1. 1 TRANSFORMING HEALTH CARE IN NEW YORK STATE: WHAT’S NEW

2. 2 Contents Key Themes of Transformation Delivery System Reform Incentive Payment (DSRIP) Program Statewide Health Innovation Program (SHIP) Supporting Sustainability Workforce Support Programs

3. 3 Key Themes of Transformation Driven by Triple Aim: Improved Population Health, Better Quality, Efficient Spending Key Themes: Integrated delivery of care Performance-based payment System sustainability Effective & trained workforce

4. 4 NYS Medicaid in 2010: the crisis > 13% anticipated growth rate had become unsustainable, while quality outcomes were lagging Costs per recipient were double the national average NY ranks 50 th in country for avoidable hospital use 21st for overall Health System Quality Attempts to address situation had failed due to divisive political culture around Medicaid and lack of clear strategy CARE MEASURE NATIONAL RANKING Avoidable Hospital Use and Cost Percent home health patients with a hospital admission Percent nursing home residents with a hospital admission Hospital admissions for pediatric asthma Medicare ambulatory sensitive condition admissions Medicare hospital length of stay 50 th 49 th 34 th 35 th 40 th 50 th 2009 Commonwealth State Scorecard on Health System Performance

5. 5 The DSRIP Challenge – Transforming the Delivery System Largest effort to transform the NYS Medicaid Healthcare Delivery System to date –From fragmented and overly focused on inpatient care towards integrated and community focused –From a re-active, provider-focused system to a pro-active, patient-focused system –Allow providers to invest in changing their business models Improving patient care & experience through a more efficient, patient-centered and coordinated system. Patient-Centered Decision making process takes place in the public eye and that processes are clear and aligned across providers. Transparent Collaborative process reflects the needs of the communities and inputs of stakeholders. Collaborative Providers are held to common performance standards and timelines; funding is directly tied to reaching program goals. Accountable Focus on increasing value to patients, community, payers and other stakeholders. Value Driven 1010

6. 6 New York State Health Innovation Plan (SHIP)

7. 7 Supporting Transformation

8. 8 Providing Regulatory Flexibility Goal: waive regulatory requirements that may prevent / delay transformation Criteria: Consistent with a federal requirement? Consistent with state statute? Consistent with patient safety considerations? Consistent with important public policy principle(s)?

9. 9 Providing Regulatory Flexibility 250 requests approved in the following categories: –Integrated Services –Public Need and Financial Feasibility –Admission, Transfer, Discharge –Offsite Services –Revenue Sharing –Bed Capacity –Transfer and Affiliation agreements –Tele-health

10. 10 Integration Models and Approaches Goal: streamline processes to integrate service Licensure Thresholds DSRIP Project 3.a.i Licensure Threshold Collaborative Care Model Integrated Outpatient Services (IOS) Regulations Multiple Licenses

11. 11 Capital Restructuring Financing Program (CRFP) $1.2 billion for capital projects to enhance the quality, financial viability & efficiency of NYS’s health care delivery system, embracing DSRIP goals. Eligible applicants: general hospitals, NH’s, diagnostic & treatment centers, substance abuse / mental health clinics, assisted living providers, home care providers, & primary care providers. 135 Awards announced March 2016; 671 applications requested $3.5 billion.

12. 12 Essential Health Care Provider Support Program (EHCPSP) $355 million in discretionary grants to essential licensed general hospitals or hospital systems Goal: preserve essential services & facilitate provider transformation to create financially sustainable systems 27 awards; 111 applications requesting $1.64 billion

13. 13 EHCPSP – Desired Outcomes Measurable Managed Care Health Improvement Reduction of Hospital Readmissions & Inpatient Admissions Increase in the number of Medicaid beneficiaries served Attaining Highest level of Patient Centered Medical Home (PCMH) Status Working with the DOH toward a shared Medicaid Savings Program

14. 14 The Statewide Health Care Facility Transformation Program $195 million discretionary funding available to fulfill a health care need for acute inpatient, outpatient, primary, home care or residential health care. Supports projects that strengthen & protect access to services & are part of an overall transformation plan to a sustainable system of care. At least $30m for community-based health care providers Priority given to projects not funded by the CRFP or EHCPSP grants RFA posted July 20. Applications due September 16. Awards anticipated December 2016.

15. 15 Protecting Safety Net Essential Providers

16. July 28, 201616 Protecting Essential Safety Net Providers Interim Access Assurance Fund (IAAF) –$500 million to support safety net hospitals in SFY 14-15 until a DSRIP transformation application could be submitted, approved and funded Vital Access Provider Assurance Program Value-Based Payment—Quality Improvement Program –Support eligible providers while they work toward longer-term sustainability, improved quality, & alignment with Value Based Payment (VBP) initiatives. –SFY 2015-16: Over $332 million –Projected SFY 2016-17: Over $450 million Vital Access Provider Program (VAP) –Supports restructuring plans for essential providers 16

17. 17 Workforce Support Programs

18. 18 Workforce Support Programs Doctors Across New York (DANY): improve access to physicians Loan Repayment & Practice Support Programs: $9 million annually to place & retain physicians in underserved area Ambulatory Care Training Program: $4 million annually to medical schools, hospitals & clinics to train residents & medical students in free-standing ambulatory care sites Health Workforce Retraining Initiative (HWRI) $24.2M grant RFA released May 11, 2016 to support training & retraining of health care & public health workers

19. 19 Workforce Programs $1 million annual funding loan repayment to non-physician health care practitioners who agree to practice in underserved areas $3.7 million annual funding to assist underrepresented & financially disadvantaged students in entering medicine & health care fields $1 million annually for 3 years through Rural Residency Program to support the development of rural-based GME programs to help alleviate regional and primary care physician shortages.

20. 20 Questions? Thank You!