1. Evan Brooksby, MBA Director Policy, Analysis, & Special Projects
Redesign Update
Evan Brooksby, MBA
Director
Policy, Analysis, & Special Projects
11/18/2018

2. Agenda DSRIP Quick Department of Health Changes
1115 Waivers & DSRIP in other states
Sustainability Planning
DSRIP Success – MAX Series
New from CMS
11/18/2018

3. DSRIP Basics $6.5 billion 25% reduction PPSs Project-focused
5 year, $6.5 billion program
$6.5 billion
Overarching goal of 25% reduction in avoidable hospitalizations and ED visits
25% reduction
Collaboration/partnerships is a key theme
PPSs
Menu of 44 projects designed to improve healthcare delivery
Project-focused
Payments are performance-based and statewide penalties can be assessed if goals not met
P4R to P4P
VBP is DSRIP legacy—at least 80% of Medicaid managed care payments must be in VBP by 2019
VBP
Quarterly reporting cycle with validation by Independent Assessor
Reporting
11/18/2018

4. 25 DSRIP PPSS Across NYS
11/18/2018

5. Project-Focused System transformation Clinical improvement activities
i.e., projects to create integrated delivery system and promote care coordination/transitions
System transformation
i.e., projects to improve care for specific chronic conditions
Clinical improvement activities
i.e., projects to promote mental health and prevent substance abuse; access and screening for other chronic disease
Population-wide projects
11/18/2018

6. 11/18/2018

7. Top Projects
5 high-value projects align with state’s vision reflect about 50% of DSRIP funding
11/18/2018

8. DSRIP in one slide

9. Department of Health Changes
Helgerson will depart on April 6, 2018 to “pursue opportunities in the private sector”
“I want to make clear that my departure will have NO impact on this important mission. The Department of Health and its leadership remains 100% committed to the causes of MRT, DSRIP and VBP. “
11/18/2018

10. DSRIP in other states 1115 Medicaid Waiver
Grants state flexibility
NYS 1115 Waiver renewed on January 19, 2017 – 5 year
DSRIP Expiration not aligned
Similarities beyond D.S.R.I.P.
. . .
11/18/2018

11. California $6.2 Billion Effective 1/2016 – 12/2020
Ambulatory and primary care focus through designated public hospitals (DPHs)
Advance alternative payment models(APMs) with Medicaid managed care plans
60% of all managed care beneficiaries receive all or a portion of their care through APM
11/18/2018

12. Massachusetts $1.8 Billion Effective 07/2017 – 06/2022
Transition to integrated accountable care by:
Launching Medicaid accountable care organizations
Linking ACOs and certified Community Partners for care coordination
Investing in more efficient statewide infrastructure.
Medicaid ACOs, Certified Community Partners, and Managed Care Organizations
11/18/2018

13. Texas $8.5 Billion Effective 10/2017 – 9/2021 Four Categories:
Infrastructure development
Program innovation and redesign
Population-focused improvement
Urgent clinical improvements
Under the terms of the new Waiver, CMS will temporarily continue DSRIP funding. However, funding is phased down to zero over the five years.
Transition from DSRIP to sustainable delivery system reforms that do not require DSRIP funding
20+ regional health provider groups
11/18/2018

14. Washington $1.125 Billion Effective 1/2017 – 12/2021
Transform Medicaid delivery through Accountable Communities of Health (ACH):
Improve data analytics and workforce development;
90% of Medicaid care to be purchased via VBP by 2021;
Care delivery redesign with more integration and community linkages; and
Prevention focus.
Partnership with ACH — partnerships will include both traditional Medicaid providers and a variety of other entities and community-based organizations.
11/18/2018

15. New Hampshire $150 Million Effective 1/2016 – 12/2020
Use integrated networks and improve access and quality
Support behavioral health infrastructure through the state's managed care delivery system using APMs
Regional Integrated Delivery Networks (IDNs), led by various entities that meet IDN criteria
11/18/2018

16. New Jersey $292 Million Effective 10/2012 – 6/2017
Improve care delivery around eight chronic diseases — including asthma, HIV/AIDS, substance abuse, and obesity
All acute care hospitals are eligible (total of 63) — 50 have approved DSRIP projects;
11/18/2018

17. Barriers to Sustainability Planning
Uncertainty of future budgetary and regulatory environment
Many PPS were hoping for DSRIP 2.0
Lack of clarity regarding future regulatory relief
PPS report delays in project implementation have impacted evaluation timelines: currently, there is limited data available to support VBP contracting
Almost all PPS cite MCO issues as a significant barrier
Access to MCO data, challenges in contracting strategy, lack of MCO support for DSRIP initiatives
Local market complexity and competition (particularly downstate) with multiple participation options offered to providers by other PPS
Continued skepticism from some partners regarding VBP transition
11/18/2018

18. Future State Business Models
January 2018
January 2018
PPS are exploring future state structures
IPA
ACO
MSO
PPS are evaluating providing services under a variety of arrangements:
Fee for service
Alternative Payment Models
Annual membership plus fees for add-on services
PMPM for population health technologies or other services

19. Vision for PPS Sustainability
January 2018
Each PPS needs to develop its own vision and plan for sustainability, leveraging the new DSRIP infrastructure
The DSRIP workforce will be needed in the future vision for sustainability.
Your PPS will play a different role beyond 2020
VBP offers flexibility to Providers and MCOs
The infrastructure developed in DSRIP will be needed to support VBP.
Performing Provider Systems themselves
NYS PCMH Status
Connectivity to Qualified Entities and SHIN-NY
Coordination with Managed Care Organizations

20. Medicaid Accelerated eXchange (MAX) Series Program– Success from DSRIP
MAX Projects were not part of the original 11 projects
Focused on a defined population
Utilized Rapid Cycle Improvement
Quantified results
11/18/2018

21. Southside Hospital
Defined super-utilizers as 4+ admissions in 12 months
Identified an Action Team
10 people from providers to administrators
Established baseline – Nothing in place
11/18/2018

22. Southside Hospital Action period 1
Created a flag to identify super utilizers
Develop a tool to assess the “driver of utilization”
Pilot a response system to a super utilizer presentation
11/18/2018

23. Southside Hospital Action period 2
Implement daily huddles to discuss super utilizers and develop a plan of care
Mobilize a point person to coordinate follow up for super utilizers
Link super utilizers consistently to the partnering social service agency
11/18/2018

24. Southside Hospital Action period 3
Develop a job description for a resource coordinator
Build community resource relationships
Articulate a business case for ongoing resources to support the super utilizer care team
11/18/2018

25. Southside Hospital
11/18/2018

26. New from CMS: Expanding Patients Access and Control of Their Data
MyHealthEData
Medicare’s Blue Button 2.0
Calling on Private Plans to Provide Patients Their Data
11/18/2018

27. New from CMS: Encouraging Patient Access Through CMS Programs
Streamlining Meaningful Use (MU) and Quality Payment Program (QPP)
Prioritizing Quality Measures That Lead to Interoperability
Preventing Information Blocking
11/18/2018

28. New from CMS:
Modernizing Provider Requirements with a Focus on Value-Based Care
Requiring Providers to Update Their Systems to Ensure Data Sharing
Ensuring Patients Receive Their Data Upon Discharge
Streamlining Documentation and Billing Requirements
11/18/2018

29. Last thoughts
11/18/2018

30. Evan Brooksby, MBA ebrooksby@hanys.org 518.431.7736 @ejbrooksby
11/18/2018