A Multi-Billion-Dollar Pot of Gold to Reshape NY Health Care

New York's multi-year, multi-part overhaul of its Medicaid system is poised to reach a critical juncture this week when the results of a multi-billion-dollar grant program are announced.

Health officials in Albany hope that by investing $6.5 billion dollars in dozens of hospitals, clinics and other institutions across the state over the next five years, these healthcare and social service providers will change how they do business, improving the health of poor people and reducing costs to taxpayers.

New York spends more on Medicaid — both total and per capita — than almost any other state, but as one key state report put it, "At best, New York is in the middle of the pack when it comes to health care quality."

As part of a "Medicaid Redesign" effort that began shortly after Governor Andrew Cuomo took office in 2011, New York sought billions of dollars in federal aid through a waiver program that allows states to experiment. After extended negotiations, the U.S. Health and Human Services Department granted Albany $8 billion dollars in 2014. Through a series of hearings, the state created a framework for healthcare systems to team up and apply for most of that money.

It's called the Delivery System Reform Incentive Payment, or DSRIP, program. The idea is that upfront payments to teams comprised of different players in the healthcare delivery system will act as an incentive for them to coordinate patient care better and ultimate keep people out of the hospital. 

Take, for example, the Nassau Queens team, led by Nassau County Medical Center, together with North Shore LIJ and the Catholic Health Services of Long Island. This "performing provider system," or PPS, consists of 22 hospitals, 66 clinics, 77 nursing homes and skilled nursing facilities, 43 pharmacies, 6 hospices and 7 community-based organizations. In all, these facilities serve more than 350,000 patients. This PPS is asking for money for many things: to integrate all these providers with electronic health records; to put primary care practices right in hospital emergency rooms, so people with low-level illnesses and aches get appropriate treatment that doesn’t clog up the E.R.; to develop programs that will improve how people with things like diabetes and heart disease get treated.

There are 25 teams across the state, each led by a hospital system — 16 in the downstate region and nine elsewhere in New York. 

The applications have already been scored, and on Thursday those scores are expected to be translated into dollar amounts.