New York State Excels in Federal Medicaid Performance Review, Improving the Lives of Recipients Statewide

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Press Release: The New York State Department of Health announced that through New York State Medicaid Redesign efforts, providers are exceeding their goals, resulting in improved health care throughout the state. New York passed its first federal test of the Delivery System Reform Incentive Payment, or DSRIP, on four key statewide performance measures: statewide metrics performance, success of statewide projects, total Medicaid spending and Managed Care Plan expenditures. New York State was required, as part of the program, to submit a statewide report card to the Centers for Medicaid and Medicare Services (CMS) detailing performance.

“Medicaid redesign is improving health care and lives throughout New York State, while saving taxpayers millions of dollars each year,” said New York State Department of Health Commissioner Dr. Howard A. Zucker. “Thanks to Governor Cuomo’s leadership, we continue to exceed not only our own goals, but federal standards in making Medicaid more efficient and accountable.”

Currently in its fourth year, DSRIP has 25 Performing Provider Systems (PPS) made up of hospitals, providers, and community-based organizations, who collaborate to provide Medicaid members and the uninsured with higher quality, more coordinated care. Through community-level collaborations and a focus on system reform, the ultimate goal of these projects is to improve quality of care and achieve a 25% reduction in avoidable hospital use over the five year program.

The report shows that through DSRIP, New York State has exceeded performance goals on the majority of measures in place, related to the transformation of care. Statewide metrics show several areas of improvement including the following critical measures:

  • Preventable hospital readmission
  • Preventable emergency room visits
  • Patient connection to a consistent source of primary care
  • Access to timely appointments

Additional report highlights include:

  • Statewide Medicaid spending for emergency departments and inpatient spending came in under target from the previous year
  • New York State as far exceeded the 10% goal of Managed Care Organizations’ (MCO) service dollars being contracted by Value-Based Payment (VBP) arrangements instead of Fee-for-Service (under Value-Based Payment, MCOs and providers agree that a portion of compensation is dependent on provider performance)
  • Majority of DSRIP performance and quality metrics were achieved

“A passing grade on all four of the milestones proves that we are making monumental progress toward improving care for millions of New Yorkers,” said New York State Medicaid Director Donna Frescatore. “While we are on a clear path to success, our work is far from over. In the months and years ahead, we will shift our focus toward improving performance metrics and health outcomes as we work to change the culture of health care.”

New York State must submit a statewide report card to CMS for each year remaining in the DSRIP program, which ends on March 31, 2020. Failure to meet any of the four milestones will result in a financial penalty of overall DSRIP dollars from the federal government. The full report card is available and can be viewed here.