DOH, Advocates Press PPSs to Spend DSRIP $ on CBO Initiatives

NYAPRS Note: New York’s DSRIP (Delivery System Reform Incentive Payment) has been allocated about $7 million of federal funds to transform their local Medicaid system of care to improve outcomes and reduce costs. In NY, DSRIP is being implemented by 25 regional Performing Provider Systems (PPSs) who have moved from planning to spending hundreds of millions of dollars to create new and improved systems of care.

A recent meeting of our DSRIP oversight panel found that the PPSs have spent less than 1/3 of their allocated dollars, with the majority going to their own facilities rather than community based organizations. State Medicaid officials are raising concerns and advocates are urging them to increase their spending to meet identified goals, including increasing the number of CBO contracts. Notably, some PPSs have already shared plans to do so in the coming year.

In this environment, community behavioral health nonprofits should be firming up well articulated value based propositions for consideration by the PPSs. NYAPRS will be working to help identify a number of templates in this area.


Several weeks ago, New York’s Project Approval and Oversight Panel for the DSRIP program met to review progress across the 25 regional Performing Provider Systems who are in the process of reforming healthcare to improve outcomes and reducing avoidable hospitalizations by 25 percent by the end of 2020.


Among the key findings were that

·         PPSs have spent less than a third of their allocated DSRIP dollars, leaving more than $565 in the bank

·         70% of what has spent thus far has gone to the PPS’ administrative functions or to a hospital.

 

NYS Medicaid Director Jason Helgerson has expressed mounting concern and will be asking PPSs to explain how they’ve spent or not spent the DSRIP dollars at a January midpoint assessment. He has implied that some PPSs may need to engage in a ‘course correction’ in the coming months.


Consumer advocates are raising the same concerns that NYAPRS and other advocacy groups have raised for the past year: PPSs are simply not engaging in a substantive number of substantive contracts with community based organizations, many of whom are extremely experienced and well poised to meet the identified goals.

 

Yet, many PPSs have selected from a menu of state identified goals that include:

·         Implementation of Patient Activation Activities

·         Integration of primary care and behavioral health services

·         Strengthen Mental Health and Substance Abuse Infrastructure across Systems

·         Behavioral health community crisis stabilization services

 

A report from the PAOP meeting indicated where PPSs are addressing unmet mental health needs but primarily within their facilities through hiring more psychiatrists, psychologists and social workers and/or training PCPs on mental health treatment approaches. One has engaged with a local case management agencies around criminal justice diversion and one is providing transitional housing for local hospital system inpatients.

 

One also has contracted with a local FQHC to help with co-location of behavioral and physical healthcare.

This morning, Politico quoted concerns raised by several PAOP panel member and consumer advocates

·         Judy Wessler: "The money not going out raises questions. Are the partners doing the work not being paid? Or is the work just not getting done? Either way it's bad."

·         Lara Kassel: "Some of the PPS are really demonstrating very well that they understand the value of working directly with CBOs that reach people in the community and have that strong track record and they have contracts out and money flowing out. (But) I also hear reports that CBOs say PPS are re-creating the wheel within the hospital walls, which is really not a way to effectively spend the money and reach the people intended to be reach."

Lara, Ann Monroe, Andy Cleek and I were invited to present at a regional statewide forum of PPSs where we urged them to contract with CBOs, an approach that was strongly supported later in the program by Medicaid director Helgerson when he told 600 PPS representatives that “CBOs are essential to the success of DSRIP.”

NYAPRS and our colleagues continue to press this case with both state officials and the PPSs and to work to identify a number of sample value based propositions that PPSs can look for from behavioral health providers.  Stay tuned for more on this.

For meeting handouts: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/project_approval_oversight_panel.htm and hear a recording of the meeting athttp://www.health.ny.gov/events/webcasts/archive/.