{"id":3492,"date":"2022-08-22T11:57:07","date_gmt":"2022-08-22T11:57:07","guid":{"rendered":"https:\/\/integratedcarejournal.com\/?p=3492"},"modified":"2022-09-06T10:22:27","modified_gmt":"2022-09-06T10:22:27","slug":"case-study-effective-integration-staten-island-pps","status":"publish","type":"post","link":"https:\/\/integratedcarejournal.com\/case-study-effective-integration-staten-island-pps\/","title":{"rendered":"A case study in effective integration: the Staten Island PPS"},"content":{"rendered":"
The pandemic provided many lessons, not least of which was that the health system could quickly pivot to less costly telehealth, digital and virtual care. For over two decades, these services were available but adopted reluctantly and not well capitalised upon.<\/p>\n
One reason is that healthcare is faced with the inherent conflict between investment in bricks and mortar, and a model of care that is more patient-centred and community-based. The US model of care is heavily invested in expensive infrastructure and its healthcare bill is nearing $4 trillion, almost double the per capita cost of other industrialised nations. Despite this extraordinary expense, quality outcomes lag global norms, as does US life expectancy.<\/p>\n
According to Forbes, US expenditure on healthcare is expected to be nearly $6 trillion by 2027. The redesign of healthcare is a matter of national importance, not just because of cost but the health disparities resulting from it. One strategy is the focus on moving from volume to value, as Michael Porter advocates in his book, Redefining Health Care<\/em>.<\/p>\n The Delivery System Reform Incentive Payment (DSRIP) was designed to improve clinical quality while reducing costs and promoting the transition from volume to value. In April 2014, the Center for Medicaid\/Medicare Services (CMS) approved New York State\u2019s (NYS) Medicaid redesign waiver, known as DSRIP, in the amount of $8 billion over five years. To earn the maximum $8 billion valuation, performance on specific, pre-set quality and utilisation targets needed to be achieved with a focus on incentivising value. The waiver permits states to use Medicaid funding in ways not specifically authorised in Federal rules so that innovative strategies may be deployed to test new models of care using non-traditional services.<\/p>\n “Community engagement, trust and collaboration were keys to the success of the PPS programme.”<\/p>\n Joe Conte, Executive Director, Staten Island Performing Provider System<\/p><\/blockquote>\n To achieve rapid change and capitalise on innovative strategies to affect nearly six million Medicaid recipients, NYS approved 25 provider networks, spread throughout the state. Known as performing provider systems (PPS), they were geographically disparate, with vastly differing population health needs and provider capacities. Their potential individual earnings over the five-year programme ranged from $45 million to $1.2 billion. Staten Island PPS (SI PPS) charted its own unique course improving population health outcomes while creating significant changes in the health care dynamic of the community.<\/p>\n Staten Island, with a population of about 500,000 is one of the five boroughs of NYC, with more than 30 per cent of the community covered by Medicaid. The SI PPS is a network of 70 medical, behavioural and social service providers, nursing homes, federally qualified health centres, primary care practices, and faith-based and community-based organisations. When the 1115 Waiver opportunity (which typically reflect priorities identified by the states and the federal Centers for Medicare and Medicaid Services) was presented to the community, great interest was demonstrated. The two major hospital systems were the anchor organisations.<\/p>\n According to New York State Department of Health, SI PPS funding was set at a valuation of roughly $208 million based on projects selected and clinical performance variables. Partner organisations attended facilitated workshops to analyse population health data to select 11 programmes (see table below) from among 50 offered. Over the course of a year, the process contributed to a sense of inclusion by the stakeholders and ownership of the implementation strategy devised for each of the programmes.<\/p>\n
\nStaten Island PPS background and programme description<\/h3>\n