NYAPRS Note: DOH will wade through the issue of DSRIP attribution over the next six months, as Performing Provider Systems are formed around regional networks of care. Attribution is not only essential to protect the needs of all Medicaid recipients, but is important for the accurate valuation of projects chosen by each PPS. As the article highlights, one of the reasons this is essential to get right rather quickly is that PPS’ need to have a good understanding of what providers to invite into their networks based on their geographic and service range. One of the tools that helps DSRIP leads to this are the Safety Net Provider Lists developed by DOH. The current list of behavioral health safety net providers does not match the attribution methodology that DOH claimed they would use; their stated intention is to attribute Medicaid recipients to networks based on the recipient’s use of services, rather than based on the type and number of claims that a provider pays for each year. The behavioral health safety net provider list was not formed using a methodology that reflects this. If that list remains incomplete, it will have severe negative impacts on the safety and care of our community members, the health of our system of safety net providers, and ultimately, the devaluation of DSRIP project success. NYAPRS is engaged in consistent advocacy to effect change in the way designation was used to design the BH safety net provider list. Along with fellow advocates, we expect that the state will maintain its stated commitment to designate appropriate providers based on the use of services from Medicaid recipients.
Assessing the Impact of Medicaid Reform
Crain’s New York Business; 6/12/2014
One of the trickiest aspects of organizing the new Performing Provider Systems forming under the Delivery System Reform Incentive Payment program is the concept of attribution. Medicaid individuals in a ZIP code will be attributed to a PPS. Attribution “is one of the most critical steps in DSRIP. Who are they trying to reach?” said Arthur Webb, a senior fellow with the consulting firm BDO.
The problem is that not everyone in a geographic area uses services where they live. They can go to an academic medical center for serious conditions, or to a community hospital in their borough for routine care. Attribution is driving new relationships and networks. “The motivation is for the lead provider to maximize their attribution in a catchment area,” added Mr. Webb.
The goal of the Medicaid waiver is to cut hospital admissions by 25%, so at roughly 2.3 million discharges, at least “500,000 discharges will be redirected,” notes Mr. Webb. “Do we have the capacity and access point to physicians to absorb this?”
DSRIP makes it very important to understand the nature of the discharges, said Patrick Pilch, managing director at BDO Consulting.
Messrs. Webb and Pilch believe the DSRIP program, with its emphasis on collaboration, has the potential to be transformative for how health care is delivered in New York. But there could be some trouble spots. Mr. Pilch cautioned that groups should make sure they are finding the right partners, and pay special attention to governance issues and measuring outcomes. “It’s like a marriage to take care of the population you are serving,” said Mr. Pilch.
The lessons learned from DSRIP could be enormously important as costs are taken out of the state’s health care system. Commercial payers also may see results that apply to their business, added Mr. Pilch.
“If we can change the cost structure and reduce costs for employers, this has a tremendous potential impact,” said Mr. Webb.