On April 14, 2014 Governor Andrew M. Cuomo announced that New York has finalized terms and conditions with the federal government for a groundbreaking waiver that will allow the state to reinvest $8 billion in federal savings generated by Medicaid Redesign Team (MRT) reforms.
The waiver amendment dollars will address critical issues throughout the state and allow for comprehensive reform through a Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program will promote community-level collaborations and focus on system reform, specifically a goal to achieve a 25 percent reduction in avoidable hospital use over five years. Safety net providers will be required to collaborate to implement transformative projects focusing on system transformation, clinical improvement and population health improvement. Single providers will be ineligible to apply. All DSRIP funds will be based on performance linked to achievement of project milestones.
The $8 billion reinvestment will be allocated in the following ways:
n $500 Million for the Interim Access Assurance Fund – temporary, time limited funding to ensure current trusted and viable Medicaid safety net providers can fully participate in the DSRIP transformation without disruption
n $6.42 Billion for Delivery System Reform Incentive Payments (DSRIP) – including DSRIP Planning Grants, DSRIP Provider Incentive Payments, and DSRIP Administrative costs
n $1.08 Billion for other Medicaid Redesign purposes – this funding will support Health Home development, and investments in long term care, workforce and enhanced behavioral health services
The purpose of DSRIP is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to the DSRIP program with payouts based upon achieving predefined results in system transformation, clinical management, and population health.
DSRIP has five program principles:
(1) Patient centered
(5) Value Driven
Performing Provider System (PPS)
In order to participate in DSRIP, providers must work together to form Performing Provider Systems (PPS), which are regional entities responsible for the health of the population in their service area. Each PPS will be responsible for selecting 5-10 projects from a specified menu of DSRIP projects and domains. The project selection process will be guided by the results of a comprehensive Community Needs Assessment (CNA) and informed by PPS members and community partners who will be engaged throughout the planning process. In total, there are twenty-five (25) Performing Provider Systems (PPS) in the State of New York – Care Compass Network being one of them.
By 2020, New York State Medicaid will have almost fully transitioned from a Fee-for-Service model to a value-based payment methodology that will put payment at risk based on performance.
The ability to manage risk will require existing Medicaid safety net providers to:
n Create a care delivery network structure for a region that has enough Medicaid covered lives to manage risk based payments.
n Organize the provider network to effectively and efficiently deliver care to Medicaid beneficiaries.
n Develop the analytical and financial core competencies for population health management.
Goals of DSRIP
n Transformation of the healthcare safety net at both the system and state level
n Reducing avoidable hospital use and improve other health and public health measures at both the system and state level
n Ensure delivery system transformation continues beyond the waiver period through leveraging managed care payment reform
n Near term financial support for vital safety net providers at immediate risk of closure
The State suggested that collaborative partnerships/coalitions should include:
n Health Homes
n Skilled Nursing Facilities
n Diagnostic & Treatment Centers (D&TCs) and Federally Qualified Health Centers (FQHCs)
n Behavioral Health providers
n Home Care agencies
n Other key stakeholders
In Care Compass Network’s selected DSRIP projects, collaboration has been very robust and inclusive of any willing stakeholder.
For more information, visit the DSRIP page on the New York State Department of Health website here.
History and Background
In the fall of 2014, many providers located in the Southern Tier region of New York State (which is comprised of the following counties - Broome, Chemung, Chenango, Cortland, Delaware, Schuyler, Steuben, Tioga, and Tompkins) came together to form the Southern Tier Rural Integrated Performing Provider System (STRIPPS), a conglomeration of two previously separate Performing Provider Systems - STPPS (Southern Tier Performing Provider System), which covered Broome, Chemung, Chenango, Delaware, Steuben, and Tioga counties, and RIPPS (Rural Integrated Performing Provider System) which covered Tompkins, Cortland, and Schuyler counties. UHS Hospitals was the co-leads for the Application process for this newly combined and single Performing Provider System (PPS) throughout the initial Application period of September 2014 through Spring 2015. As the Application and implementation planning progressed through the winter and spring of 2015, a new organization was created to lead the PPS in an effort of creating an Integrated Delivery System, Care Compass Network.
Today, Care Compass Network (CCN) is a not-for-profit, community organization that was created to champion new models of providing Medicaid members and the community at large, with higher quality of care, while reducing expenses through care coordination and community-focused care and education.
CCN convenes and collaborates with over 210 partner organizations, which include hospital systems, community-based organizations, nursing homes, behavioral health and substance use disorder programs, social services agencies, and similar entities.
CCN has received funding from the New York State Department of Health to develop a comprehensive plan for expanding and improving healthcare delivery within our 9-county region, as well as help healthcare organizations make the transition from a traditional fee-for-service model to a new, pay-for-performance approach or Value-Based Payment (VBP) program.
Care Compass Network will be receiving protected health information (PHI) data from Medicaid and are bound to security requirements consistent with New York State information technology security policies and the Data Exchange Application and Agreement (DEAA).
Care Compass Network operates on the calendar fiscal year, and was incorporated on January 15th, 2015. We are governed by our Board of Directors and the four Board Committees: Clinical Governance, Finance, IT, Informatics, and Data Governance, and the Compliance & Audit Committee.
The mission of Care Compass Network is to improve the health and wellbeing of the community members in the CCN service area by supporting the development of enduring partnerships of clinical and community service providers and empowering those partnerships to flourish in a value-based payment environment.
The Vision of Care Compass Network is to improve the health and life of Medicaid beneficiaries who engage in coordinated, culturally sensitive services that utilize the most appropriate, effective setting given medical, behavioral, social, and health literacy needs.
(1) Develop and implement a model of care that right sizes, realigns, and integrates the continuum of community based and institutional services to achieve Delivery System Reform Incentive Payment (DSRIP) goals to improve access to care while simultaneously reducing patient Emergency Department visits, re-admissions, and preventable admissions, thereby reducing costs.
(2) Retrain and redeploy the healthcare workforce to align with and support the transformed service delivery model.
(3) Implement community based care coordination to deploy early intervention and prevention to people with rising risk for chronic illness and facilitate access and movement through care settings in the service continuum.
(4) Build organizational infrastructure for population health management, financial operations, contracting and electronic information management needed to support the Care Compass Network in the achievement of DSRIP quality and utilization goals.
Helpful References / Links:
n Care Compass Network website: https://carecompassnetwork.org/
n Governor Cuomo's DSRIP Announcement, including PPS funding information: https://www.governor.ny.gov/news/governor-cuomo-announces-medicaid-redesign-efforts-saving-taxpayers-billons
n New York State Department of Health - DSRIP Related Webinars and Videos: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/webinars_presentations.htm
Community Health Needs Assessment
In order to get a full representation of the healthcare marketplace in the Care Compass Network region, RMS, an independent market research firm, conducted a 3-tier qualitative and quantitative market research study comprised of: (1) an online survey shared with healthcare providers, community leaders across many organizations, and the general community, (2) telephone in-depth interviews with healthcare providers and community leaders, and (3) focus groups across the counties with recruited community residents. To learn more about the research, review the Community Health Assessment Report
Based on the completed Community Health Needs Assessment, Care Compass Network has selected to work on the following eleven DSRIP projects. Many of these projects are overlapping or are complimentary in their approach to specific care needs.
These DSRIP projects do not impact an individual’s Medicaid coverage, nor do they limit access to services. The intent of these programs and the work of Care Compass Network is to optimize Medicaid beneficiaries’ health outcomes by engaging the beneficiaries in a coordinated delivery of care that utilizes the most appropriate, cost-effective setting given medical, behavioral and social needs. By transforming the way services are provided to Medicaid beneficiaries, care will be better coordinated with improved access to a variety of care settings. Additionally, early intervention and prevention strategies will be more readily available to people with rising risk for chronic illness.
1. 2.a.i. - Integrated Delivery System - Create a clinically integrated delivery system focused on evidence-based medicine and population health management.
2. 2.b.iv. - Care Transitions for Chronic Diseases - Provide 30-day transition support after hospitalization to reduce risk for readmission, targeting cardiac, renal, diabetes, respiratory and/or behavioral health disorders. Work to expand the Balancing Incentive Plan (BIP) currently used in Tompkins County.
3. 2.b.vii. – INTERACT - Implement the Interventions to Reduce Acute Care Transfers (INTERACT) model in all participating skilled nursing homes.
4. 2.c.i. - Development of Community Based Health Navigation Services - Develop community-based healthcare navigation services to assist patients in accessing appropriate healthcare services efficiently. We will use existing 211 infrastructure to identify individuals in need of navigation services.
5. 2.d.i. - Patient Activation - Engage and activate the uninsured, non-utilizing and low-utilizing populations to increase utilization of primary and preventative care services and increase the level of patient engagement across these populations. Outreach workers and patient activation training teams will be employed by community-based organizations.
6. 3.a.i. - Integration of Behavioral Health and Primary Care - Integrate behavioral health and substance abuse care with primary healthcare services to ensure coordination of care for both services and a more comprehensive approach to healthcare delivery.
7. 3.a.ii. - Crisis Stabilization - Provide readily accessible behavioral health crisis services that will allow timely access to the appropriate providers.
8. 3.b.i. - Evidence-Based Strategies for Disease Management - Support the implementation of evidence-based best practice strategies for cardiovascular disease management, in adults only. Will consider using tele-monitoring technology to track patient indicators at home.
9. 3.g.i. - Palliative Care - Increase access to palliative care programs in Patient Centered Medical Homes (PCMH.)
10. 4.a.iii. - Strengthen Mental Health and Substance Abuse Infrastructure - Strengthen chronic mental health/substance abuse disease prevention, treatment and recovery and infrastructure for mental/emotional/ behavioral health promotion and disorder prevention. Will expand existing prevention programs across the PPS and develop targeted intervention and screening.
11. 4.b.ii. - Chronic Disease Preventative Care and Management - Increase access to high quality chronic disease preventive care and management in both clinical and community settings for chronic obstructive pulmonary disease (COPD.) Implement a more robust screening and education effort.
For more information regarding Care Compass Network, visit the Care Compass Network web page at: https://carecompassnetwork.org/.