Delivery System Reform Incentive Payment (DSRIP) Program Answers the Asthma Challenge

Transcription

1 Delivery System Reform Incentive Payment (DSRIP) Program Answers the Asthma Challenge Douglas G. Fish, MD November 20, 2015 JOINT EPA-HHS-HUD Regional Summit on Sustainable Funding for Asthma In-Home Interventions 1

2 The Asthma Challenge 2

3 Annual Emergency Department (ED) Spend per Medicaid Member

4 Health And Recovery Plan (HARP) Members with Asthma

5 Annual Inpatient Spend per Medicaid Member 2014 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $- Per-Member Annual Inpatient Spending $11,578 $8,221 $2,687 $1,189 All Medicaid All Asthmatics HARP HARP Asthmatics 5

6 Children with Asthma Spending per Medicaid Member As demonstrated in the graphs below, success in DSRIP will be dependent on improving outcomes in terms of children s health IP Spend per Medicaid Member (under age 22) General Population vs. Asthmatic Population ER Spend per Medicaid Member ( under age 22 General Population vs. Asthmatic Population 6 Statewide Average $526 $1,338 Statewide Average $95 $227 WESTERN NY $491 $1,039 WESTERN NY $111 $234 TUG HILL SEAWAY SOUTHERN TIER $374 $692 $718 $795 TUG HILL SEAWAY SOUTHERN TIER $79 $135 $163 $236 NYC $557 $1,515 NYC $89 $227 NORTH COUNTRY $483 $1,060 NORTH COUNTRY $77 $150 MOHAWK VALLEY $491 $791 MOHAWK VALLEY $103 $195 MID-HUDSON $536 $1,321 MID-HUDSON $74 $180 LONG ISLAND $510 $1,185 LONG ISLAND $101 $215 FINGER LAKES $398 $770 FINGER LAKES $164 $412 CENTRAL NY $406 $930 CENTRAL NY $100 $218 CAPITAL DISTRICT $505 $886 CAPITAL DISTRICT $92 $194 $- $200 $400 $600 $800 $1,000 $1,200 $1,400 $1,600 $- $50 $100 $150 $200 $250 $300 $350 $400 $450 General Population Asthma Population Source: Medicaid Data Warehouse, claims data within calendar year 2014 General Population Asthma Population

7 The DSRIP Program s Response 7

8 MRT Waiver Amendment In April 2014, Governor Andrew M. Cuomo announced that New York State and CMS finalized an agreement on the Medicaid Redesign Team (MRT) Waiver Amendment. Allows the state to reinvest $8 billion of the $17.1 billion in federal savings generated by MRT reforms for 6.3 million members. The MRT Waiver Amendment will: Transform the State s Health Care System Bend the Medicaid Cost Curve Assure Access to Quality Care for all Medicaid members 8

9 October 2015 Performing Provider Systems (PPSs) in NY State s DSRIP Program 25 Performing Provider Systems 9 Key Public Hospital led PPS Safety Net (Non-Public) led PPS

10 ASTHMA: Ambulatory Care Sensitive Condition Primary diagnosis is an ambulatory care sensitive condition ASTHMA, and.. Severity of illness is minor or moderate, leads to Potentially Avoidable Admissions, and further. Potentially Preventable Readmissions 10

11 Asthma-based Projects in DSRIP PPS 3.d.ii 3.d.iii Adirondack Health Institute Advocate Community Providers Albany Medical Center Hospital Alliance for Better Health Care, LLC (Ellis) Bronx-Lebanon Hospital Center Central New York Care Collaborative (CNYCC aka CNY) Finger Lakes PPS Lutheran Medical Center Maimonides Medical Center Millennium Collaborative Care (ECMC) Mohawk Valley PPS (Bassett) Montefiore Hudson Valley Collaborative Mount Sinai Hospitals Group Nassau Queens Performing Provider System, LLC New York City Health and Hospitals-led PPS Refuah Health Center Samaritan Medical Center Sisters of Charity Hospital aka Community Partners of WNY Southern Tier Rural Integrated PPS (United) St. Barnabas Hospital (dba SBH Health System) Staten Island Performing Provider System, LLC Stony Brook University Hospital The New York and Presbyterian Hospital The New York Hospital Medical Center of Queens Westchester Medical Center Total PPSs engaging in Asthma-based Projects 7 6 Over half of the PPSs have chosen a project from Domain 3, Sub-domain D (Asthma): 3.d.ii: Expansion of asthma homebased self-management programs 3.d.iii: Evidence-based medicine guidelines for asthma treatment 3.d.ii. Asthma home-based selfmanagement program components Home environmental assessment Education on the role of the home environment and asthma control Modification of home environment as needed Comprehensive asthma self-management education Coordinated care and root cause analysis of ED and hospital asthma-related visits 11

12 Project 3.d.ii & Project 3.d.iii: Asthma Related Prevention Agenda Intervention Region New York City Capital District New York City Capital District New York City New York City New York City Mohawk Valley Mid-Hudson New York City Long Island New York City Mid-Hudson PPS Advocate Community Partners (AW) Albany Medical Center Hospital Bronx-Lebanon Hospital Center Ellis Hospital HHC Facilities Lutheran Medical Center Maimonides Medical Center Mohawk Valley (Bassett) Montefiore Medical Center St. Barnabas Hospital Stony Brook University Hospital The NY Hospital of Queens Westchester Medical Center 12

13 DSRIP Asthma Metrics Domain 2 System Transformation Metrics Measure Name Statewide Measures Measure Steward DY 2 P4R/P4P DY 3-5 P4R/P4P 2. A. Create Integrated Delivery System Potentially Avoidable Emergency Room Visits 3M Reporting Performance Potentially Avoidable Readmissions 3M Reporting Performance PQI Suite Composite of all measures AHRQ Reporting Performance PDI Suite Composite of all measures AHRQ Reporting Performance Domain 3 - Clinical Improvement Metrics DY2 & DY3 DY4 & DY5 Measure Name Measure Steward NQF# Source Measure Type P4R/ P4P P4R/ P4P 3.d Asthma PQI # 15 Adult Asthma AHRQ 0283 Claims Outcome Performance Performance PDI # 14 Pediatric Asthma AHRQ 0638 Claims Outcome Performance Performance Asthma Medication Ratio NCQA 1800 Claims Process Performance Performance Medication Managed for People with Asthma NCQA 1799 Claims Process Performance Performance Domain 4 - Population-Wide Metrics 4. Prevent Chronic Diseases Asthma emergency department visit rate per 10,000 SPARCS Reporting Asthma emergency department visit rate per 10,000 - Aged 0-4 years SPARCS Reporting 13 The tables were taken from STC Attachment J Strategies and Metrics Menu

14 Transformation also requires payment reform: Value Based Payments and the DSRIP Vision 14 Integrated Physical & Behavioral Primary Care Includes social services interventions and community-based prevention activities Prenatal and Maternity Care Elective Care (Hip-, Knee replacement, ) Depression Acute Cardiovascular (AMI, Stroke) Pneumonia Cancer care, Chronic care (Asthma, Diabetes, CHF, Hypertension, HIV ) Multimorbid disabled / frail elderly (FIDA population) Severe BH/SUD conditions (HARP population) Episodic Continuous Population Health focus on overall Outcomes and total Costs of Care Care for the Developmentally Disabled Sub-population focus on Outcomes and Costs within subpopulation/episode 14

15 15 Summary DSRIP PPSs doing Asthma Projects encouraged to work with Regional Asthma Coalitions and Healthy Neighborhoods Programs across New York State Implementation Plans for the PPSs have been reviewed and finalized, and we are now through the second quarter of Year 1 of DSRIP PPSs report quarterly throughout the 5 years of DSRIP, and payments driven by q 6-month reporting and performance Additional information available at: DSRIP dsrip@health.ny.gov