Will Helgerson's New Vision Ask us to 'Boil the Ocean?"

Here’s a report from yesterday’s United Hospital Fund’s “Progressing to Value-Based Payment” conference in NYC, which featured a provocative keynote from state Medicaid Director Jason Helgerson and included panels on both member and provider focused themes. I was pleased to be on that first panel and want to offer great thanks to UHF for giving member related issues a prominent place in the program….something far too rare!

During his annual address, NY Medicaid director Jason Helgerson took the state’s vision well beyond all of the efforts that have already been launched to improve care and reduce costs, a stirring vision that looks to break down silos between healthcare, education, criminal justice, housing, employment and social services to advance both individual and societal needs.

Building on a review on the various initiatives associated with Medicaid Redesign, he then moved to propose that the healthcare system could play an unprecedented role in helping to solve broader social problems, while at the same time reassuring the bemused audience that adding this to our already full plates wouldn’t require us to have to “boil the ocean.”

For example, pediatricians see about 90% of all children under the age of 2 and 65% of all children under the age of 3. That gives them the unique opportunity to screen not only for health related issues but for developmental readiness to enter kindergarten, a useful predictor for third-grade literacy, which in turn is a predictor for high school graduation, incarceration, and employment.

Helgerson referred to an Albany based pilot that will provide financial incentives to pediatricians who perform these screenings and refer children for assistance to improve their school and social readiness.

He proposed a time where “no longer will we limit ourselves in our ambitions to improving the health and well-being of the populations in the Medicaid program. But that we actually begin to identify other metrics, societal metrics that are important and begin to address those metrics…. not because it is going to generate savings for us long term, not because it is going to drive some other health care metric, but because it is the right thing to do."

Some factoids from his progress report on Medicaid Redesign, which is in its 6th year and has launched 340 programs, of which 80% are essentially complete:

  • Average annual per person Medicaid spending has dropped from $9,500 in 2009 to $8,300.
  • Total Medicaid members rose from 4.9 million in 2009 to 6.7 million today.
  • 99.4% of available DSRIP dollars have been awarded to qualifying regional networks (Performing Provider Systems)

The United Hospital fund is to be congratulated for making “Engaging And Protecting Medicaid Members” one of 2 follow up panels. Our panel suggested several strategies for engaging and supporting members with multiple costly needs, including peer initiatives, and looked at ways to be educate and assist members and providers to successfully transition into the HARP, Health Home, HCBS, DSRIP and Value Based Payment environments.

We explored how electronic healthcare records can advance care, and the corollary value of finding a prominent role for the use of psychiatric advance directives to guide healthcare systems to provide the right and desired care for those in the midst of psychosis.

We looked at a variety of strategies to protect member choice and rights, including a recommended expansion in the state’s Medicaid ombuds program, and briefly reviewed a number of examples of culturally relevant incentives that could be offered to help encourage members to improve their own self-care.

We also focused on the challenges in helping medical providers to work more closely with behavioral health and social service providers and to emphasize the social determinants of health.

Dr. Christina Jenkins, CEO of NYC PPS OneCity Health emphasized that getting some clinicians to be comfortable working with care managers and other members of an interdisciplinary team will also take time, adding “a lot has to do with training and attitudes, and it will take at least another 12 to 18 months to get there.”

During the 2nd panel, “Implementing the Medicaid Value-Based Payment Roadmap,” EmblemHealth’s Carl Lund emphasized that “…for a very long time in health care, we’ve tried to make decisions for patients. The payment for service and what was right was separated away from the patient … We’ve got to find a way to get the patient back involved in their own care and what it is they want.”