The Alliance for Better Health Participating Performance System (PPS) was established to participate in New York State’s Delivery System Reform Incentive Payment (DSRIP) program. DSRIP requires states to reduce hospitalizations, improve health outcomes, and move Medicaid providers to value-based contracts. Our NYS Medicaid Director calls this program and its goals a “moral imperative,” and we agree.
In New York state, one third of our population depends on Medicaid coverage. 50% of all babies born in our state are covered by Medicaid. This is a vital program for a large portion of our population, and it also covers many individuals living with complex conditions and comorbidities.
Our current medical model pays health care providers for services delivered, not for health outcomes. All of that is changing though. Value-Based Payment is the future and only seven states have little to no activity around value-based payment models. By 2020, 80-90% of all NYS Medicaid contracts will be required to be value-based.
What does that mean? (1) Health care providers get paid for positive health outcomes. (2) Health care providers can’t do that without contracting with Community-Based Organizations (CBOs) like shelters, food pantries, and work programs, to produce those outcomes. (3) CBOs get integrated into healthcare and paid to do more of what they do well – provide vital services addressing social determinants of health.
Alliance for Better Health is a collaborative network of more than 2,000 providers and community-based organizations who are partnering to transform how health care is delivered in our region, with a focus on Medicaid members and uninsured individuals.
We serve an estimated 193,000 Medicaid and uninsured members of our communities across a six county area in upstate New York (Albany, Fulton, Montgomery, Rensselaer, Schenectady, and Saratoga counties).
We are energized by the collaborative spirit that is driving the more than 2,000 providers and community organizations in our alliance.
This is challenging work, but we are dedicated to making positive changes to ensure the people we serve and the communities we live in are much healthier tomorrow because of our efforts today.
The Alliance’s initial work was focused on the following eleven projects, selected from the state’s Project Toolkit after a comprehensive Community Needs Assessment was conducted to identify top health care needs.
- Integrated Delivery System Development
- Hospital-Homecare Collaboration
- Emergency Department Triage for At Risk Populations
- Care Transition to Reduce 30-Day Readmissions
- Palliative Care Integration into Primary Care
- Integration of Behavioral Health and Primary Care
- Ambulatory Detoxification
- Strengthen the Mental, Emotional and Behavioral Health Infrastructure
- Tobacco Cessation
- Asthma Self-Management
- Patient Activation for Uninsured, Under-Insured and Low Utilizers of Health Care