NYAPRS Note: A number of speakers at yesterday’s public comment session on NY’s plan to apply for a second round of DSRIP strongly pressed for significant investments in hard pressed community based behavioral health services, especially those that address the social determinants of health, in recognition of the high degree of preventable behavioral health related emergency and inpatient use. NYAPRS will be submitted and sharing our public comments later this week.
As State Prepares DSRIP Extension Plan, Groups Make Their Pitch for Funding
By Jonathan Lamantia Crain’s Health Pulse October 28, 2019
Speakers from organizations that felt overlooked in the first Delivery System Reform Incentive Payment program spoke out Friday to convince the state Department of Health to pay greater attention to issues such as behavioral health, diabetes and pediatrics.
New York is preparing to submit a four-year waiver renewal to the Centers for Medicare and Medicaid Services that requests $8 billion to continue to improve its Medicaid program. The state held a public comment day at Baruch College ahead of its Nov. 27 deadline to submit its application to CMS. Written comments can be submitted to the state through Nov. 4.
New York is requesting $5 billion for the next phase of DSRIP, which is slated to end March 31. It requested $1.5 billion to address the social determinants of health, such as access to food, housing and transportation; $1 billion for workforce development; and $500 million to support financially struggling hospitals.
Crain’s Nov. 21 summit will focus on the next phase of DSRIP in New York.
Chris Norwood, executive director of Health People, which offers diabetes self-management classes, was joined by several of the nonprofit’s peer educators to ask for more action on the disease, which is estimated to affect nearly 2.1 million state residents.
“We have to ask why again the state has not named diabetes as a high-need priority area,” Norwood said.
John Javis, CEO of Behavioral Health NYC IPA, said behavioral health providers should play a greater role in the next phase of DSRIP. “Many of the state’s high-value DSRIP metrics are behavioral health in nature,” such as emergency department visits that are tied to behavioral health.
The first round of the program focused on adult care in hospitals at the expense of investing in community-based services for children, said Alice Bufkin, director of policy for child and adolescent health at Citizens’ Committee for Children.
“The state must not overlook this opportunity to invest in child health and particularly children’s behavioral health,” Bufkin said.
At the hearing, the state shared that through the first four years of DSRIP, the 25 Performing Provider Systems around the state had collectively reduced preventable hospital admissions by 21%. The goal of the five-year program is to cut avoidable hospital use by 25%, and the state is on track to do so, said Greg Allen, director of program development and management at the Department of Health.
He noted that 11 Performing Provider Systems had exceeded the 25% target, including three that had reduced preventable admissions by more than 40%.
“DSRIP is not a story about the statewide average,” he said. “DSRIP is a story of excellence when we look under the hood of individual Performing Provider Systems.”
Allen said the state had met its target of shifting toward value-based care and away from fee-for-service payment—a transition that New York health care providers have been slow to embrace. It had exceeded its goal of moving 65% of Medicaid managed-care contracts to meet Level 1 value-based care standards, including at least 35% that met Level 2 standards.
The Health Department wants those payment changes to continue. It is also targeting several areas that were not a main focus of current DSRIP projects: maternal mortality, children’s health and long-term care.
“We have a tiger by the tail,” Allen said. “We have a very good thing that has started, and we want to keep it going.”
Of course, the state is facing the political reality that the Cuomo administration and the Trump administration have frequently been at odds over health policy issues since 2017. Anthony Feliciano, director of the Commission on the Public’s Health System, acknowledged the prospect that New York might not get $8 billion.
“If you don’t get all the money you’re requesting, there should be prioritization around community-based organizations and the social determinants of health,” Feliciano said. “It would be a shame to have that cut.”