Health System Transformation Overview of Health Systems Transformation in New York State. July 23, 2015

Transcription

1 Health System Transformation Overview of Health Systems Transformation in New York State July 23, 2015

2 2 The Vision Healthier New Yorkers (population health) Lower costs Engaged consumers Systems, programs, financing, policies that support and value these goals Triple Aim

3 3 The Systems, Programs, Policies, Financing ACA Affordable Care Act ACO Accountable Care Organizations APC Advanced Primary Care APD All Payer Database DISCO Developmental Disability Individualized Supports & Care Coordination Organization DSRIP Delivery System Reform Incentive Payment Program FIDA Fully Integrated Dual Advantage HARPS Health and Recovery Plans HH Health Homes (HH) MLTC Managed Long-Term Care MRT Medicaid Redesign Team NYSOH New York State of Health PA Prevention Agenda PCMH Patient Centered Medical Home PHIP Population Health Improvement Program PPS Performing Provider System SHINY-NY Statewide Health Information Network for New York Systems SHIP New York State Health Innovation Plan SIM State Innovation Model VAP Vital Access Provider VBP Value Based Payment

4 4 The Initiatives Federally Driven ACA ACOs PCMH HH FIDA Wellness Care Coordination Primary Care & Population Health Collaboration, Cooperation Shared Accountability Attention to Behavioral Health Value-Based Payment State Driven MRT HARP, DISCO Prevention Agenda NYSOH APD SHIN-NY SHIP DSRIP (PPS) PHIP

5 5 Prevention Agenda Priorities Prevent chronic diseases Promote a healthy and safe environment Promote healthy women, infants, and children Promote mental health and prevent substance abuse Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases, and health care associated infections

6 MRT Waiver Amendment: $8 Billion Allocation 6 $500 Million for the Interim Access Assurance Fund (IAAF) Time limited funding to ensure current trusted and viable Medicaid safety net providers can fully participate in the DSRIP transformation without unproductive disruption $6.42 Billion for Delivery System Reform Incentive Payments (DSRIP) Including DSRIP Planning Grants, DSRIP Provider Incentive Payments, and DSRIP Administrative costs and DSRIP related Workforce Transformation. $1.08 Billion for other Medicaid Redesign purposes This funding will support Health Home development, and investments in long term care workforce and enhanced behavioral health services, (1915i services) 1.2 billion in capital investment enacted in budget Regulatory relief to support provider collaboration on DSRIP projects

7 7 DSRIP Six Themes: 1.Integrated delivery creating performing provider systems 2. Project value drives a. Transformation # and types of projects b. # of Medicaid members served (attribution) c. Application quality speed and scope of implementation 3. Performance based payments process and outcome measures 4. Statewide performance matters 5. Regulatory relief and capital funding available 6. Lasting change a. Long-term transformation b. Health system sustainability

8 8 SHIP/SIM Overarching Goals The SHIP is New York s overarching vision to integrate and coordinate multiple ongoing initiatives with the goal of optimal health and well-being for all New Yorkers. Population Health Goal of the SHIP: Improve population health through strengthened capacity and improved screening and prevention through closer linkages between primary care, public health, and community based supports Goal: Achieve top quartile performance among states in prevention and public health 80% of payments risk-based by year 5

9 9 PHIP Overview and Objectives The Population Health Improvement Program will promote the Triple Aim better care, better population health, and lower health care costs by selecting regional contractors to provide a neutral forum for identifying, sharing, disseminating, and helping implement best practices and strategies to promote population health and reduce health care disparities PHIP contractors will, within their regions: Support and advance the Prevention Agenda Support and advance the SHIP Serve as resources to DSRIP performing provider systems in their regions upon request

10 10 HARPs Behavioral health will be managed by: o Special needs health and recovery plans (HARPs) for individuals with significant behavioral health needs o Mainstream managed care plans: Plans may operate services directly only if they meet rigorous standards Plans that do not meet rigorous standards must partner with a BHO which meets standards Plans can partner with BHOs to meet the rigorous standards Integration of all Medicaid behavioral health and physical health benefits under managed care will go into effect in spring 2015 in NYC and fall 2015 in the rest of the state

11 11 DISCOs Managed care designed to meet unique needs of people with developmental disabilities Governed by special statute enacted in 2012 DISCOs will have modified reserve requirements to facilitate start-up DISCOs must be controlled by one or more non-profit organizations with experience providing or coordinating health and long-term care services to people with IID

12 12 Next Steps SHIP Workgroups convening DSRIP PPSs Payments begin this year PHIPs Analyzing data and engaging community stakeholders APD/SHIN-NY RFP out for APD, SHINY-NY working regionally HARP/DISCOs/FIDA rollout Payments become value-based Better care management DISCO/HARP/FIDA/HH/PCMH/ACO Primary care APC model being developed, practice transformation roll-out Providers become more vested in outcomes shared risk and savings Workforce importance recognized joint workforce group convening Consumers more empowered Population health, prevention, primary care at the forefront ALIGNMENT & IMPLEMENTATION