Submitted by John Paul Perez,
on behalf of the African American Health Coalition
With a new U.S. President taking office, there has been much talk about the future of the federal Patient Protection and Affordable Care Act (otherwise known as the “ACA” and commonly nicknamed “Obamacare”). Regardless of what happens with that legislation, one health care reform effort underway will not be affected: The Delivery System Reform Incentive Payment (DSRIP) program.
DSRIP provides funding to focus on Medicaid reform, with the overarching goals of reducing avoidable hospital use by 25 percent over 5 years, improving health outcomes for Medicaid beneficiaries and providing access to a strengthened and integrated health care system. The goal of this column is to introduce you to DSRIP, which will have a dramatic impact on local health care.
First, it is important to note the difference between Medicaid and Medicare, which are often confused with each other.
- Medicare is a federal health insurance program for older adults
- Medicaid, run by individual states, provides health insurance for people with
In New York state, we have the largest Medicaid program in the country, costing $53 billion per year and serving about 5 million people. The DSRIP program is part of the state’s effort to redesign Medicaid. The DSRIP model focuses on creating provider delivery networks or Performing Provider Systems (PPS). There are 25 of these systems across New York state.
Here in Rochester and the Finger Lakes region, our PPS is the Finger Lakes Performing Provider System. FLPPS spans Monroe and 12 neighboring counties, the network includes 19 hospitals, thousands of clinical providers and hundreds of clinical organizations and community-based organizations. Our regional PPS is serving approximately 400,000 Medicaid beneficiaries and uninsured individuals.
The DSRIP program in our region requires safety net providers to collaborate around the implementation of 11 innovative projects that seek to improve the health care system and better coordinate care. If done successfully, the region could potentially earn up to $565M to reinvest in health care.
What does an integrated partnership look and feel like?
- Clinical, social and human services (housing, transportation, etc.) are integrated
- Clinical, social and human service providers are connected through IT solutions to allow for better transitions in care and seamless information sharing
- A patient can enter the system at any point and that provider will have a global view of the total needs of that patient and provide them with the right care at the right time
- Patients and providers will be better supported by care coordination across multiple clinical and social services. Care coordination organizes holistic care for the patient and allow the physician to focus on the clinical care delivery.
The goals of this partnership include:
- Managing chronic health conditions, such as heart disease, diabetes and hypertension, which make up 85 percent of potentially avoidable hospitalizations; and assisting patients in understanding how behavior modification can prevent the onset of chronic diseases
- Removing the major barriers to health care, such as transportation and housing
- Supporting women and children, as our infant mortality rate is higher than the state average
- Addressing the “social determinants of health” − the conditions in which we are born, live, work, worship and age − such as race, education, job status, family culture, physical environment and individual behaviors
- Delivering health care in a culturally competent manner that accounts for patient preference
Together, using DSRIP practices, we will move closer to providing better access to care, increasing quality of care, and reducing unnecessary hospital use. We can be successful locally by working together to improve our health care system and by building a stronger Medicaid safety net.
John Paul Perez, MS, is senior project manager of community engagement at Finger Lakes Performing Provider System (FLPPS) and Finger Lakes Health Systems Agency (FLHSA). Governor Cuomo recently appointed him to the New York State Intra Agency Council on Homelessness.