, Wayne, Yates
 Southern Tier-Broome, Chenango, Delaware, Tioga, Tompkins
 Central NY-Cayuga, Cortland, Madison, Onondaga, Oswego
 Mohawk Valley-Fulton, Herkimer, Montgomery, Oneida, Otsego, Schoharie
 North Country-Clinton, Essex, Franklin, Hamilton, Warren, Washington
 Tug Hill Seaway-Jefferson, Lewis, St. Lawrence
 Capital Region-Albany, Columbia, Greene, Saratoga, Schenectady, Rensselaer
 Mid-Hudson-Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster,
Westchester
 New York City-Bronx, Kings, New York, Richmond, Queens
 Long Island-Nassau, Suffolk
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Conclusion
 Multiple initiatives restructure health delivery
 Shift in focusquality and outcomes vs. volume
 Planning and collaboration
 Social determinants of health and impact on
health outcomes
 Hard for everyone to keep pace
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