Rural Challenges: DSRIP & VBP Greg Allen Director,

Rural Challenges: DSRIP & VBP Greg Allen Director, Division of Program Development & Management Office of Health Insurance Programs September 2017 September 2017 DSRIP: Preparing for VBP Performance on DSRIP measures can be a good indicator for the relative readiness and expected performance in VBP arrangements VBP contract arrangements will not mirror PPS formation, but PPSs can be a strong incubator and convener of willing providers Where your potential VBP contracting network is strong, consider how continued performance can be an asset to your MCO partner in strengthening their overall performance Where your potential VBP contracting network has room for improvement, consider the opportunity for potential shared savings Do not ignore areas of care for which you may not have participated in relevant DSRIP projects 2 September 2017 3 Rural County Analysis Population For the purposes of analysis, NYS counties were divided into 4 groups:

New York City Bronx Queens Kings New York Richmond Suburban NYC Nassau Rockland Suffolk Westchester Upstate Urban Albany Broome Chautauqua Chemung Dutchess Erie Monroe Niagara Oneida Onondaga Orange Rensselaer Saratoga Schenectady Tompkins Warren Upstate Rural

Alleghany Montgomery Cattaraugus Ontario Cayuga Orleans Chenango Oswego Clinton Otsego Columbia Putnam Cortland Saint Lawrence Delaware Schoharie Essex Schuyler Franklin Seneca Fulton Steuben Genesee Sullivan Greene Tioga Hamilton Ulster Herkimer Washington Jefferson Wayne Lewis

Wyoming Livingston Yates Madison 23.72% 43.24% 12.00% New York City Suburban NYC Upstate Rural Upstate Urban 21.05% Medicaid Enrollment 19.58% 9.80% 15.09% 55.53% New York City Suburban NYC Upstate Rural Upstate Urban September 2017 4 Systemwide KPIs

Upstate Rural Counties perform well on PPRs But PPVs show room for improvement Potentially Preventable Readmissions (lower is better) New York City 597.21 Suburban NYC Upstate Urban Potentially Preventable ED Visits (lower is better) Upstate Rural 560.64 463.32 481.19 New York City Suburban NYC Upstate Urban 32.53 29.90 22.84 Upstate Rural 35.51 September 2017

5 Strengths in Rural Medicaid Performance Among projects commonly selected by rural PPSs Statewide Goal Follow Up after MH Inpatient Statewide Goal 62.81 47.06 49.47 46.83 64.21 49.39 7 Days New York City 64.55 30 Days Suburban NYC Upstate Urban Upstate Rural

Takeaway: Investigate whether strong performance on BH measures would position potential VBP contractor well for HARP arrangement 67.29 September 2017 6 Strengths in Rural Medicaid Performance Among projects NOT commonly selected by rural PPSs Low Birth Weight (lower is better) New York City Suburban NYC Upstate Rural Upstate Urban 125.00 85.03 75.80 Statewide Goal 66.69 Takeaway: Investigate whether strong performance on maternity measures would

position potential VBP contractors well for Maternity arrangement September 2017 7 Opportunities for Improvement Revisiting PPV Performance Potentially Preventable ED Visits (lower is better) New York City Suburban NYC Upstate Urban Upstate Rural 35.51 32.53 29.90 22.84 Takeaway: Unnecessary utilization of ED might indicate strong potential for Shared Savings in IPC or TCGP arrangements Questions on DSRIP or VBP? [email protected] [email protected]

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