Integrating Public Health and Social Services with Delivery System Reform

Integrating Public Health and Social Services with Delivery System Reform New York State Department of Health Office of Health Insurance Programs Greg, Policy Director October 2015 1 Agenda 1. DSRIP & Performing Provider Systems (PPS) Overview 2. Population Health in DSRIP 3. Social Determinants of Health in DSRIP 4. Measuring Performance in DSRIP 1

2 DSRIP & Performing Provider Systems (PPS) Overview DSRIP Explained 3 Short for: Delivery System Reform Incentive Payment Program Overarching goal is to reduce avoidable hospital use ED and inpatient by 25% over 5+ years of DSRIP This will be done by developing integrated delivery systems, removing silos, enhancing primary care and community-based services, and integrating behavioral health and primary care. Built on the CMS and State goals in the Triple AIM Improving Quality of Care Improving Health Reducing Costs 2

Performing Provider Systems (PPS) 4 Partners include: Hospitals Health Homes Skilled Nursing Facilities Clinics & FQHCs Behavioral Health Providers Home Care Agencies Physicians/Practitioners Other Key Stakeholders Community health care needs assessment based on multi-stakeholder input and objective data. Building and implementing a DSRIP Project Plan based upon the needs assessment in alignment with DSRIP strategies. Meeting and reporting on DSRIP Project Plan process and outcome milestones. Performing Provider Systems (PPS) 25 Performing Provider Systems 5 Key Public Hospital led PPS Safety Net (Non-Public) led PPS 3

DSRIP Payment Reform Moving Towards Value Based Payment (VBP) 6 By DSRIP Year 5 (2019), all Managed Care Organizations (MCOs) must employ non fee-forservice payment systems that reward value over volume for at least 80-90% of their provider payments (outlined in the Special Terms and Conditions of the waiver) The State and CMS have thus committed itself to the VBP transformation Core Stakeholders (providers, MCOs, unions, patient organizations) have actively collaborated in the creation of the Roadmap that guides the reformation process If Roadmap goals are not met, overall DSRIP dollars from CMS to NYS will be significantly reduced Learning from Earlier Attempts: VBP as the Path to a Stronger System VBP arrangements are not intended primarily to save money for the State, but to allow providers to increase their margins by realizing value 7 Goal Pay for Value not Volume 4

8 Population Health and DSRIP The Need for Addressing Population Health in DSRIP 30,000 25,000 20,000 15,000 10,000 Estimated Number of Deaths Due to Modifiable Behaviors New York State, 2009 26,222 22,021 46% of all deaths are attributed to these eight modifiable behaviors 9 5,000 5,071 4,521 3,315 2,592 1,748 1,206 0 Tobacco Poor diet and physical inacdvity Alcohol ConsumpDon Microbial agents Toxic agents Motor vehicle crashes Incidents involving firearms Unsafe sexual behaviors Es#mates were extrapolated using the results published in: Actual Causes of Death in the United States, 2000", JAMA, March 2004, 291 (10) and NYS 2009 death data 5

10 The NYS Prevention Agenda, 2013-2017 Collaborative effort led by committee appointed by Public Health and Health Planning Council, including leaders from Healthcare, Business, Academia, Community Based Organizations, Local Health Departments, and other State Agencies including OMH and OASAS. Final priorities based on active participation from members of committee and stakeholder feedback. 11 The NYS Prevention Agenda, 2013-2017 Goal: Improve health status of New Yorkers and reduce health disparities through increased emphasis on prevention in the community and healthcare settings. Call to action to broad range of stakeholders to collaborate at the community level: to assess local health status and needs; identify local health priorities; and plan, implement and evaluate strategies for local health improvement. DSRIP will be a key instrument in achieving the Prevention Agenda s goal 6

The Prevention Agenda, part of State Health Reform 12 DSRIP & Population Health Domain 4 13 DSRIP s health reform projects are divided into four Domains. The fourth Domain, Population-wide Projects, focuses on reforming the State s approach to population health Domain 4 projects are based on the 5 priorities of the NYS Prevention Agenda All PPS must undertake at least one Domain 4 project, based on the particular needs of their network s population While other projects success is based on the health outcomes of the Medicaid population, Domain 4 covers the entire population 7

14 Domain 4 Projects in DSRIP - Subdomain A. Promote Mental Health and Prevent Substance Abuse (MHSA) - 4.a.i Promote mental, emotional and behavioral (MEB) well-being in communities - 4.a.ii Prevent Substance Abuse and other mental Emotional Behavioral Disorders - 4.a.iii Strengthen Mental Health and Substance Abuse Infrastructure across Systems - Subdomain B. Prevent Chronic Disease - 4.b.i Promote tobacco use cessation, especially among low SES and poor mental health populations - 4.b.ii Increase Access to High Quality Chronic Disease Preventative Care and Management (note: this project targets chronic diseases that are not included in Subdomain 3.b) - Subdomain C. Prevent HIV and STDs - 4.c.i Decrease HIV morbidity - 4.c.ii Increase early access to, and retention in, HIV care - 4.c.iii Decrease STC morbidity - 4.c.iv Decrease HIV and STD disparities - Subdomain D. Promote Healthy Women, Infants, and Children - 4.d.i Reduce premature births 15 The NYS Prevention Agenda & DSRIP Prevention Agenda Priorities Promote mental health and prevent substance abuse Prevent chronic diseases Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases and healthcare associated infections Promote healthy women, infants and children Domain 4 Project Categories Subdomain A. Promote Mental Health and Prevent Substance Abuse (MHSA) Subdomain B. Prevent Chronic Disease Subdomain C. Prevent HIV and STDs Subdomain D. Promote Healthy Women, Infants, and Children Promote a healthy & safe environment 8

NYS Prevention Agenda Priorities selected by Counties 16 17 Social Determinants of Health & DSRIP 9

18 Social Determinants of Health & DSRIP There is a clear synergy between DSRIP s goals and the need to address social determinants of health (SDH) DSRIP rewards Medicaid providers for decreasing their potentially preventable admissions taking a proactive stance to SDH is a vital part of meeting this goal PPS include the entire spectrum of care delivery, allowing Community Based Organizations and hospitals to cooperatively address individuals affected by SDH There are ongoing discussions throughout NYS on how best to use DSRIP to tackle longstanding SDH issues VBP is the best path through which to bridge the gap between the health system and social issues surrounding SDHs As NYS moves toward shifting 80-90% of Medicaid dollars to VBP, it will be imperative to align these dollars in ways that address SDH 19 Social Determinant Categories The State has identified and evaluated social determinants across the following five categories of SDH Neighborhood and Environment Social, Family and Community Economic Stability Education Health and Healthcare 10

20 Social Determinant Categories Expanded Economic Stability Education Health and Healthcare Social, Family and Community Neighborhood and Environment Economic instability, poverty, and lack of employment Lack of education, educational disparities Lack of healthcare engagement Criminal justice involvement Substandard housing Homelessness, housing instability, and lack of access to affordable housing Lack of English literacy and proficiency Lack of accessible/ competent primary care Isolation and lack of family/community support Physical barriers in the home Food insecurity and lack of adequate nutrition and lack of access to healthy foods Lack of access to culturally competent staff Trauma Lack of transportation Lack of health literacy including cultural context Stigma and discrimination 21 Identifying Effective Interventions for SDH No one SDH should be prioritized over others Prioritizing which SDH a PPS network should address will depend upon an assessment of individual patients, community needs, and resources Flexibility to select which SDH to address is imperative so that provider systems can properly address their communities needs The impact of interventions should be tracked on both the individual and population level Even if imperfect, a tracking tool would allow for the development of a common understanding of the breadth of SDH and new evidence of their impact on health outcomes, and therefore lay the foundation for understanding the cost and efficacy of a variety of interventions 11

22 Identifying Effective Interventions for SDH (2) Interventions should be measured and evaluated on an ongoing basis and be subject to a continuous quality improvement process Addressing SDH should come naturally to health care providers Traditionally, the interventions are seen as being beyond the scope of healthcare The interventions are often much less costly than medical interventions that become necessary when chronic health conditions advance PPS now have both the means (through their provider network) and the incentive (through VBP) to address SDH The State should create a living laboratory for addressing SDH Incentivize and require networks to collect data on SDH and to test, track, report, and share findings on interventions Support the development of standardized tools to allow for statewide sharing 23 Measuring Performance in DSRIP 12

24 Measuring Performance in DSRIP The Medicaid Analytics and Performance Portal (MAPP) will be a gateway to analytical tools and data to actively measure performance in DSRIP and drive improved outcomes. Dashboards have been designed to specifically monitor Prevention Agenda Priorities Access to data and performance analytics will be: 1. Transparent: PPSs, Plans, providers, and the State all have access to the same performance data 2. Actionable: Data views will be useful and timely 3. Accessible: Easy to deploy and use without significant training (Dashboard displays) 25 State Solution Performance Dashboards 13

26 State Solution Performance Dashboards 27 State Solution Performance Dashboards 14

28 Performance Dashboards to Member Detail State Prevention Agenda Performance Dashboards State View 29 15

State Prevention Agenda Performance Dashboards County View 30 Questions? DSRIP e-mail: dsrip@health.ny.gov 16