New York provider consortium takes aim at Medicaid costs, and state grant money

More than 200 community-based organizations that provide various health services across the 14-county area around Rochester, New York, are teaming up to identify ways to reduce the state’s Medicaid costs while improving care quality. Along the way, they also hope to win some of the state’s Delivery System Reform Incentive Payment program, or DSRIP, $8-billion waiver from the Centers for Medicare and Medicaid Services.

The consortium is called the Finger Lakes Performing Provider System, and it was established by leaders from UR Medicine, Rochester General Health System, and Unity Health System. These are the dominant healthcare systems in the region, but they are not all powerful. To reach their goal of reducing avoidable hospital admissions by 25 percent over the next five years, they will need the help of the other consortium members, which include health planning organizations, physician groups, nursing homes, behavioral health and substance abuse programs, and social service agencies.

“For decades, the Rochester region has been recognized nationally for its innovative and collaborative approach to quality healthcare,” stated Mark C. Clement, president and CEO of the Rochester General Health System, in a press release. “We are proud to co-lead this planning grant aimed at fundamentally changing the way healthcare is provided to Medicaid patients in our region.  With this grant, and with the collaboration of literally hundreds of healthcare providers in our 14-county area, we expect to refine delivery systems that not only continue to control cost, but more importantly improve quality and access for patients.”

According to the press release announcing the Finger Lakes Performing Provider System, the Rochester region includes approximately 320,000 Medicaid recipients. Ideas for reducing potentially avoidable hospital admissions for the Rochester Medicaid population include:

• Creating additional primary care services and establishing “medical homes” for Medicaid patients, who often rely on hospital emergency departments for health care because they don’t have a doctor.
• Intervening immediately when Medicaid patients visit the emergency department because they don’t have a primary care provider.  New triage systems would be set up to immediately assign those patients a primary care provider.
• Co-locating behavioral health and primary care services in the same locations to simplify referrals.
• Expanding transportation options so patients don’t miss routine medical appointments, which can cause conditions such as diabetes or asthma to worsen, resulting in hospitalization.
• Expanding transitional housing and care options, so patients discharged from a hospital can receive proper care and avoid readmission.

The final project selection recommendation by the Finger Lakes Health Systems Agency will be decided over the next two months with input from the consortium’s various stakeholders and through completion of  an organized needs assessment analysis. Plans are for a final grant application to be submitted to the state’s DSRIP program in December. If the grant application is funded, teams from across the consortium will start work in early 2015 to launch the projects and measure their effectiveness.