Healthcare transformation


In mid-June a collaborative planning application from several prominent Ulster County-based healthcare organizations will be sent to the state health department (DOH) in Albany. A work product of the New York State Health Innovation Plan, the application will be unlike any document upon which local healthcare providers have previously collaborated.
“It’s new for us,” said HealthAlliance of the Hudson Valley’s chief strategy officer, Josh Ratner, who is playing an important role in drafting the application. “It’s new for DOH, too.”

The state innovation plan is geared toward the so-called “Triple Aim”: improved health, better healthcare quality and consumer experience, and lower cost. Five-year goals include specific outcomes in disease prevention and health improvement, a 20 per cent reduction in avoidable hospital admissions, and $5 to $10 billion in savings from better care management and lowered vendor prices.
The foundation of the state innovation plan is built on creating “an advanced primary-care model that integrates care with all parts of the healthcare system.” By the end of five years, 80 per cent of the population will be enrolled in primary care, with a focus on coordination (assuming effective health information technologies). Eighty per cent will be on a value-based financial arrangement rather than paying fees for services (“paying for value, not volume”), DOH has said. And by then there’ll be full information transparency enabling informed consumer choices.
Ratner, who works closely with HealthAlliance CEO David Scarpino, expected participation in the June application to the DOH by the Institute of Family Health (the dominant provider of training for primary-care practice in the county), Ellenville Hospital, the county health department, and local physicians associated with HealthAlliance. The inclusion of insurers, physician groups, additional care organizations and other players will come later, Ratner said.
The state may also recommend the inclusion of additional geographic areas in the local plan, which for now covers Ulster County. Individual area plans will later be “aligned” in a regional plan for the Hudson Valley, one of the state’s eleven regional health planning areas. Regional organizations, noted the text of the state innovation plan, “can provide further locally tailored assistance that is reflective of unique regional characteristics.” DOH sees regional organizations as driving state implementation of reform.
The DOH sees hospitals as indispensable players in the integration of a healthcare system based on primary care at the community level. As the largest healthcare providers, they provide the linkages.
HealthAlliance is continuing to explore partnerships with other hospital systems, as it announced it would last July. Each hospital group Ratner has talked to has been developing its own strategy in approaching the state’s healthcare transformation. All were asking similar questions about the state’s plans, Ratner reported.
David Scarpino is scheduled to speak to the Ulster County Regional Chamber of Commerce breakfast next Wednesday morning, May 21.

Fragmented delivery system
Will the complex planning process yield positive results? Though the broad-reaching changes the state innovation plan will bring make many in the healthcare industry uncomfortable, something of that magnitude has become inevitable.
Describing the nation’s present healthcare system as “chaotic” is being generous. “Healthcare delivery in the United States is often inefficient and uncoordinated, leading to wasteful public and private spending and avoidable health problems for patients,” reported a scathing April 11 paper by Mark McClelland and Alice Rivlin of the Brookings Institution. “Healthcare providers tend to practice medicine in silos and fail to coordinate care when patients transition across care providers and settings. This fragmented delivery system leads to duplicative and avoidable services and complications, particularly for the growing number of patients with complex chronic conditions who account for most healthcare costs. Patients receive many treatments that evidence suggests are often unnecessary, or for which better and less costly alternatives exist. Substantial variations in costs that appear unrelated to patient health occur across geographic areas large and small, as well as across different providers and payers, including Medicare, Medicaid, and private insurance systems.”
To its credit, the state innovation plan didn’t promise success. It simply said that there was no alternative to transformation. The plan would “work quickly to support and enable regional entities to take stock of the resources and capability needs that must be addressed to jointly deliver on the full aspirations of our plan.”
The DOH innovation document sees a four-phase timeline in its “transformational journey.” Fundamental change will come in the next two years. The steps are:
1) Detailed plan design, ending in September. How will practice transformation and care coordination be accomplished, rate review established and plan delivery supported? Ratner’s engagement of local partners appears crucial to this phase.
2) Preparing for implementation, ending April 2015. Building access points and analytic capabilities, including regulations to capture data appropriately.
3) “Going live,” ending a year later. Heavy data reporting and supporting regional coordination, fine-tuning investments and innovations.
4) Continuous improvement after April 2016.

High Obamacare participation in New York
No matter what you think of the federal Affordable Care Act (Obamacare), the fact is that some states have been doing a better job planning for it and managing its opportunities than others have, just as some organizations have been more efficient and more effective than others in providing quality care. This is a time for experimentation with different service models, an openness to trying things that have never been tried.
Since healthcare constitutes more than a sixth of the gross national product, the difference between effective and ineffective management of the transition of so major an industry is no small potatoes. In New York State, tens of billions of dollars are involved. According to the New York State Health Innovation Plan, New York healthcare spending is 22 per cent more than the national average — and that spending difference was until recently growing.
The statistics show New York to have been among the states that have handled the rollout of its health-plan marketplace relatively well. The New York State of Health, the state’s health-plan marketplace, attracted considerable participation. Twelve per cent of New Yorkers had been uninsured in July 2012, according to the state planning study, compared to 15 per cent nationally. With the increasing number of adverse effects being recorded, has made it it’s mission to alleviate the harm being done. Since the enrollment period opened last October, almost half the state’s eligible uninsured population enrolled for coverage.
State health department figures show that as of April 16, completed applications for coverage totaled 1,319,239 New Yorkers and that 960,760 had enrolled in a plan. The state said that more than 70 per cent of enrollees were uninsured at the time of application. The enrollment rate in New York was around double what it was nationally.
Despite the much-publicized national troubles at the program’s October 1 start, New York State of Health enrolled 242,000 New Yorkers by the end of 2013, 380,000 by the end of January, about 530,000 by the end of February, and 812,000 by the end of March.
Open enrollment will begin again November 15, and the state is confident. “We are well on our way to meeting or exceeding our goal of enrolling 1.1 million by the end of 2016,” said NY State of Health executive director Donna Frecatore in a press release.
So far, so good. On to the hard part.


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