Helgerson: Delivery Reform Needed for Health Care System's Survival

Helgerson: Delivery Reform Needed for Health Care System's Survival
By Dan Goldberg Politico September 27, 2107

New York's health care delivery system must radically reform in the next decade or it will be swamped by the costs and demands of a boomer population that begins to turn 80 years old in 2026, according to Jason Helgerson, the state Medicaid director.

"If we don't get ourselves and our own house in order ... we are on a crash course for a very, very bad outcome," Helgerson said Wednesday during a health care conference in lower Manhattan sponsored by the New York State Society of CPAs.

That imminent crisis, he said, is why he has made the Delivery System Reform Incentive Payment, or DSRIP, program the focus of his nearly seven-year tenure as state Medicaid director.

"We need more of our money tied to outcomes," Helgerson said.

The solutions, he continued, are not going to come from Albany, "and, frankly, given what we are seeing in Washington we shouldn't expect anything from there," he said.

"Ultimately it is going to be a local response," he said.

The 25 Performing Provider Systems, which are groups of providers that implement delivery reform projects, are a local force that needs to push most, if not all, providers into value-based contracts by the end of the decade.

The more than $7 billion that the state could receive to implement these ideas is "a once in a lifetime opportunity," Helgerson said, to get the state ready for the gray boom that's coming.

"We do not have a high degree of confidence that the Trump administration will extend the program," he said.

Helgerson wants 80 percent of Medicaid contracts to be value-based by 2020. Right now, the state is at 38 percent.

For this all to work, Helgerson said, providers need to expand beyond their core business of treating the sick.

"Sometimes I feel that we in the health care sector are dealing with the symptoms of the broader economic decline and malaise that exists in the communities which we serve," Helgerson said. "Now we can sit back and say, 'Woe is me, wish there were more jobs, wish there was more economic activity, wish there was a greater focus on trying to address the underlying economic challenges,' or, since many of us are the largest employers in our community ... we could join an effort or if necessary lead an effort to really galvanize communities."

For Helgerson, that means jump-starting the kinds of preventive medicine programs that lead to a decrease in hospital admissions and readmissions.

And it means elevating the needs of the patient, thinking of patients as consumers to be wooed instead of a captive market that has nowhere else to turn.

"We still debate in this country whether we should extend hours for things like primary care so that it makes it more convenient for working people," Helgerson said. "And we're shocked when 40 percent of ER utilization is unnecessary, could be treated in a better place. Most Americans work for a living. Most Americans don't have time to come in. Many of them have jobs that don't give them the luxury of taking hours out of their day to come to us."