Balancing Medicaid cost & quality
Albany Medical Center, PPS leads regional initiative to boost care quality and slow Medicaid costs.
New York is among the first US states to participate in the Delivery System Reform Incentive Payment (DSRIP) initiative, a program designed to improve healthcare quality for Medicaid patients. Albany Medical Center, PPS (Performance Provider System) sought regional leadership in the federal program.
Accenture was asked to help lay the groundwork for a clinical integration model for a five-county region serving more than 100,000 Medicaid patients and the uninsured. The not-for-profit PPS and its extended network of providers are closely collaborating to achieve a goal of reducing avoidable Medicaid admissions by 25 percent over five years.
Albany Medical Center, PPS needed to meet major milestones for DSRIP funding while investing in system transformation, clinical management and population health management. These challenges required standardization, and communication and coordination across scores of regional healthcare and social service organizations.
The program management office needed help designing a framework to achieve its goals and qualify for payments to support implementation. Leaders of the organization turned to Accenture for experienced resources to design a large-scale model for clinical integration, initially for Medicaid patients yet capable of serving additional population groups in the coming years.
Accenture assembled an interdisciplinary team of health consultants and strategists, complemented with the knowledge of physicians, nurses and information technology specialists. Team members worked with Albany Medical Center, PPS to assess challenges, and six themes emerged:
Weekly meetings, interviews and analysis led to the creation of an overarching model for integration. The framework outlined foundational components, assumptions, guiding principles and enabling technologies. The project team worked closely with members of the Albany Medical Center, PPS technology team so electronic medical records systems and preferred tools would be integrated and supported. Accenture also designed and led training sessions so participants could learn new processes and protocols. The first trained group serves as super-users, championing the model to others.
This is an increasingly complex population combined with a lack of resources and fragmented care.
Inconsistent communications across levels of care was a challenge for almost every affiliate.
For most of the sites these functions are dependent on expertise of staff rather standard process.
The affiliates use a multitude of systems that are often not interfaced, use of the New York health exchange varies and adoption is low.
There are limited options and extreme wait times for patients needing care, services is a key issue across sites.
Social barriers often prevent patients from taking basic steps for proactive health maintenance.
Organizations throughout the region appreciate the broadly inclusive approach, including patient navigators and community health workers. Lay representatives are assisting Medicaid patients in navigating barriers in transportation, housing and finance. Community-based organizations are providing support in areas such as meal delivery and counseling. Telemedicine is also a part of the mix, making expert diagnosis and follow-up guidance more affordable in remote areas.
Albany Medical Center, PPS and its extended network of providers are focused on a goal of reducing avoidable Medicaid admissions by 25 percent over five years.
"We have started to transform our care delivery processes…DSRIP is becoming the springboard to find better ways to improve care, not only for Medicaid and uninsured patients, but also for the broader community we serve."