Dec 1, 2016, 7:41am EST
Tracey Drury Reporter Buffalo Business First
Local efforts to reform Medicaid spending are on par with other programs around New York State, but have room for improvement.
Already, more than $36 million has been awarded in the Western New York region, with $23.5 million distributed to health care providers participating in the effort. That’s one reason the state Department of Health has issued mid-point assessment reports, intended to hold each group accountable.
The programs fall under the state’s Delivery System Reform Incentive Program — DSRIP, which has allocated up to $335 million over five years to Western New York hospitals and other partners working to reduce Medicaid costs. Statewide, $7.3 billion is expected to flow to 25 performing provider systems (PPS).
Both Millennium Care Collaborative, led by Erie County Medical Center Corp., and Community Partners of Western New York, led by Catholic Medical Partners, were encouraged to make efforts to improve engagement with primary care providers and other partners in their Buffalo-area networks; and both need to do a better job helping partners remain sustainable through value-based payment arrangements.
Millennium, the larger of the two networks, has distributed 56.8 percent of the $29.7 million earned to date, just slightly higher than the the state average of 56.2 percent. The organization has spent about $6.8 million, or 37.8 percent, on administrative costs of the total $16.9 million distributed, compared to the statewide average of 42.8 percent.
The other two partner categories receiving the highest portion were hospitals, which received 13 percent, community-based organizations, which received 10.6 percent.
The assessor said while most partner categories have received funds, it pointed to the primary care practitioner category, which received less than 1 percent, as an area that requires improvement.
Community Partners was ranked second among the state’s 25 PPOs for total funds distributed: Of the $6.8 million the group has earned, 95 percent, or $6.4 million, has been distributed, well above the statewide average. And Community Partners has had lower administrative costs thus far compared to the statewide average: Of the $6.4 million distributed so far across its network, 10.9 percent went to administrative costs.
But the assessor criticized the group for distributing 84.3 percent of funds to date to three partner categories: 45 percent went to hospital programs; 23.5 percent to community-based organizations; and 15.5 percent to primary care practitioners. No funds have yet been distributed to the behavioral health category, including mental health and substance abuse.
The group was also called out for three projects considered at risk of missing milestones and required completion dates; while five projects have already missed patient engagement targets in at least one quarterly report.
Executives from both systems offering contrasting feedback to the initial report. Al Hammonds, executive director at Millennium, said while the reports highlighted higher percentages going to hospitals, the reality is that most of these institutions also provide services in categories like primary care, skilled nursing and behavioral health. He said there are also some discrepancies in the reporting tool, which is behind schedule when it comes to reflecting partner engagement.
“I feel like we received an outstanding evaluation from the assessors,” he said. “But there’s definitely things we need to work on.”
Amy White-Storfer, director of the project management office at Community Care, called the recommendations premature, pointing to a public comment period yet to come from partners and the public. Still, it gives each group areas to focus their efforts.
“They’re stewards of this money, so they rightly look critically at all components of the organization,” she said.
Both Hammonds and White-Storfer stressed that all 25 PPS groups are performing better than expected, with no major structural recommendations for any. Early on, there was some concern that some would be merged together.
“In general, we’re really proud of the work we’re doing,” White-Storfer said. “We’re also working closely with Millennium, leveraging opportunities to work together. The DSRIP transformation is a significant lift, and it’s important to have friends every step of the way.”
Tracey Drury covers health/medical and nonprofits