by Brett Kinsler | Sep 18, 2015 | DSRIP
We’ve had several meetings with clients who have asked us about DSRIP. For the well-informed, you can skip this blog post, but for everyone else, we offer this brief DSRIP 101 primer:
Q. What is DSRIP?
The Delivery System Reform Incentive Payment Program is a Medicaid restructuring plan that reinvests money into the health care system in an effort to transform how hospitals and providers deliver care to Medicaid recipients.
Q. Why does Medicaid need restructuring?
Really?
Q. Yes, really. What is wrong with Medicaid?
Soaring costs for the government coupled with huge cuts to providers has led to difficulty in access for the patients with Medicaid. Plus, Obamacare requires states to add an additional 20 million people to the system — mostly pregnant women, children and the elderly. Just having a Medicaid card in your wallet is far from a guarantee of care. Many physicians decline to participate citing low reimbursement and mountains of paperwork to complete. There is also evidence that Medicaid enrollees receive a lower quality of care. A study from the University of Virginia found that Medicaid patients have worse surgical outcomes than individuals without insurance, even controlling for numerous confounding factors. As Federal spending for Medicaid has gotten out of control, there have been three bailouts to the system.
Q. How much is spent on Medicaid in New York?
New York’s Medicaid program is the single largest health care payer, serving more than 6 million (one in three) residents. Total spending on Medicaid in New York is expected to reach $62 billion this year alone.
Q. What are the main DSRIP focuses in New York?
Reduce avoidable hospitalizations by 25% through a series of transformative investments in community based care, including expanded care coordination, facilitated access to care, integrated health and behavioral health, and others, and to better manage chronic health conditions.
Q. How much money is available in New York for DSRIP?
$6.42 Billion over the next 5 years.
Q. What is a PPS?
Performing Provider Systems are the groups that submit DSRIP applications. They comprise eligible public hospitals and safety net providers in each pre-existing or newly formed networks. Included are health and behavioral health care providers, social service providers and community-based organizations. Safety net partners can include an array of providers: hospitals, health homes, skilled nursing facilities, clinics & FQHCs, behavioral health providers, community based organizations and others.
Q. Is membership in a PPS is enough to receive payment from DSRIP?
To receive payment, the PPS must coordinate in order to meet predetermined benchmarks and achieve outcomes related to each project. Goals are set by each PPS in accordance with their community needs. Incentive payments are not guaranteed, but can be utilized at the discretion of the network.
Q. How many PPSs are in New York State?
There are 25 in New York. Our region is part of the the Finger Lakes PPS (FLPPS).
Q. Which states have DSRIP programs?
The program was originally introduced in California and followed by Texas, Massachusetts, New Jersey, Kansas and New York. Other states are expected to establish DSRIP programs soon as well.
Q. Is the program the same from state to state?
DSRIP differs somewhat across state borders but there are some common themes that are universal: DSRIP initiatives promote collaboration, support innovation, and bring renewed attention to social services.
Q. So DSRIP is the same as Managed Medicaid?
Not quite. While DSRIP waivers often share many of the same goals as Medicaid managed care programs – slowing the rate of growth in spending, improving care and offering greater accountability, DSRIP offers providers – rather than health plans – the opportunity to change the way that they provide care. Keeping that in mind, the relative roles of DSRIP-funded provider networks and managed care plans has not been fully defined in all situations.
Q. What does Strategic Interests have to do with DSRIP?
SI has strong relationships with several PPSs, their founding partners and members. We’ve collaborated to define vision, write grants, provide strategic planning and formulate vendor selection in alignment with DSRIP initiatives. We understand the DSRIP big picture for individual organizations up to nationwide commercial ventures and everything in between.
by Strategic Interests News | Sep 15, 2015 | DSRIP
On October 8, 2015, Strategic Interests president Al Kinel is scheduled to speak at a Digital Rochester/HIMSS partnered educational event. Per the NYS Department of Health, DSRIP´s purpose 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 this program with payouts based upon achieving predefined results in system transformation, clinical management and population health. Many of the projects in the DSRIP program require subtantial technology initiatives around analytics/reporting, interoperability, and infrastructure.
Join us and learn about the IT initiatives required to support this transformation and what is being done in the Rochester and Western NY area to facilities the technological requirements.
Speakers include:
Chris Bell, Sr. Project Manager, Finger Lakes Performing Provider System
Al Kinel, President, Strategic Interests
Denise DiNoto, Director of Community Services, Rochester RHIO
Jose Rosario, Director of IT & Analytics, Finger Lakes Performing Provider System
When: Thursday, October 8, 2015
Time: 7:30 AM
Where: Locust Hill Country Club
2000 Jefferson Rd, Pittsford, NY 14534
Admission: $20 for DR Members, $35 for Non Members.
Promo Codes: Not-for-Profit Attendees, use promo code NFP2015
Register or get more information here
by Brett Kinsler | Sep 15, 2015 | Telemedicine
At the dawn of medicine, when a physician wanted to assess a patient’s heart, he would put his ear directly on the patient’s chest to listen. Then came stethoscopes. At first people didn’t trust they would be as accurate as the human ear alone and deemed the scopes to be simply gadgets.
In the development of modern medicine, when a physician wanted to assess a patient’s heart rhythm, he would use an electrocardiogram. At first, people didn’t trust all of those wires and electrodes and deemed them to be just gadgets. The stethoscope, of course, was the standard.
During the growth of technology based healthcare, when a physician wanted to assess a patient’s cardiac function, he might order an echocardiogram. At first, people didn’t trust their accuracy and deemed them to be just new gadgets. What could deduced from an image that could not be detected from EKG tracings?
Well into the stride of evidence-based, data-driven, patient-centered healthcare, the emergence of telehealth devices allow physicians to assess their patients from a distance of another building, state or even a different country. Whether in real-time (synchronous) or using a store and forward method (asynchronous), remote visits bring a level of care to people who otherwise might not receive it. Specialized telehealth-enabled instruments, like video otoscopes or dermatologic cameras are operated by a nurse, technician or sometimes by the patient. Such procedures increase access, convenience, lower costs and can improve quality of care when a physician or specialist could not otherwise be consulted locally.
Just as prior breakthroughs permitted hearing and seeing what we could not previously perceive, this technology breaks the barriers of geography and access to healthcare and education. Unfortunately, there are people who do not view telehealth this way.
There is a debate occurring in some states whether or not to permit physicians to rely on telehealth when they have not seen the patient face-to-face. In some areas, like Texas, technology is losing the battle. At a time when people need better access to quality care at lower costs, you may think this is a surprising and alarming trend. You will recall that people often fear and dismiss technology they don’t yet understand.
We trust our physicians to prescribe medications, perform surgeries and myriad other procedures that hold a life in the balance of their judgement. If a physician deems a remote visit sufficient to make a diagnosis, and the research supports that decision, shouldn’t he or she be permitted to treat the patient as they see fit? But a great barrier is erected when telemedicine is restrained: research populations remain low and quality measures are often called into question when any measurements have been taken by patients themselves.
Better standards need to be in place for certain, but this can only be accomplished through an increase in telehealth initiatives, third-party reimbursement parity and industry advocacy to standardize telemonitoring data collection. And, as we’ve proven with so many other new technologies in healthcare, it should not be dismissed out of hand but vigerously studied, tested and validated.
To paraphrase The Independent journalist John Diamond, “perhaps there is no such thing as [telemedicine]…just medicine that works and medicine that doesn’t.”
There is no need to apologize for disrupting our beliefs about the traditional doctor-patient relationship; that’s par for the course in technology. Rather, when we find something that is safe and effective, especially when it is an improvement or provides an option where none existed previously, it should be fully enveloped into the scope of modern healthcare.
by Brett Kinsler | Sep 14, 2015 | Electronic Health Records, Population Health
Most hospitals and health systems in the US have instituted EHRs across their enterprises for health data management. However, the realization of value from that significant investment is sometimes lacking. This is often due to improper or incomplete installation, failure to leverage features or an organization that has not otherwise prioritized initiatives to extract value from their EHRs.
CIOs in healthcare are now seeking and forming programs to increase the benefits their hospitals and health systems can gain from electronic health record systems. According to a recent survey of the 1,400+ members of the College of Healthcare Information Management Executives (CHIME), the HIT industry should expect an increased focus on the optimization of EHRs. More than 70% of responding CHIME members stated that this coming year’s top IT priorities for their organization will be projects that harness value from their EHRs. And of these respondents, almost three quarters plan to utilize outside firms to assist their internal teams with these projects.
This is a forward-thinking and positive trend which should have tangible benefits on an organization’s bottom line as well as yielding outcomes-based improvement for stated initiatives. More data is of no benefit without using that information in a positive way. Programs like the Unity Health System’s Community Diabetes Collaborative (CDC), which helped Rochester-area patients with diabetes improve their blood glucose levels by 14 percent in the first 18 months, take what could have been background noise and transform it into population health initiatives that improve care quality and save money.
by Brett Kinsler | Sep 13, 2015 | Interoperability
The disconnect in U.S. health care results in higher costs and less favorable outcomes for patients. In the United States, personal health information is largely held within hospitals, physician practices and pharmacies, and typically cannot be shared routinely outside those individual settings. Organizations that permit secure sharing of pertinent information, like Health Information Exchanges (HIEs) and Regional Health Information Organizations (RHIOs) are an effective method to ameliorate the situation.
Transfers of care from one provider to another are a common pitfall for gaps in care. When patients move from within and across health care systems, delayed patient care and reduced quality and efficiency of health care occurs without also the proper transfer of information. The exchange of health care data improves provider communication, provides for better coordination of care and transfers, increases patient engagement and lowers overall costs of care. Coordinated efforts of treatment and procedure documentation also provide a higher level of patient safety by decreasing unnecessary duplication of services, such as repeated imaging.
At the present time, there is no universal grid that permits all providers to plug and play their information. Due to security concerns and the difficulty of establishing interoperability standards, health systems that utilize differing EHRs often need assistance making sense of the data, workflows and establishing peer relationships of data. The health care technology industry, in concert with vendors, providers, payors and regulatory agencies, need to embrace present and future efforts to establish universal standards — the safety of our patients is depending on it.
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