Welcome - All PPS Meeting

Jason Helgerson
NYS Medicaid Director

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September 11, 2017

DSRIP Year 3 Theme: Design the Platform for Constant Design

Statewide Accountability Milestones

The STCs identify four measures for which statewide performance is evaluated, beginning in DY3:

Statewide Milestone Pass Criteria
1. Statewide metrics performance More metrics are improving on a statewide level than are worsening 1
2. Success of projects statewide 2 More metrics achieving an award than not
3. Total Medicaid spending 3 1) The growth in the total Medicaid spending is at or below the target trend rate (DY4–5 only) and
2) The growth in statewide total IP & ED spending is at or below the target trend rate (DY3–5)
4. Managed care plan Achieving VBP roadmap goals related to value–based payment transition
If the state fails any of the four statewide milestones:
  DY 3 DY 4 DY 5
Penalty $74.09M (5% of funds) $131.71M (10% of funds) $175.62M (20% of funds)

Notes:
1. Based on previous year and baseline comparisons.  1
2. Based on project–specific and population–wide quality metrics.  2
3. At or below target based on trend rate.  3

Statewide Milestone #1 Summary

Statewide Milestone #1 is a test of the universal set of statewide delivery system improvement measures1 consisting of 18 measures;16 of which have comparable data as of MY2.

In MY2, with nine of 16 measures maintaining or improving, the state is on track to pass, as more measures are improving than are worsening.

Statewide Category Statewide Measure Name Status MY1 vs MY2 Status MY3 Trend (6 mos.) Total Performance $
Potentially Avoidable Services Potentially Preventable Readmissions (rate per 100,000) Maintain/Improve Improving $111,472,650
Potentially Preventable Emergency Room Visits (rate per 100) Maintain/Improve Improving $111,472,650
PQI – 90 – Composite of All Measures Maintain/Improve Improving $111,472,650
PDI – 90 – Composite of All Pediatric Measures Maintain/Improve Worsening $111,472,650
Access to Care Children´s Access to Primary Care – 12 to 24 Months Maintain/Improve Improving $27,868,163
Children´s Access to Primary Care – 25 months to 6 years Maintain/Improve Worsening $27,868,163
Adult Access to Preventive or Ambulatory Care – 20 to 44 years Maintain/Improve Worsening $36,993,372
Adult Access to Preventive or Ambulatory Care – 45 to 64 years Maintain/Improve Worsening $37,157,550
Adult Access to Preventive or Ambulatory Care – 65 and older Worsen Worsening $37,157,550
Children´s Access to Primary Care – 7 to 11 years Worsen Improving $27,868,163
Children´s Access to Primary Care – 12 to 19 years Worsen Improving $27,868,163
Primary Care Primary Care – Usual Source of Care (C&G CAHPS) Maintain/Improve N/A $55,736,325
Primary Care – Length of Relationship (C&G CAHPS) Worsen N/A $55,736,325
Percent of PCP (Primary Care Providers) Meeting PCMH or Advance Primary Care Standards Worsen N/A N/A P4R only
Timely Access Getting Timely Appointments, Care and Information (C&G CAHPS) Worsen N/A $111,472,650
Care Transitions Care Coordination (C&G CAHPS) Worsen N/A $111,472,650
System Integration Meaningful Use Providers Percent of Eligible Providers Who Have Participating Agreements with Qualified Entities N/A N/A N/A P4R only
Percent of Eligible Providers Who Are Able to Participate in Bidirectional Exchange N/A N/A N/A P4R only

N/A: Data collection began in MY1 and/or MY2, and therefore, comparative results not available.

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1. At the close of DY3, the Independent Assessor will determine whether the state has passed this milestone. The milestone will be passed when more metrics are improving on a statewide level than are worsening, as compared to the prior year as well as compared to initial baseline performance. 1

Current Priorities

  • Performance, performance, performance!
  • The move to VBP
  • Innovate!