Local Medicaid Redesign

November 12, 2014

Bassett Medical Center and over 90 collaborating organizations across Delaware, Herkimer, Madison, Otsego and Schoharie counties learned that $71.8 million dollars has been allocated to help them reform the region’s Medicaid delivery system over the next five years.

Bassett is the lead agency for the five-county Performing Provider System (PPS) formed under the Delivery System Reform Incentive Payment Program (DSRIP). The New York State Department of Health announced the DSRIP PPS awards Thursday, May 21. Actual receipt of the full amount of the Medicaid redesign funds will be dependent upon achieving certain goals outlined for the 62,043 Medicaid recipients living in the five counties and assigned to the Bassett DSRIP PPS.

The funding is intended to incentivize providers to create high performing sustainable health care delivery systems that can effectively meet the needs of Medicaid beneficiaries and low-income uninsured individuals in their communities by improving care, improving health and reducing costs. Ultimately, the goal is to improve clinical outcomes and reduce avoidable hospital admissions and emergency department visits by 25 percent over five years.

“We have a tremendous opportunity now to tackle some of the most critical health care issues facing the populations we serve,” explains Sue van der Sommen, executive director of the Bassett DSRIP program. “Under the umbrella of the PPS, 11 projects have been selected that are designed to improve health and health care delivery in the five counties assigned to us. These projects address a wide spectrum of issues including behavioral health and substance abuse, chronic disease, hospital readmissions of vulnerable populations and more.”

Patricia Kennedy, CEO of Springbrook, a not-for-profit agency in Otsego County that serves individuals with developmental disabilities throughout New York State, including the DSRIP region, says, “The work we are undertaking is profoundly important and provides us the chance to effect truly meaningful change. The projects are ambitious and the funding alone won’t assure success, but we and our partners are committed to this work. It will be challenging at times, but also very rewarding.”
Kennedy and van der Sommen also note that the work the PPS is undertaking will transform health care delivery in a way that improves the lives of not only the uninsured and Medicaid recipients, but the entire population living in the five county region assigned to the PPS.”

PPS – Selected Projects

Delaware, Herkimer, Madison, Otsego and Schoharie counties

  1. Increase certification of primary care practitioners with patient-centered medical home (PCMH) certification and/or advanced primary care models
  2. Interventions to reduce acute care transfers (INTERACT)
  3. Hospital-home care collaboration to reduce risk of re-hospitalization 
  4. Grow community-based health navigation services
  5. Implementation of patient activation activities to engage, educate and integrate the uninsured and low/non-utilizing Medicaid populations into community based care 
  6. Integration of behavioral health services into the primary care setting 
  7. Development of a withdrawal management program (e.g. Ambulatory Detox)
  8. Implementation of evidence-based medicine guidelines for asthma management 
  9. Integration of palliative care into the Patient-Centered Medical Home (PCMH)
  10. Strengthen the mental health and substance abuse infrastructure 
  11. Promote tobacco use cessation, especially among high risk populations

About the PPS

On April 14th, 2014, Governor Andrew M. Cuomo announced that CMS (Center of Medicaid and Medicare Services) approved and finalized New York’s waiver request. Due to this approval, New York State can now reinvest the $8 billion generated by Medicaid Redesign Team (MRT) reforms. The DSRIP Program will use these dollars for a performance based sustainable transformation of health care throughout the state. Under the DSRIP Program, various providers are coming together to collaborate and provide better care to the patients.

The PPS currently has more than 90 providers enthusiastic about transitioning health care towards patient-centered care, collaboration, better access and reduced costs of health care. Learn more at http://leatherstockingpartners.org/selected-dsrip-projects/

About DSRIP in NYS

One component of the Medicaid waiver amendment approved in 2014 enables New York State to provide incentives for Medicaid providers to create and sustain an integrated, high performing health care delivery system that can effectively and efficiently meet the needs of the Medicaid beneficiaries and low-income uninsured individuals in their local communities by improving care, improving health and reducing costs. The DSRIP Program is focused on the following goals:

  1. Safety net transformation at both the system and state level
  2. Accountability for reducing avoidable hospital use and improvements in other health and public health measures at both the system and state level 
  3. Efforts to ensure sustainability of delivery system transformation through leveraging managed care payment

Learn more at: www.health.ny.gov/health_care/medicaid/redesign/dsrip/

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