CHP: State Not Waiting for Supreme Court Verdict

State Not Waiting for Supreme Court Verdict

Crain’s Health Pulse  June 22, 2012


Even if the Supreme Court strikes down the Affordable Care Act, New York has made major reforms that are likely to stick, health officials said yesterday.


"We are seeing a major sea change," said Susan Waltman, executive vice president and general counsel for the Greater New York Hospital Association, "A huge amount of reform is already going on."


Ms. Waltman and other health officials spoke yesterday at a special meeting in Albany of the state Department of Health's health planning committee. The group is working to overhaul the state certificate of need process, part of New York's own effort to improve care and reduce costs.


The biggest changes are affecting hospitals. Those include a push to get all patients into medical homes where doctors coordinate a patient's care to better manage chronic conditions. Electronic health records networks, which the state is already helping create, are essential to creating medical homes.


The medical-homes efforts could help the state achieve another goal: reducing the cost of caring for "dual eligibles," New Yorkers who qualify for both Medicaid and Medicare because they have chronic conditions, mental health problems, drug addiction - and sometimes all three. The state wants to put dual-eligible residents into managed care organizations to prevent crises that lead to costly hospitalizations.


The Cuomo administration has articulated dozens of similar goals as part of its Medicaid Reform Team recommendations that will soon be presented to the Centers for Medicare & Medicaid Services for approval and funding.


Reforming the certificate of need process is also part of redesigning Medicaid, said committee chairman Dr. John Rugge. "We need a health-planning process that is ongoing and continuous," he said. The committee's work will not be "a free-floating hot air balloon," he promised.