State paying health providers to cut costs

PHOTOGRAPHER: Marc Schultz

Ellis Hospital, located in the northside of Schenectady, in June 2011.

Two groups of the Capital Region’s largest health care providers got nearly $400 million from the state this week to transform the way they provide care in a way that will reduce unnecessary, costly hospital visits.

The money is just one chunk of a $7.3 billion pot that will be doled out over the next five years to 25 different provider networks across the state. New York reached an agreement with the federal government last year to reinvest the federal savings it had achieved through Medicaid reforms into a new Medicaid reform project called the Delivery System Reform Incentive Program. Those savings will be doled out piecemeal, with the providers expected to hit goals along the way that eventually add up to a 25 percent reduction in visits by 2020.

The Alliance for Better Health Care, a network of providers led by Ellis Medicine in Schenectady, St. Peter’s Health Partners in Albany and St. Mary’s Healthcare in Amsterdam, received $250 million. Albany Medical Center Hospital received $141 million.

“They won’t just give us this money,” said Joseph Twardy, vice president of post-acute services at Ellis Medicine, who helped organize that alliance. “We have to earn it. So in the first year, we’ll get money to invest in the infrastructure of this thing, and by year five we have to show results.”

Ellis, St. Peter’s and St. Mary’s are working with four other key partners on the project: Whitney M. Young Health in Albany, Hometown Health Centers in Schenectady, CapitalCare Medical Group and Community Care Physicians. Altogether, though, the list of providers across Albany, Rensselaer, Saratoga, Schenectady, Fulton and Montgomery counties totals about 1,400, Twardy said.

The group has targeted 11 projects they can all work to implement, including one overarching project that involves coordinating their efforts across all six counties. The rest are focused on more specific goals, but all involve coordination.

One is to keep patients in home care out of the hospital by making sure providers in both settings talk to each other. Another is to get frequent visitors to the emergency room into primary care. Another project aims to reduce 30-day rehospitalizations, the occurrence of patients being discharged but then winding up back in the hospital within the month.

“This is one of the most costly, most avoidable types of health care,” Twardy said. “And it’s been proven that if you can keep that person out of the hospital for those first 30 days, usually by helping them transition from one setting to another, that you can reduce costs.”

Several projects will work to transform the way mental health issues and substance abuse are treated in the community. Since many patients with mental health issues also deal with substance abuse, one program is going to involve getting these “dually diagnosed” patients on a single, coordinated treatment plan.

“Believe it or not, but some of these things are still treated in silos,” he said.

Another project will create an ambulatory detox option for those with substance abuse issues who may not want to enter a restrictive, long-term, inpatient program. Another will put primary care physicians into behavioral health clinics and behavioral health providers into primary care settings.

“Oftentimes, we have primary care physicians and nurse practitioners assigning prescriptions, and behavioral health workers and social workers assigning separate prescriptions to the same patient,” Twardy said. “The whole goal here is to integrate that so that someone who goes to their primary care physician can go right down the hall for counseling or other treatment.”

Providers across the six counties are also working to roll out coordinated palliative care, tobacco cessation and asthma self-management programs. The final program aims to improve care for the uninsured or underinsured, like undocumented immigrants, by getting them insured and into primary care.

“Every emergency department in the state and just about the country has to treat anyone and everyone, regardless of their ability to pay,” Twardy said. “So if you have a huge portion of uncompensated care coming from these individuals, it just makes sense to get them covered in a less-costly way.”