Redesign Medicaid in New York State
A Plan to Transform the Empire
State’s Medicaid Program
2013 Ten State Regional Conference
February 23, 2013
Jason A. Helgerson, Medicaid Director
NYS Department of Health
Overview
1)
Medicaid Redesign Team (MRT)
A Quick Recap
2)
MRT Multi-Year Action Plan
Achieving the CMS Triple Aim
3)
Key Initiatives
4)
Results
5)
Next Steps
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MRT Recap
THE MRT WORKED IN TWO PHASES
Phase 1:
Phase 2:
Provided a blueprint for lowering
Medicaid spending in state fiscal
year 2011-12 by $2.2 billion.
Developed a comprehensive multiyear action plan to fundamentally
reform the Medicaid program.
o
This is the first effort of its kind in New York State.
o
By soliciting public input and bringing affected
stakeholders together, this process has resulted in a
collaboration which reduces costs while focusing on
improving quality and reforming New York’s Medicaid
system.
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MRT Phase I Overview
o
MRT Phase 1 recommendations provided a blueprint for
lowering Medicaid spending in state fiscal year 2011-12 by
$2.2 billion.

Phase 1 completed February 24, 2011.

Initial MRT report met the Governor's Medicaid spending
target contained in his 2011-2012 budget.

o
79 recommendations were included in MRT report and 78
recommendations were approved by the legislature as part of
the budget and are currently being implemented.
The plan allowed NYS to move from an environment where growth in
the Medicaid program was anticipated to rise by 13% (state share),
and ensured growth would rise by 1% (state share).
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MRT Phase II Overview
o
The MRT continued its innovative work in a
second phase:

MRT broke into 10 work groups to address more
complex issues.

MRT monitored the implementation of key
recommendations enacted in Phase 1.

MRT Phase 2 completed on December 13, 2011.
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MRT Phase II Overview
o
MRT work groups gave an additional 175
stakeholders the opportunity to participate in
the MRT process:

All work group meetings were public.

Each work group produced a final report of
recommendations.

All work group reports were approved by the MRT.

Recommendations from Phase 1 & Phase II combined
into a single, multi-year Medicaid reform strategy.
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Final Product
o
Most sweeping Medicaid reform plan
in state history.
o
Pulls together the work of the MRT
into a single action plan.
o
Plan is closely tied to successful
implementation of the federal
Affordable Care Act (ACA).
o
The plan also embraces the CMS
“triple aim” of: Improving care,
improving health, and reducing
costs.
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Key MRT Initiatives
o
o
Medicaid Global Spending Cap

Multi-year spending cap with growth linked to CPI-Medical.

Introduced fiscal discipline and transparency.

New York is actually managing its Medicaid program on a
daily basis.
Universal Access to High Quality Primary Care

GOAL – All Medicaid members access primary care from
nationally accredited Patient Centered Medical Homes.

New York invested in this effort - $100 million per year.
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Key MRT Initiatives
o
Care Management for All

End the inefficient FFS Medicaid program that distorts
incentives in health care delivery.

Multi-year phase in.

Contract with around 50 fully integrated health plans
statewide.

Capitation is not enough – Provider level payment
reform will also be required (shared savings, subcapitation, shared savings, etc.)
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Key MRT Initiatives
o
Health Homes

New York is creating “Accountable Care Organizations” for
the state’s highest needs patients.

Health Homes are integrated provider networks (including
housing and human service providers) that work together,
share information in real time and help coordinate care for
the population that drives Medicaid spending.

The goal with Health Homes – transform health care delivery
into to a true “team sport” starting with our most complex
patients.
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Key MRT Initiatives
o
Other Initiatives

First state in the nation to redirect Medicaid savings to
expand access to supportive housing for high needs
Medicaid patients.

Integration of behavioral health with physical health at
both the plan and provider levels.

Complete transformation of FFS reimbursement in long
term care in preparation for managed care.

Investing in innovative public health strategies and
program wide acceptance that Medicaid must be a force
for addressing population health problems.
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MRT Results
o
Spending down 9% on a per recipient basis.
o
Lowered Medicaid spending by over $4 billion on an
annual basis.
o
In Year 1, generated enough savings for the federal
government to “flat-line” the national growth rate in
Medicaid.
o
Increased the number of Medicaid members using
PCMH’s by one million.
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MRT Results
o
Launched 34 health homes statewide. 16,000 high
needs patients enrolled.
o
Invested $75 million in supportive housing and the first
units of “MRT Housing” are now open in the Bronx.
o
Generated statewide consensus on how to
fundamentally reform New York’s Medicaid program.
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Next Steps
o
Thanks to the MRT we now have a
multi-year action plan, a roadmap, for
meaningful Medicaid reform.
o
Need to get the MRT waiver
amendment approved.
o
Need to continue to implement MRT
action plan.
o
Biggest risks are continued enrollment
growth and potential federal cuts in
Medicaid/Medicare.
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Contact Information
We want to hear from you!
MRT Waiver e-mail:
mrtwaiver@health.state.ny.us
Subscribe to our listserve:
http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm
‘Like’ the MRT on Facebook:
http://www.facebook.com/NewYorkMRT
Follow the MRT on Twitter: @NewYorkMRT
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