New York's Medicaid program is ramping up efforts to shift its reimbursement system from volume to value. NY1's Erin Billups filed the following report.
New York has a history of being progressive when it comes to its Medicaid program, so as the federal goverment looks to aggressively shift its Medicare reimbursement formula, the state's Medicaid program will do the same.
"This sea change in health care financing will have practical and significant impacts in the actual patient experience," says New York State Medicaid director Jason Helgerson.
This value-based model, as officials call it, reimburses payments to providers based on how well the patient is doing, not on the number of visits or procedures performed. The Affordable Care Act allows for this change through the management of Accountable Care Organizations, groups of providers who strategize together over their patient's care.
"Care will be better coordinated, providers will actually work together as a team, and more care will be provided in the community," Helgerson says.
On top of preventing or better managing a patient's chronic illnesses, the financing shift aims to bring down cost and lower hospital readmission rates.
Health and Human Services Secretary Sylvia Burwell visited the Bronx last week, highlighting Montefiore Medical Center, which has been a leader in value based care, and applauding the state's Medicaid program as well.
"They're working toward a better, smarter, healthier system here in New York, but leading the way for the entire nation," Burwell says.
In January, Burwell announced the agency's goal to tie 85 percent of all traditional Medicare payments to health outcomes by 2016, and 90 percent by 2018.
New York's Medicaid director says the state will do the same thing with Medicaid payments.
"This is no small task," Helgerson says. "What it means is, over $50 billion in health care reimbursement will be in value-based arrangements by the end of this decade."
While much of the state's provider community is on board with shifting focus to more preventative-based care, it's still a heavy lift. A change like this costs dollars that many providers may not have.