Learning from New York's DSRIP

We recently had the opportunity to participate in a collaborative learning session with Joe Conte, a leader in New York’s Delivery System Reform Incentive Payment (DSRIP) Program. Joe works with Staten Island’s Performing Provider Systems (PPSs), the equivalent of ACHs in New York, and we were excited to share in some of what they have learned along the way.

New York PPSs are almost in Year 4 of their demonstration, and their partners include over 75 fully engaged organizations and 20 population health practice partners which include 100 percent contracted healthcare providers, agencies, schools and community-based organizations. Their goal, similar to our own, has been to improve quality of care and transform the healthcare delivery system of Staten Island as well as ready providers for VBP contracting. Staten Island currently has 180,000 Medicaid beneficiaries, and Joe stated that combining cultural competency into their PPS work has been extremely important.

By Year 5 of their demonstration, they anticipate that 80 percent of funds in New York will be by performance and 20 percent by reporting. A priority for them has been minimizing overhead expenses while maximizing the amount of funds used for:

1.     Project implementation
2.     Incentive payments
3.     Lost Revenue/Innovation Funds/Cost of Services Not Offered

Joe also emphasized that it was important to give a voice to SDOH organizations and smaller practices for equivalent payments for units of work regardless of organization size. 97 percent of provider satisfaction for Staten Island was reportedly due to financial engagement. They found that if there was a network-wide loss, then everyone was affected. “You don’t want to lose partners just because they are unable to make a financial commitment,” said Joe. Creating necessary partnerships and supports for participating organizations has been crucial.

Lastly, Joe openly shared some unanticipated issues with DSRIP, which we found very relevant. These issues included:

1.     Working with the plans should be a top priority.
2.     Understanding the best way to gather data from different sources is necessary with community consent.
3.     Co-located services could be talked about more at a state-level and earlier on.

While much of DSRIP in New York looks very different than in Washington, we are so grateful for this chance to share in lessons learned. It is inspiring to compare efforts of folks across the nation as we work to improve the health system in our respective regions.

You can download more detailed notes from the webinar here, and watch a recording below.


Our Region Wide Vision

In our region every person, regardless of background, life experience, or environment, will live a productive, high quality life, with access to stable housing, nutritious food, transportation, education, meaningful employment that pays the bills with some left over for savings, and social support networks that foster emotional, social, and psychological wellbeing. Each person’s health will be supported by an integrated community health system, accountable to improving health through delivering culturally competent, whole person care. 

At our July Leadership Council meeting we debuted an updated vision statement drafted by BHT staff, looking for feedback and truthing on our vision to be included in our ACH's Phase 2 Certification Process. 

Thank you to everyone who gave feedback during the leadership council meeting, or through the survey we sent out. With the work we are trying to accomplish being so expansive, it sure is hard to define a "short and succinct" vision, but with your help wordsmithing we are feeling pretty happy with what we came up with. 

If you'd like to follow our process, you can see comments we received on our vision statement here, and a redlined word doc showing the changes we made in response to feedback

Leadership Council and Health Champions Engagement Structure

Better Health Together has intentionally built a multi-tiered governance structure with distributed decision-making, joint ownership and mutual accountability that drives innovation and creativity, and fosters co-investment that leads to results, not process. This structure rests on our partners aligning around a common agenda with mutually reinforcing activities, and continuous communication between all parties.

The Standard Terms and Conditions of the Medicaid Demonstration specifically call out requirements for ACH engagement with stakeholders and opportunities for community feedback. To these ends, the Better Health Together ACH is establishing more robust protocol for membership as a Leadership Council Organization or Health Champion to ensure we meet these requirements. All meetings will remain open to the public, however there will be specific requirements to be considered a Member Organization.

Leadership Council

Leadership Council Meetings are open to all organizations located or delivering service in the BHT Region. This is an open forum for community members to receive and share updates on ACH work and activities in the region. These meetings will always remain public. 

Membership within this council is granted at an Organizational basis. To be considered a member of the Leadership Council as the strategic synthesizer for the ACH, your organization must sign an ACH Community Commitment form. This indicates your organization’s alignment with our Regional Health Priorities and commitment to collaborating on health improvement. Members are expected to have representatives participate in at 2 out of every 3 Leadership Council meetings.

If attendance requirements are not met, members will be flagged as "Disengaged." This is an internal designation only, which signals to ACH staff that this organization needs outreach to stay up to speed. If outreach cannot be met, membership and voting rights will be suspended after 3 missed meetings. Membership can be reinstated after contact and catch up with BHT staff. With the incredibly fast pace of information flow, this structure ensures everyone at the decision making table is equipped with the latest information. 

Health Champions

Similar to Leadership Council, starting 2017 we will be asking Coalitions to sign a Community Commitment form, and formalize their organizational members in order to meet Health Champion status. Health Champions do NOT have a vote at the Leadership Council level, because it is expected all organizations making up the coalition would be members.

Rural Health Champions Expectations:
Each Rural Health Coalition has a slightly different structure to meet the unique logistical needs of their community. Better Health Together Staff will work with Coalition members to design a Rural Health Coalition (RHC) engagement structure that is consistent with each Coalition’s unique needs while meeting minimum requirements for the ACH.

BHT will ask each RHC to designate a Coordinator and Ambassador.

The Coordinator is responsible for scheduling, logistics, agenda, attendance and minutes for each meeting. The Coordinator could be a BHT staff member OR coalition member.

The Ambassador represents the County Coalition at the Leadership Council level, and maintain the following responsibilities:

  • Attend ALL Leadership Council Meetings (in person OR by webinar) or designate a proxy when unavailable, to ensure coalitions are always represented at Leadership Council meetings. 
  • Sharing any updates of concerns from the County Coalition, speaking on behalf of coalition interests in Leadership Council discussions and reporting back to Coalitions with updates and any opportunities for action or next steps
  • Attending Quarterly All-Coalition check in call - June 26th, 2017
  • Recruiting new members to Coalition based off of community and engagement goals, with strategic alignment from Leadership Council membership requirements

BHT Staff can serve in the coordinator role where coalition does not have local capacity; Coordinator and Ambassador can be the same person, however BHT staff may NOT serve in the Ambassador role. 

BHT Staff is available to support coalitions in the following capacity:

  • Staffing, scheduling, creating agendas, taking minutes and attendance
  • Writing By-Laws and designing structure
  • Supporting and training an Ambassador and Coordinator
  • Providing clarity on ACH activities
  • Staff quarterly All-Coalition call between each regions Coordinators/Ambassadors

Spokane Health Champions Expectations:
Spokane County, as an urban center, has many active and robust community coalitions centered around key community health issues and priorities. To capitalize on the momentum and expertise these groups have already gathered, ACH Staff will staff a Spokane Health Champions coalition, formed as a quarterly call between Spokane based coalitions. Examples of this would include collaborative that are not a standalone organizations, and therefore can’t be a standing LC member.


HCA Public Forum

On Sunday March 12th, we welcomed the Health Care Authority to the Philanthropy Center for a Public Forum on Medicaid Demonstration. We want to thank the nearly 50 folks who attended for taking time out on a Sunday to talk Medicaid! 

If you missed it, HCA will be giving one final Public Forum through a webinar on March 28th, which you can register for here: https://engage.vevent.com/index.jsp?eid=7198&seid=26

You can see the slide HCA used in their presentation here.

After, BHT gave a short update on our ACH Pilot Project, using these slides

Medicaid Demonstration Toolkit Overview

To the best of our abilities in a 45 minute time slot, at our 1/25/17 Leadership Council meeting, Alison gave an overview of the projects outlined in the Medicaid Demonstration Toolkit. This Toolkit is open for public comment until 5PM February 2nd, we strongly encourage you to get together with some peers (it's 78 pages...), explore the listed projects, and make a public comment to the Health Care Authority. BHT is also requesting feedback on our regions interest and readiness in these projects in a survey below. We will post any feedback we share, or receive from the community on our blog. Here are some useful links from our discussion:

In response to feedback from our January 25th meeting, we are attempting to schedule more opportunities to deep dive into the toolkit. Stay tuned. In the meantime, BHT staff are available for questions.