June 23, 2021

Last week we shared some information with everyone regarding the state’s ongoing work to answer the question of what comes next for the state’s Medicaid Program and specifically, what’s the next step (post-DSRIP) that will allow New York to continue to build on the advances made during DSRIP, prepare the service delivery system for the next major public health crisis, and use the Medicaid Program to promote health equity across the healthcare system.  Attached to this email are slides from a Power Point deck that Brett Friedman has been using to orient the members of the various Clinical Advisory Groups (CAGS) that are responsible for identifying the quality measures that will be used in value based arrangements for specific bundles including the maternity care bundle and the HARP bundle. 

To summarize what we shared last week via email: NYS is in the beginning stages of conversations with CMS that will likely result in the submission of a new 1115 waiver that would permit NY to (hopefully) make improvements to the healthcare delivery system.  Given the new Administration in Washington, New York’s continued interest in proceeding down the path of healthcare system reform, and the healthcare inequities that became so clear during the COVID crisis, it seems logical the state would pursue a new demonstration program that permits it to continue and expand prior work while using the Medicaid Program to address longstanding health inequities, and to do so using Value Based Payment arrangements and other tools at its’ disposal.

State leaders envision a new initiative where federal funds could be used to make strategic investments (including upfront investments) to stabilize the healthcare workforce, build capacity so that the healthcare system is ready for the next public health crisis, and to ensure health equity through regional coordination of healthcare services using large networks of providers and planning entities called HEROs (Health Equity Regional Organizations).  HEROs differ from PPSs in that the PPSs were necessary to act as the funding intermediary for DSRIP.  This model is different.  The general plan includes use of value based contracting with health plans as a vehicle for incentivizing desired health outcomes.  HEROs do the planning and coordination.  Large networks of providers deliver medical and social care interventions that address the wholistic needs of a community or population.  Strategic investments are made to advance data collection and interoperability, making the large networks better able to zero in on the needs of a specific community or population.  The vision seems to include a more significant role for BHCCs/IPAs as well as other networks that have come together over these last many years, and PPSs do not need to be the leads.

Attached please find slides that continue to paint a picture of what the state envisions at this point.  We can talk more about this on one of our upcoming Thursday morning calls.

Please note:  Brett Friedman is clear that the information attached is fluid and subject to change.  We will continue to share the details as they become clear.