June 16, 2021
As some of you know, New York State is having conversations with CMS officials that will likely result in the state submitting a new 1115 waiver proposal that would allow it to make improvements to New York’s healthcare delivery system post-DSRIP and (for the most part) post-pandemic. Given the new Administration in Washington and New York’s obvious interest in continuing what it started with the DSRIP, it makes sense that the state would again pursue a demonstration program that includes significant federal funds to assist New York with its’ (now) updated healthcare delivery system reform objectives.
I was on a call yesterday with Brett Friedman who (with Donna Frescatore’s departure) recently became the point person on all matters pertaining to the NYS Medicaid Program. Brett was speaking to one of the Clinical Advisory Workgroups (CAG) responsible for the identification of metrics that can be incorporated into 2021 VBP contacting arrangements. Brett briefed the group on the state’s current thinking behind a potential application to CMS for a new 1115 waiver. He provided some details that I I have attempted to summarize (below).
In light of the last 18 months and given what NYS learned from the DSRIP, the state’s overall healthcare reform objective is to build a more resilient, equitable and flexible healthcare delivery system post-pandemic by ensuring New York addresses the racial health disparities and health inequities that were so glaring during the pandemic. State leaders envision a new initiative where federal funds are used flexibly – not just for one objective (e.g. reducing hospitalizations by 25%) to address several priorities by funding strategic interventions as well as networks tasked with ensuring the interventions are the right ones for the population being served and are inclusive of both medial and social determinants of health services. Federal funds would be used to (this is not an exhaustive list) stabilize and train/re-train the healthcare workforce to be ready for the next pandemic, to incentivize MCOs to contract with diverse regional networks of providers that are expert at addressing the health and social determinant needs of the population being served, and by making upfront investments in regional networks that are on the ground to initiate population health and care coordination interventions while advancing interoperability and improving outcomes. The vision appears to include a more significant role for BHCCs/IPAs as well as other networks that have come together to try to improve health outcomes. Interestingly, the model under discussion would not require hospitals or large health systems to be the recipients of the federal funds as was the case with DSRIP. This opens the door to a different approach in terms of regional leadership. In this scenario value based contracting would be used as a vehicle for implementing the kinds of interventions a community requires. MCOS would be incentivized to partner (and contract) with the regional networks and work with them to ensure these networks are diverse and appropriate to meet the unique needs of the communities being served.
The timing of the application process was not discussed specifically although it sounds like leads at DoH are hard at work and acting assertively. If you think back to the last time the state applied for a new DSRIP waiver it did so in the late spring and a decision came down from the Trump Administration in early December of that same year. It seems possible that NY is following the same or a similar timeline with this new application, but this is just speculation on my part.
There are several new acronyms and details that are not discussed in this brief summary. Brett was crystal clear that all of this is fluid and subject to change. The state has begun conversations with CMS but we advise caution at this juncture. Do not make any major decisions based on this information. We will continue to seek more details and share them with you promptly.
As always if you have questions please feel free to contact me at 518 461-8200 at your convenience.
Lauri