New York State's DSRIP Program: A Key Moment for Healthcare Technology & Improving Care for All New Yorkers
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The DSRIP program in New York aims to transform healthcare delivery by enhancing safety net systems and improving population health while reducing avoidable hospital use. It focuses on care coordination, special population interventions, chronic disease prevention, mental health services, and integrated care systems. Various public and private health organizations participate to implement diverse strategies, evaluated through specific metrics and expected outcomes.
New York State's DSRIP Program: A Key Moment for Healthcare Technology & Improving Care for All New Yorkers
- 1. New York State’s DSRIP Program: A Key Moment for Healthcare Technology & Improving Care for All New Yorkers Jordanna Davis, Sachs Policy Group
- 2. 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. 5 SOURCE: “The State of New York’s Medicaid Program,” Jason Helgerson. July 15, 2014
- 6. 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. 6
- 7. “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
- 8. 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 Required 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
- 9. 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
- 10. 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
- 11. Sample Valuation 11 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
- 12. 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 12
- 13. Contact 13 email: jdavis@sachspolicy.com phone: 212.827.0660