NYAPRS Note: The article below refers to a webinar hosted by the state last Friday, during which Jason Helgerson and Greg Allen outlined the way uninsured and disengaged New Yorkers would be attributed to DSRIP projects statewide. The new initiative will be paid for using the same funding mechanism as the other projects in DSRIP (despite the speculation in this article’s final paragraph). Accounting for individuals without insurance or a primary care doctor was a significant issue for advocates, and represents not only a triumph for community protections but also the commitment by the state to fully acknowledge the needs of all individuals served by the safety net system.
Learn more about DSRIP at this year’s annual NYAPRS conference, at which Greg Allen, Bob Myers, and Rob Kent will offer a featured presentation on the shift to managed care and the way initiatives like DSRIP and Health Homes will impact behavioral health services. Register for the conference today! http://www.nyaprs.org/conferences/annual-conference/2014.cfm
New Initiative for Uninsured New Yorkers
Crain’s Health Pulse; 8/4/2014
The state Department of Health revealed a new twist to the Delivery System Reform Incentive Payment program with a name that sounds more like a summer blockbuster movie than a new program for the uninsured: the 11th Project.
“The 11th Project is about getting patients to use primary-care providers and to get them to better managed health care,” Jason Helgerson, New York’s Medicaid director, said at a DOH webinar on Friday. “Our policy target is to assign 100% of the uninsured to the 11th Project.”
The name is derived from the fact that Performing Provider Systems must sign on for 10 projects to be eligible, and they must also demonstrate they have the network capacity to handle an 11th project. The five public hospitals defined by DSRIP have the right of first refusal to take part in the 11th Project in their region. If they take a pass, then one or more nonpublic PPSs in that region may be approved. The opt-out date for public hospitals hasn’t been set yet.
The project covers the uninsured (including undocumented immigrants) as well as Medicaid enrollees who barely use the health care system. Mr. Helgerson said there were 1.1 million Medicaid members who don’t use services in any given year, and another 750,000 who had three or fewer encounters with health care providers and little connection to a PCP.
“Public hospitals already take care of this population,” said Kathleen Shure, GNYHA’s senior vice president, managed care and insurance expansion. “This focuses on engaging the uninsured to get primary and preventative care and not episodic care or accessing care through the ER.”
Providers may have many questions about the 11th Project, including how to cover financial costs. It isn’t an enrollment or Medicaid expansion initiative, but merely a policy approach toward engaging the uninsured.