Background

MapGraphicOn April 14, 2014 Governor Andrew M. Cuomo announced that New York had 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 funds are to 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.

The Centers for Medicare & Medicaid Services (CMS) is changing the way Medicare and Medicaid pay for hospital care by rewarding hospitals for delivering services of higher quality and higher value. With pay-for-performance, hospitals, nursing homes and other providers are required to demonstrate that patients receive the most effective care possible, with fewer re-admissions, appropriate emergency room utilization, good follow-up care and efficient use of electronic medical records.

DSRIP funds are intended to support qualified providers with more money over the next five years, through a period during which fee-for-service revenue will decline but financial rewards based on performance will not yet be fully developed.

Goals of DSRIP

  • Transformation of the healthcare safety net at both the system and state level
  • Reducing avoidable hospital use and improve other health and public health measures at both the system and state level
  • Ensure delivery system transformation continues beyond the waiver period through leveraging managed care payment reform
  • Near term financial support for vital safety net providers at immediate risk of closure

shutterstock_154007477Collaboration

Collaboration Across the Continuum of Care: Building Relationships to Support an Effective Provider and Community-based Network

Care Compass Network supports and encourages partners to develop and establish collaborative partnerships/ coalitions to better meet the needs and demands of addressing the patient’s socio, behavioral and medical needs effectively. Our partners from across our nine-county region are collaborating to ensure patients are effectively and efficiently treated and discharged. One such collaboration is an independent counseling agency embedding a Licensed Clinical Social Worker (LCSW/ LCSW-R) in a primary care clinic to provide brief onsite counseling, interventions and assessments.

Collaboration can be between the following:

  • Primary Care Clinics
  • Community-based Organizations
  • Hospitals
  • Health Homes
  • Skilled Nursing Facilities
  • Behavioral Health Providers and Agencies
  • Home Care Agencies
  • Specialty Care Providers
  • Diagnostic & Treatment Centers (D&TCs) and Federally Qualified Health Centers (FQHCs)

Community-based Organization (CBO) Tiers – Defined by the Department of Health

Tier 1: Non-profit, non-Medicaid billing, community-based social and human service organization (i.e. social services, housing, religious organizations)

Tier 2: Non-profit, Medicaid billing, non-clinical service providers (i.e. transportation, care coordination)

Tier 3: Non-profit, Medicaid billing, clinical and clinical support service providers

Contracted Partners

Interested in Collaboration?

Are you interested in collaborating with other organizations? If yes, please take few minutes to fill out our partner collaboration form below.  To view other partners that are looking to collaborate, click the ‘View Partners’ link below.

View Partners

Partner Collaboration Form:

 

What is a PPS Expected to Manage?

By 2020, New York State Medicaid will fully transition from Fee-for-Service 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:

  • Create a care delivery network  structure for a region that has enough Medicaid covered lives to manage risk based payments.
  • Organize the provider network to effectively and efficiently deliver care to Medicaid beneficiaries.
  • Develop the analytical and financial core competencies for population health management.