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New York State is in the process of undergoing an unprecedented transformation of its healthcare system through the implementation of the $6 billion Delivery System Reform Incentive Payment (DSRIP) program. Why? New York must not only reduce the vast cost of care, but it must also assure that individuals’ care is optimized through better collaboration. DSRIP will require comprehensive networks of providers to work together in Performing Provider Systems (PPSs), delivering population-based healthcare to Medicaid beneficiaries and uninsured New Yorkers. Through this process, the State intends to transform New York’s healthcare safety net, improve healthcare quality, and increase sustainability through payment reform. Success in the DSRIP program will require innovative strategies in communication, patient care, data analytics, and many other areas. Technology must therefore be foundational to a solid PPS platform. This panel of leading PPS participants and tech solutions providers will examine the vital role that healthcare technologies will play in DSRIP implementation, and the potential for DSRIP to accelerate the introduction of new, innovative technologies into New York’s healthcare delivery system. • Jordanna Davis - Principal, Sachs Policy Group • Stan Berkow - Co-Founder & CEO, Sense Health • David Cohen, MD, MSc - Executive Vice President, Clinical Affairs & Affiliations; Chair, Department of Population Health, Maimonides Medical Center • Lori Evans Bernstein - President, GSI Health • Stephen Rosenthal - President & Chief Operating Officer, CMO, The Care Management Company of Montefiore Medical Center New York eHealth Collaborative Digital Health Conference November 17, 2014
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New York State’s DSRIP Program:
A Key Moment for Healthcare Technology &
Improving Care for All New Yorkers
Jordanna Davis, Sachs Policy Group
2 SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY 2010 MSIS and
CMS-64 reports.
Total Medicaid Spending Per Beneficiary
5
SOURCE: “The State of New York’s Medicaid Program,” Jason Helgerson. July 15, 2014
DSRIP Goals
• Safety net transformation at the system and
state level.
• Accountability for reducing avoidable hospital
use and improvements in population health
measures at the system and state level.
• Sustainability of delivery system transformation
through managed care payment reform.
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“Emerging” PPSs
AW Medical Lutheran Medical Center HealthAlliance Hudson Valley
Mount Sinai Hospitals Group NY Hospital Med Center Queens Erie County Medical Center Corp
NYC Health and Hospitals Corp Stony Brook University Hospital Catholic Medical Partners
Maimonides Medical Center Long Island Jewish Medical Center
Ellis Hospital
St. Barnabas Hospital Catholic Health Services of LI Albany Medical Center Hospital
SUNY Downstate Medical Center Nassau University Medical Center CNY PPS
Bronx‐Lebanon Hospital Center Finger Lakes PPS United Health Services Hospitals
The Jamaica Hospital Montefiore Medical Center Adirondack Health Institute
New York Presbyterian Hospital Westchester Medical Center Mary Imogene Bassett Hospital
RUMC & SIUH Refuah Health Center Samaritan Medical Center
7
Choosing from the DSRIP Menu
Care Coordination/ Transitional Care • Ambulatory ICUs • Development of co-located primary care services in the ED • ED care triage for at-risk populations • Care transitions intervention model to reduce 30-day readmissions for chronic health conditions • Care transitions intervention for skilled nursing facility residents • Transitional supportive housing services • Implementing the INTERACT project (inpatient transfer avoidance program for SNF) • Hospital-home care collaboration solutions • Implementation of observational programs in hospitals
Connecting Settings • Development of community-based health navigation services • Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services
Special Populations* • Implementation of patient and community activation activities for the uninsured and low/non-utilizing Medicaid populations
Requir
ed
Mental Health and Substance Abuse • Promote mental, emotional, and behavioral well-being in communities • Prevent substance abuse and other mental emotional behavioral disorders • Strengthen mental health and substance abuse infrastructure across systems
Chronic Disease Prevention • Promote tobacco cessation, especially among low SES population and those with poor mental health. • Increase access to high quality chronic disease preventive care and management in both clinical and community settings
HIV and STD Prevention • Decrease HIV morbidity • Increase early access to and retention in HIV care • Decrease STD morbidity • Decrease HIV and STD disparities
Women, Infants, and Children • Reduce premature births
Integrated Delivery Systems
• Create integrated delivery systems that are focused on evidence based medicine and population health management
• Increase certification of PCPs within PCMH certification or Advanced Primary Care Models
• Health home at-risk intervention program
• Create a medical village using existing hospital infrastructure
• Create a medical village or alternative housing using existing nursing home
Behavioral • Integration of primary care services and behavioral health • Behavioral health community crisis stabilization services • Implementing evidence based medication adherence program in community based sites for behavioral medication compliance. • Development of withdrawal management capabilities within communities • Behavioral interventions paradigm in nursing homes
Cardiovascular Health • Evidence based strategies for disease management in high risk/affected populations (adults only) • Implementation of evidence-based strategies in the community to address chronic disease, primary and secondary prevention projects (adults only)
Diabetes Care • Evidence-based strategies for disease management in high risk/affected populations (adults only) • Implementation of evidence-based strategies in the community to address chronic disease, primary and secondary prevention projects (adults only)
Asthma • Development of evidence-based medication adherence management programs in community settings- asthma medication • Expansion of asthma home-based self-management program • Evidence based medicine guidelines for asthma management
HIV • Comprehensive strategy to decrease HIV/AIDS transmission to reduce avoidable hospitalizations-development of a Center of Excellence for management of HIV/AIDS
Perinatal • Increase support programs for maternal and child health, including high risk pregnancies (e.g., Nurse-Family Partnership)
Palliative Care • IHI Conversation Ready model • Integration of palliative care into medical homes • Integration of palliative care into nursing homes
Renal • Specialized medical home for chronic renal failure
Behavioral • Integration of primary care services and behavioral health
• Behavioral health community crisis stabilization services
• Implementing evidence based medication adherence program in community based sites for behavioral medication compliance.
• Development of withdrawal management capabilities within communities
• Behavioral interventions paradigm in nursing homes
Optional
Up to three more of any of the above BLUE choices, for a maximum of five BLUE choices. * The special populations project can only be chosen as the
11th project. Up to two more of any of the above GREEN choices, for a maximum of four GREEN choices.
Up to one more of the above PURPLE choices.
Choose ONE from each of the five buckets below.
Choose as many additional as desired, but only options chosen according to the below guidelines count towards project valuation.
System Transformation Clinical Improvement Population-Wide 8
DD
Nursing Home
SMI/SUD
All Others
Residential (Waiver and
IID) Day/Vocational
Care Management (MSC or CAH)
Article 16 Clinic
Other OPWDD Waiver Services
Nursing Home
Care Manager*
Intermediate or Intensive
Residential Care**
OMH/OASAS Outpatient Treatment†
Freestanding Psychologist/Psychiatrist
Specialty Medical or BH Inpatient/ED
Health Home
members
PCP (if meeting utilization standard)
Other Primary Care Provider or Outpatient
Clinic
Emergency Department
Inpatient
*Health Home, TCM, ACT, or HCBS waiver care
management provider for children.
**RTF, RRSY, rehabilitative services for residents of
a Community Residence, etc.
†Outpatient clinic, CDT, PROS, day treatment,
MMTP, or outpatient rehabilitation. Attribution
PPS REGION PPS DEVELOPMENTAL
DISABILITIES LONG TERM CARE BEHAVIORAL
HEALTH OTHER OUTSIDE LOYALTY GRAND TOTAL
NYC AW MEDICAL 155 3003 13157 421323 437,638
MOUNT SINAI HOSPITALS GROUP 1,817 8,970 35,287 307,930 354,004
NEW YORK CITY HEALTH AND HOSPITALS 3,676 4,294 35,013 262,965 305,948
MAIMONIDES MEDICAL CENTER 821 2,865 14,800 276,119 294,605
ST. BARNABAS HOSPITAL 494 5,305 20,346 229,967 256,112
SUNY DOWNSTATE MEDICAL CENTER 169 2,138 8,386 166,166 176,859
BRONX-LEBANON HOSPITAL CENTER 11 2,849 7,354 72,264 82,478
THE JAMAICA HOSPITAL 6 816 5,903 72,566 79,291
THE NEW YORK PRESBYTERIAN HOSPITAL 38 542 4,514 69,380 74,474
RUMC & STATEN ISLAND UNIVERSITY HOSP 84 3,243 5,023 57,566 65,916
LUTHERAN MEDICAL CENTER 191 773 2,919 52,745 56,628
THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS 3,315 1,062 30,992 35,369
LONG ISLAND STONY BROOK UNIVERSITY HOSPITAL 206 6,516 9,474 53,449 141,697 211,342
LONG ISLAND JEWISH MEDICAL CENTER 97 1,897 4,503 120,986 127,483
CATHOLIC HEALTH SERVICES OF LONG ISLAND 52 2,756 3,068 57,634 63,510
NASSAU UNIVERSITY MEDICAL CENTER 111 4,966 4,906 51,095 61,078
FINGER LAKES FINGER LAKES PPS 2,201 7,584 24,036 172,806 50,359 256,986
MID-HUDSON MONTEFIORE MEDICAL CENTER 429 6,549 14,217 80,353 101,548
WESTCHESTER MEDICAL CENTER 1,308 1,822 8,169 74,896 86,195
REFUAH HEALTH CENTER 100 141 927 29,575 30,743
HEALTH ALLIANCE OF THE HUDSON VALLEY 509 2 8 22 541
WESTERN NY ERIE COUNTY MEDICAL CENTER CORPORATION 267 4,216 15,223 132,274 151,908
CATHOLIC MEDICAL PARTNERS 159 1,799 5,808 42,533 50,229
CAPITAL REGION ELLIS HOSPITAL 1,289 2,632 11,902 72,601 5,103 93,527
ALBANY MEDICAL CENTER HOSPITAL 1,250 1,665 4,337 36,667 6,861 50,780
CENTRAL NY CNY DSRIP PPS 340 3,951 11,500 70,676 56,825 143,292
SOUTHERN TIER UNITED HEALTH SERVICES HOSPITALS 832 2,348 6,067 48,772 26,475 84,494
NORTH COUNTRY ADIRONDACK HEALTH INSTITUTE 681 2,226 5,852 46,425 18,015 73,199
MOHAWK VALLEY MARY IMOGENE BASSETT HOSPITAL 12 734 2,019 30,375 2,727 35,867
TUG HILL SEAWAY SAMARITAN MEDICAL CENTER 456 767 2,917 20,785 5,071 30,050
GRAND TOTAL 17,761 90,684 288,751 3,161,907 313,133 3,872,236
Sample Valuation
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Project Project Index
Scores
Valuation
Benchmark
Project
PMPM
Project Plan
Application
Score
# of Attributed
Medicaid
Beneficiaries
# of DSRIP
Months
Maximum Project
Valuation
Project 1: 2.a.i 0.93 $4.88 $4.53 0.80 50,000 60 $10,872,000
Project 2: 2.a.ii 0.62 $4.88 $3.02 0.80 50,000 60 $7,248,000
Project 3: 2.b.vii 0.68 $4.88 $3.32 0.80 50,000 60 $7,968,000
Project 4: 2.c.i 0.62 $4.88 $3.02 0.80 50,000 60 $7,248,000
Project 5: 3.a.i 0.65 $4.88 $3.17 0.80 50,000 60 $7,608,000
Project 6: 3.b.ii 0.43 $4.88 $2.10 0.80 50,000 60 $5,040,000
Project 7: 3.c.i 0.50 $4.88 $2.44 0.80 50,000 60 $5,856,000
Project 8: 3.d.iii 0.52 $4.88 $2.54 0.80 50,000 60 $6,096,000
Project 9: 4.a.i 0.33 $4.88 $1.61 0.80 50,000 60 $3,864,000
Project 10: 4.b.ii 0.38 $4.88 $1.37 0.80 50,000 60 $3,288,000
Maximum Application Value $65,088,000
DSRIP Tentative Timeline
Date Milestone
December 22nd DSRIP Project Plan application due
March 2015 PPSs receive DSRIP award grants
April 2015 Performance Period Begins (DY1)
January 2016 DY2 Begins
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