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The New York

State Delivery

System Reform

Incentive

Payment Program

(DSRIP)

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New York State Medicaid and the DSRIP

Program

Performing Provider System Formation

Overview

Value Based Payments



What is New York State Medicaid?

Medicaid is the single largest healthcare payer in New York (as it is

also in all other states)

Approximately 6 million individuals in New York State are

Medicaid beneficiaries

Current Medicaid spend in New York is approximately $60 billion annually, making it the largest spender on Medicaid services in the country



Transformation Initiatives Have Successfully Brought Back Medicaid

Spending per Beneficiary to 2003 Levels

$30

$35

$40

$45

$50

$55

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

To

tal M

A S

pe

nd

ing

(b

illio

ns)

2011 MRT

Actions

To

tal M

A S

pe

nd

ing

(p

er

recip

ien

t)

Projected Spending

Absent MRT Initiatives

Since 2011, total

Medicaid spending

has stabilized,

generating ~$17B in

Federal Savings to

2013

Medicaid spending

per-beneficiary has

continued to

decrease

Spending Trends Financial Outcomes

1 – New York State Department of Health: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf



DSRIP Has Pivoted the Focus to Sustainable Change

Over the next 5 years, New York is reinvesting $8 billion of the $17.1 billion of

the MRT savings into its Medicaid system to drive sustainable Healthcare Delivery Reform

Key objectives of the DSRIP Program include:

1 25% reduction

in avoidable

hospital use

over the next 5

years

2 90% of managed

care payments to

providers are

value-based by

Year 5

3 Preservation and

transformation of

New York State’s

fragile healthcare

safety net system



New York State’s sustainability and transformation strategy

Goal A Triple Aim – Better health, better care, lower costs

Pillars

1

Improve

access to care

for all, without

disparity

2

Integrate care

to address

patient needs

seamlessly

3

Make cost and

quality of care

transparent

4

Pay for

healthcare

value, not

volume

5

Promote

population

health

Four components of change

Provider

collaboratives

Analytics and

evaluation

Delivered through

Care System Redesign

Payment model

reform

A workforce

transformation

strategy



Self-management

(eHealth & Prevention)

Primary Care

Hospital

Hospital Care

Self- manage-

ment

Primary Care

The goal of DSRIP is to shift focus from high cost hospital care to

patient-focused community and primary care

Future Now



Providers will Form Networks of Care That Collectively Manage

Population Health: Performing Provider Systems (PPSs)

25 Performing Provider Systems

Assigned primary

Care Physician

PCP Medicaid

Beneficiaries



Every PPS will select between 5 and 11 projects from the DSRIP project

options

Domain 2: System

Transformation Projects

Domain 3: Clinical

Improvement Projects

Domain 4: Population-wide

Projects

Applicants must choose

Minimum 2, Maximum 4

Projects



Projects



Projects

Ap

plic

an

ts m

ay c

ho

ose

betw

een

5 a

nd

11 P

roje

cts

Domain 1 comprises of Process Outcomes that all PPSs must achieve.

Each project is linked to standard measures and metrics that are described in the DSRIP

Measure Specification and Reporting Manual https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/dsrip_specif_report_manual.pdf

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/dsrip_specif_report_manual.pdf

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/dsrip_specif_report_manual.pdf



The Following are Commonly Selected DSRIP Projects

February 2015

Domain 2 Projects: Address System Transformation

• Create Integrated Delivery Systems focused on Evidence-Based Medicine /Population Health Management

• Care transitions intervention model to reduce 30 day readmissions for chronic health conditions

Domain 3 Projects: Clinical Health Improvement

• Integration of primary care and behavioral health services

• Evidence-based strategies for disease management in high risk/affected populations

Domain 4 Projects: Population-wide Strategy

• Strengthen Mental Health and Substance Abuse Infrastructure across Systems

• Promote tobacco use cessation, especially among low SES populations and those with poor mental health



Performance Dashboards

NYS is developing Performance Dashboards that will allow PPSs to actively monitor

progress, visualize problem areas, and target opportunities for improvement

Scorecard

How are we

performing?

Snapshot

How can I

improve?

Attribution

Who are my

patients?

Network

Who are my

providers?

What is the cost?

*Not available in Phase 1 of Dashboards

Value*



With Value Based Payment Reform, The Product Structure Changes

Rather than payment per service (e.g. visit), payment is done for entire care packages

(e.g. a year of diabetes care)

Episodic

Integrated Physical &

Behavioral Primary

Care

Includes social services

interventions and

community-based

prevention activities

Chronic care (Diabetes, CHF, Hypertension, Asthma, Depression…)

Multimorbid disabled / frail elderly (FIDA population)

Continuous

Severe BH/SUD conditions (HARP population)

Care for the Developmentally Disabled

Maternity Care (including first month of baby)

Acute Stroke (incl. post-acute phase)

Depression

…

Hemophilia

AIDS/HIV

Chronic Kidney Disease



The Current VBP Roadmap Contains a Menu of Options

In addition to choosing what integrated services to focus on, providers can choose

different levels of Value Based Payments:

VBP Roadmap: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/vbp_roadmap_final.pdf

Level 0 VBP Level 1 VBP Level 2 VBP

Level 3 VBP

(only feasible after experience with

Level 2)

FFS with bonus and/or

withhold based on

quality scores

FFS with upside-only shared

savings available when outcome

scores are sufficient

(FFS may be complemented with

PMPM subsidy)

FFS with risk sharing

(upside available

when outcome scores

are sufficient)

Prospective capitation PMPM or

Bundle (with outcome-based

component)

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/vbp_roadmap_final.pdf

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/vbp_roadmap_final.pdf



Prioritisation

involves not

trying to solve

everything at

once

Governance is

important, but

not definitive

Investment in

data quality is

a powerful

enabler

Alignment of

incentives is

necessary to

foster

collaboration

Shared vision

and strategy

provides

direction &

focus

Overarching reflections and lessons learnt

Thank you!

Sebastian Habibi

Health Director

T: +44 (0) 7801 106754

E: [email protected]



MY LIFE A FULL LIFE Isle of Wight

Loretta Outhwaite

Chief Finance Officer (IW CCG) [email protected]

Learning from

New York

State



AIMS

Person-centred, allowing & enabling individuals

to take control of their lives & their care

Services based in the community/at home,

delivered by integrated teams

Prevention-based, promoting health & wellbeing

Quality of life & keeping well

Linking together & building on schemes already

up & running/being planned across our

communities



Local System Financial Challenge

2016/17

Health & Council

Up to

£30m (9%) Savings for 2016/17



OUR ‘MY LIFE’ MODEL

http://www.nurturedevelopment.org/ Based on ABCD approach – Cormac Russell

Our integrated ‘My Life’ model is: Prevention-based Health and wellbeing promoting Built on experience-based co-design Founded on self care and empowered

communities.

At the centre of our model is the person My Life coordination supports the individual to navigate the community and system. This single point of access triages, reduces the perceived system complexity, increases awareness of services, and maximises efficiency.

The Integrated Locality Teams deliver person centred care and support in the community, with GP clinical leadership and multi-specialist teams.

Intimate / Family

Key enablers

My Life, A Full Life – care services

Associated Life

Friendships

Support Groups

Home

On

e Le

ade

rship

Hospital Services

Integrated Locality Teams

Ambulance Service

Public Health

Commissioned voluntary

sector

Adult social care Children’s

social care

Integrated single point

of access

Community Faith

Groups

Voluntary Sector

Isle Help

Town and Parish

Councils

Family

Friends

Colleagues

My Life Coordination

Informal community

links

Transport

Education

Housing Association

Environment

Health- watch

People Matter

Crisis Response

Team

DomiciliaryCare

Out of Hours

Independent Sector

Palliative Care

10.06.2015

Home

09.06.2015

Community Health

Services

MH & LD Services



PARTNERS: the list is growing…

Isle of Wight Council (incl. fire & children’s srvs)

Isle of Wight Clinical Commissioning Group

Voluntary Sector

Independent Sector (Care Homes & Home Care)

Isle of Wight NHS Trust

One Wight Health (All 17 GP Practices)

Town & parish councils

Hampshire constabulary

The Island’s citizens



Key Learning Points

• Wider social determinants

• Primary Care Medical Homes • Case/care management

• Embedding mental health

• Governance • Don’t need legal structures to work

collaboratively

• Values based payment

• Workforce

• Data/analytics

• Focus on a few areas

• Some things won’t work



Develop community assets

to ensure focus on wider

social determinants of health

The most at risk

people receive

care/case

management and

care

coordination

Implement integrated

locality teams who

provide integrated

physical, mental health

and social assessment,

care and plans

Implement a whole

population, outcome

based payment

system

Implement co-ordinated

access to all Island

health and wellbeing

services

Develop workforce to

deliver safe and

sustainable Island

services

Roadmap – Implementing the Isle of Wight Model

Focus on

prevention, self

care and self help

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