1. Delivery System Reform Incentive Payment Program (DSRIP), Transforming the Medicaid Health Care System

2. The Beginning In 2011,the MRT began implementing the Triple Aim in NYS Medicaid: Cost Control: Reduced Medicaid's annual spending growth rate from 13% to less than 1%. Global Spending Cap: Introduced fiscal discipline to an out-of-control government program; focus on transparency with monthly report on spending. Care Management for All: Expanded existing and created new models of improved primary/coordinated care that will both improve outcomes and lower costs, moving Medicaid members from fee-for-service to managed care. PCMH and Health Homes: Investments in high- quality primary care and care coordination through major MRT reforms such as Patient Centered Medical Homes and the creation of Health Homes.

3. NYS DSRIP Program: Key Goals Transformation of the health care safety net at both the system and state level. Reducing avoidable hospital use and improve other health and public health measures at both the system and state level. Ensure delivery system transformation continues beyond the waiver period through leveraging managed care payment reform. Near term financial support for vital safety net providers at immediate risk of closure.

4. Five Themes of DSRIP Collaboration, Collaboration, Collaboration!!! Project Value drives Transformation and types of projects # of Medicaid members served (attribution) Application Quality Performance Based Payments Statewide Performance Matters Lasting Change Long-Term Transformation Health System Sustainability

5. Follow the Money After lengthy discussions and multiple versions, CMS approved the waiver program in April 2014. The amount allotted to the waiver was $8 billion with $6.42 billion for DSRIP. The program is build upon Performing Provider Systems, regional groups of public hospitals, safety net providers and community based organizations, implementing up to 11projects chosen from the CMS approved DSRIP Toolkit. These projects must be chosen based upon issues identified from a comprehensive Community Needs Assessment. In designing the DSRIP programs, synchrony with the Prevention Agenda and integration of behavioral health into projects were overarching themes.

6. What Does it Mean?

7. Key Impacts and Change Agenda This is an incentive program. Performing provider systems (PPSs} will earn payments only when they have met their process and outcome goals described in their project plans. High performing PPSs can earn additional payments. Exceptional success on behavioral health metrics can earn additional payments. We are all in this together. Overall state performance will affect the money available for DSRIP. Reducing avoidable hospital use will require removing silos in healthcare, improving the primary and preventive services available in communities, and integrating behavioral health and social services into medical services. There will be a need for more health care workers in the community and less in institutions. At the end of five years, value based purchasing will be implemented for the majority of Medicaid services.

8. NYS DSRIP Plan: Key Components Key focus on reducing avoidable hospitalizations by 25% over five years. Statewide initiative open to large public hospital systems and a wide array of safety-net providers. Payments are based on performance on process and outcome milestones. Providers must develop projects based upon a selection of CMS approved projects from each of three domains. Key theme is collaboration! Communities of eligible providers are required to work together to develop DSRIP Project Plans.

9. PERFORMING PROVIDER SYSTEMS Local Partnerships Partners should include: Hospitals Health Homes Skilled Nursing Facilities, Clinics & FQHCs Behavioral Health Providers Home Care Agencies Community Based Organizations Practitioners and Other Key Stakeholders Responsibilities must include: 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.

10. What Does it Mean?

11. What Does It Mean for Homeless Community Health Plans and Provider Networks will be incentivized to engage and better serve High cost patients Hard to service clients Multi system clients Community based providers are well positioned to identify, engage, and serve these populations

12. Considerations Large Scale system changes Impacts on organizations and staff Size and capacity does mater Outcome focused Value driven

13. Challenges and Barriers Power Assets Culture Values Competition Fear Risk aversion Philosophic differences Human capital depth/expertise Customer and community Politics Chaos Too much change Conflict History Risk Aversion Lack of data and intel Governance

14. Other Key Department Activities aligning with DSRIP Health Homes - Additional funding from the waiver will be used to provide additional development funds for Health Homes. Health Homes are considered critical elements to PPS due to their role in managing super utilizers of health care resources. HARPs and New Behavioral Health Benefits – Additional services which were covered under Fee for Service Medicaid are now rolling into managed care. HARPs are a plan for recipients with the most complex behavioral health issues.

15. How to Engage? It Takes Time and Energy Subscribe to DoH List Serve Links Attend Webinars Engage Alliances and Hospital Networks Prepare for the Change Focus on Outcomes Organizational Readiness

16. End of the Day Desire Outcome

17. Important Links https://www.health.ny.gov/health_care/medicaid/r edesign/dsrip/webinars_presentations.htm https://www.health.ny.gov/health_care/medicaid/r edesign/dsrip/webinars_presentations.htm https://www.health.ny.gov/health_care/medicaid/r edesign/dsrip/providers_professionals.htm

18. Get Ready

19. We Deal With the Unexpected