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CLIENT CASE STUDY


Case study:
Balancing medicaid
cost & quality

OVERVIEW

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.

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OPPORTUNITY

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.

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SOLUTION

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 current 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.

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RESULTS

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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. Initial measures of qualitative and quantitative gains are expected by mid-2017.

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"We have started to transform our care delivery processes, not only within our own organization but also in collaboration with community-based organizations across northeastern New York State. This is an exciting time for our region. 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."
LOUIS D. FILHOUR, PhD, RN

Chief Executive Officer
Albany Medical Center Hospital’s PPS