From Process to Value: New York State’s Success from DSRIP to Population Health

sgruber-200 (1)By Sarianne Gruber
Twitter: @subtleimpact

The ground breaking waiver, as chronicled by Gregory Allen, Program Development and Management Director at the New York State Department of Health, spurred a transition for the State’s underserved communities.  Beginning back in 2011, Governor Cuomo initiated a redesign team, its mission—to funnel ideas for reconstructing elements of Medicaid.  The State did witness many individual projects help bend the cost curve and population health improve.  However, the health delivery system was still extremely fractured.  A grave concern was the inability to facilitate effective communication among all the components of patient care.  After reinvesting $17 billion in proven federal savings, in 2014 Governor Andrew Cuomo was able to get an unprecedented $8 billion back in a waiver.  With this federal money as “jet fuel”, the State built a Delivery System Reform Incentive Payment Program now commonly called DSRIP.

Hosted at New York Academy of Medicine,  the Health Informatics Work Group and NY HIMSS Chapter held its spring meeting on the subject of Population Health Information Technology: From the Bedside to the Community.   Frontline healthcare leaders shared their working knowledge and current projects  including Gregory Allen on Value-based Purchasing and Dr. Raj Lakhanpal on Digital Medicine.  Many accredit the marked improvement in population health to DSRIP’s inception and its focus on underserved communities. Here are some notable discussion points from the session.

The Value of PPSs: Connectivity and Measurement
“We were able to build Performing Provider Systems and the job of this system [DSRIP] is to disrupt the care patterns that exist now and give localities the capability to think about care differently, to measure care more precisely, and to try to create local capabilities to drive change,” stated Allen.  He went on to explain how Performing Provider Systems or PPS were established to integrate care within networks of providers, and in doing so how they have been advancing the overall goals of DRISP.   To date, PPS  have enhanced the connectivity between community-based services and medical services, especially for primary care.  “All of this is measurement based, based on data, based on reward structure, which is driven by dollars that are attached to actually achieving something. We are going to reduce by 25% avoidable hospitalizations by 2020 — that is our five-year adventure,” voiced Allen.

Digital Medicine and Population Health: Metrics for DSRIP Success
Dr. Raj Lakhanpal favorite slogan is “data is oxygen”, and gives full acknowledgment to the originator Dr. Joseph Conte, Executive Director at the Staten Island PPS.  Formally trained in Emergency Medicine, Dr. Lakhanpal is the founder and CEO of SpectraMedix.  He is currently bringing business intelligence and data solutions to several PPS with much success.  He advocates that the groundwork for improving value-based care is the proper management of clinical quality measurements and population health analytics. SpectraMedix clients include Mount Sinai PPS, Staten Island PPS, and the Finger Lakes PPS.  He shared with the audience 10 key essentials for maintaining and measuring data.  The list includes:

  1. Very critical to have good data.
  2. Data governance – starts when entering data into the EMR.
  3. Data for building intelligence.
  4. Populating data into a data warehouse.
  5. Maintaining a clinical warehouse.
  6. Value-based care says reduce hospital use by 25%.
  7. There are about 90 to 95 measures you need to track.
  8. Monitor performance improvement.
  9. Predictive modeling – find high-risk patients and non-system users
  10. Population Health.

Population Health Management can also serve to recognize key markers for poor outcomes in an underserved community.  Dr. Lakhanpal cited the following observations that may need to be addressed:

  1. Patients who have limited engagements with a healthcare system. Instead, these patients may use the emergency department for their primary care or any other serious events.
  2. Patients who have significant behavioral health issues. For example, if a diabetic is depressed there is a 60% chance they will be non-compliant with their medications.
  3. Social Determinants of Health make a huge impact in patient lives, which include shelter, food, and transportation. Patients may not be able to come to the hospital or appointment because they didn’t have money for the cab. More often it is the case after a missed appointment, the patient shows up four days later at the emergency room with a serious emergency such as heart failure.
  4. Patients who have remarkable high rates of substance abuse and addiction.
  5. Patients who lack social support. If they fall sick, nobody is at home to take care of them.

Healthcare’s Challenges for Connectivity and Measurement
Dr. Lakhanpal gave an excellent overview of appears to be crucial barriers to achieving a 25% reduction of avoidable admissions – a key objective of the DSRIP initiative.  Within the PPS framework, he addressed the following issues that need to solutions for the underserved patients.  Dr. Lakhanpal considers first providing more access to primary care in order to reduce preventable hospital use. Secondly, it is very important to have care coordination integrate chronic disease care with behavioral health.  As an example, a diabetic usually goes to his primary care doctor for care.  However, recently he is experiencing periods of depression due to his complications of diabetes and goes to a psychiatrist. Our system is lacking the “interoperability” that is critical for managing a patient’s care with specialists or other care providers.  Thirdly, providers must use models to identify high-risk patients that are more likely to go to the hospital. They must also identify patients those that not coming to the hospital or setting appointments at all. Without annual physicals and a loss opportunities for intervention, a patient can suddenly end up with heart failure, which could have been occluded.