NYAPRS Note: The most recent assessment of the 25 regional DSRIP networks (Performing Provider Systems) indicates that, while they spent much more of the funds in the last quarter, than they continue to spend about almost ¾ on themselves, rather than engaging experienced behavioral health and other community based agencies in serving Medicaid beneficiaries with the most extensive needs, many of whom have mental health and addiction related conditions.
This flies in the face of comments Medicaid Director gave to the groups at their last Learning Community that “community based organizations are essential to the success of the DSRIP program.”
Further, the state has continued to spend a very small amount of the $645 million allocated for Home and Community Based behavioral health Services on them, due to the complexities and engagement challenges associated with our health home programs.
NYAPRS continues to work with DOH and OMH on addressing these issues. Stay tuned.
Assessment: More Than Half Of Federal Funds For Medicaid Reform Program Remain Unspent
By Dan Goldberg Politico January 4, 2016
More than half the federal money awarded to the 25 organizations participating in the state’s ambitious Medicaid reform program remains unspent, according to the latest independent evaluation, a mid-point assessment from the Public Consulting Group meant to examine whether the state is on track to meet its goal of reducing avoidable hospitalizations by 25 percent over a five-year period.
Through Sept. 30, which was the end of the second quarter of the program’s second year, the 25 organizations charged with implementing reforms for the state’s more than 6 million Medicaid recipients had spent 43 percent of the money they received from the federal government, according to data provided by the state Department of Health. That’s about $80 million more than was reported at the end of the first quarter, though more than 70 percent of the money is still going to either a hospital or for administrative functions.
April 1 will mark the midpoint of the state’s Delivery System Reform Incentive Payment program, also known as DSRIP, during which the federal government is making available up to $6.4 billion for providers across the state.
The money flows through 25 Performing Provider Systems, or PPS, that have each chosen from a menu of public health projects with the ultimate aim of reducing avoidable hospitalizations by 25 percent by 2020. Each PPS is made up of different provider groups such as physicians, hospitals, community-based organizations and others that interact with Medicaid patients. Each PPS is eligible to earn a set amount, which is based on the number of attributed lives in its system and the projects it chose.
Care Compass Network, which operates in the Southern Tier, has spent approximately 8 percent of the money it received, the lowest percentage of any of the 25 groups in the state.
What little it did spend went mostly for administrative costs, according to the assessor's report, which found that the organization is spending $38.06 on administrative costs for each Medicaid life it is responsible for, compared to a statewide average of $23.93.
Care Compass Network is lagging in both its partner and patient engagement, indicating “an elevated level of risk for the successful implementation of these projects,” the assessor reported, and two of its projects are at “high risk” for failing to meet its goals.
Care Compass Network did not respond to a request for comment.
Albany Medical Center’s provider group, which has so far spent 35 percent of the money it has received, was the only group in the state to have four projects considered at a high risk of failing, owing to its failure to complete multiple project requirements, a failure the assessor's report described as “significant.”
The group did not respond to a request for comment.
Most of the provider groups, however, received positive marks and few recommendations.
Maimonides’ group, also known as Community Care of Brooklyn, received the highest mark on all but one the projects that was scored.
The Maimonides PPS spent about 60 percent of its money, which placed it in the middle of the pack. It spent $14.39 on administrative costs for each Medicaid recipient it is responsible for, about one-third of what Care Compass Network has so far. It doled out almost $2 million to community-based organizations, or roughly 9 percent of what it was awarded. That’s the third-highest percentage in the state.
“Community Care of Brooklyn, is a collaboration of more than 800 provider organizations, community based organizations, and physicians working together to improve the health of the population of Brooklyn,” said David Cohen, executive vice president of clinical affairs and affiliations. “We were pleased by the results of the midpoint assessment of our activities, but are aware that there is a great deal more that we and our partner Performance Provider Systems will do together to transform healthcare in our borough.”
Montefiore’s Hudson Valley Collaborative has given out roughly 83 percent of its money, the sixth most in the state. Like Maimonides, it received the highest mark on all but one of its projects.
"We were very pleased with the Independent Assessor’s report,” said Allison McGuire, executive director, of the Montefiore Hudson Valley Collaborative. “Our success is a testament to the importance of partner involvement and provider desires to be part of an effective integrated network."
The group spent only $5.41 on administrative costs for each Medicaid life it is responsible for, though only $8,600 has gone to community based organizations.
“It will be important for the [Hudson Valley Collaborative] to expand its fund distributions across all of its CBO partners to maintain engagement of these key partners,” the assessor’s report said.