New York

New York State has been a national leader in medical home activity and currently has the largest number of regional, multi-payer PCMH initiatives. In 2009, the New York State Assembly authorized two medical home demonstration projects - a multi-payer Medical Home Demonstration in the Adirondack region and a statewide Medicaid PCMH demonstration. In July 2010, Article 5, Title 11 of the New York State Social Services Law, Section 364-m gave the Commissioner of Health the authority to establish a Statewide PCMH program whereby providers who are recognized by the NCQA are eligible to receive additional payments for services provided to Medicaid FFS and managed care enrollees. Preliminary analyses conducted by the NYSDOH indicate that MMC enrollees assigned to a provider within a PCMH have higher quality of care and outcomes as defined by standardized measures of quality. In addition, clinical areas where PCMH providers were initially underperforming such as appropriate antibiotic prescribing, have improved from 2010 to 2011. The Commissioner of Health has the authority to continue the Adirondack program until March 31, 2014. A recent budget request will extend the statewide program until March 31, 2016. 

CHIPRA: 
No
MAPCP: 
Yes
Dual Eligible: 
Yes
2703 Health Home: 
Yes
CPCi: 
Yes
SIM Awards: 
Yes
PCMH in QHP: 
No
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
19,518,100
Uninsured Population:
9%
Total Medicaid Spending FY 2013: 
$54.4 Billion 
Overweight/Obese Adults:
61.3%
Poor Mental Health among Adults: 
35.1%
Medicaid Expansion: 
Yes 
CPC+: 
CPC+
Investment Description: 
New Yorks's legislation was vetoed. 

Medical Home program will continue

A federally-funded experimental program in regional collaboration between health care providers and insurance companies has been extended through the end of 2016, Adirondack Health Institute announced.

Extension of the five-year-old Adirondack Medical Home program, which originally was to end Dec. 31, 2014, will bring an estimated $1.68 million in additional federal funding to the program, said Barbara Iverson, a spokeswoman for Adirondack Health Institute, a regional health care planning agency based in Glens Falls.

News Author: 
Maury Thompson

NY regulator to push alternative health care payments

New York's top insurance regulator says most health insurance in the state pays hospitals and doctors for each service regardless of quality, efficiency or outcome, and his staff will try to encourage alternatives to reduce costs and improve health.

Department of Financial Services Superintendent Ben Lawsky says their recent survey shows every major insurer in New York's commercial market is making some effort at payment reform, like "pay-for-performance" or pay-per-member fees for health care.

However, the pilot projects account for less than 15 percent of payments.

Article 5, Title 11 of the New York State Social Services Law, Section 364-m

The law gave the Commissioner of Health the authority to establish a Statewide PCMH program whereby providers who are recognized by the NCQA are eligible to receive additional payments for services provided to Medicaid FFS and managed care enrollees.

risk-adjusted base payments can support the move to value

As healthcare reform takes hold across the nation, primary care physicians are preparing for the shift to value-based payment by including risk-adjusted base payment in their payment models. Among other goals, these models aim to cover the additional costs associated with keeping people well, beyond merely treating disease, and aligning payment with expected use of resources.

News Author: 

$148M could be saved if mental health gets better attention, study says

New Jersey taxpayers could save hundreds of millions of dollars a year and thousands of patients could have improved health and better quality of life if clinicians coordinated physical and mental health care, a new Rutgers University study says.

The report, produced by the Center for State Health Policy, found that more than a third of the $880 million in hospitalization costs in the 13 communities it studied were associated with behavioral health issues such as mental health disorders and substance use.

News Author: 
Tim Darragh

Bronx Behavioral Health Integration Project (Bronx-BHIP)

Montefiore Medical Center received a CMS Health Care Innovation Award to develop the Bronx Behavioral Health Integration Project (Bronx-BHIP), a program that integrates behavioral health care for children and adults in primary care settings. 

NewYork-Presbyterian Regional Health Collaborative

The NewYork-Presbyterian Regional Health Collaborative began in 2008, when NewYork-Presbyterian collaborated with Columbia University Medical Center to find ways to improve health care delivery for the some 205,000 residents of the Washington Heights-Inwood community. They found that the community could benefit from improvements in several targeted areas: cultural competency, information technology and access to care, especially patient-centered medical homes.

Triple aim shouldn't miss the mark

Right care, right place, right time.

Ask any health policy wonk what modern health care is supposed to be about, and the person will recite that mantra.

The goal is to provide people with the appropriate level of care where it makes the most sense and without overly delaying treatment. The policy folks will say this "triple aim" is the key to reducing costs and improving quality.

News Author: 
Patti Singer

EmblemHealth Medical Home High Value Network Project

The EmblemHealth Medical Home High Value Network Project took place in New York from 2008-2010.  Modeled on 2008 NCQA (National Committee for Quality Assurance) Physician Practice Connections-Patient-Centered Medical Homes (PPC-PCMH) guidelines, intervention practices received 18 months of tailored practice redesign support; two years of revised payments, including up to $2.50 per member, per month, for achieving quality targets; up to $2.50 per member, per month for PPC-PCMH recognition; and 18 months of embedded care management support. Controls received yearly participation payments.

Aetna expands ACO agreements in New York

Weill Cornell Physicians, Cornell University’s physician group, has inked a new accountable care agreement with Aetna, intended to enhance care for approximately 9,000 of the insurer's commercial and Medicare members in New York.

“This collaboration will add to the effort of aligning our Weill Cornell faculty with the Triple Aim of improving quality, lowering costs and performing population-health management,” said Michael Wolk, MD, chair of the Weill Cornell Physicians’ Managed Care Committee, in a press release.

News Author: 
Richard Pizzi

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