Ideas to change healthcare, leading to a more collaborative approach that incentivizes quality over quantity, should be put to the test in a St. Barnabas Health System led effort that reaches out to the community for help.
The hospital will be leading a Performing Provider System. It will work in collaboration with a consortium of community health care providers, social services agencies, behavioral health/substance abuse treatment centers, doctors and housing non-profits to improve outcomes of Medicaid patients.
The goal is to reduce costs to the federal government for their portion of Medicaid funding and encourage earlier treatment of health problems before they worsen into more costly conditions.
The approach will eventually link the PPS funding, expected to exceed $1 billion dollars over five years for St. Barnabas and at least 60 plus partners, to results that emphasize quality care over quantity, said Len Walsh, St. Barnabas chief operating officer.
“The whole idea is to connect the social determinants of health to patient outcomes,” said Walsh, adding that under the current health care system – not just in the borough, but in the state and nationally – there are no incentives to emphasize preventative quality care over quantity.
“We feel that this is a transformation from volume to value,” said Walsh.
Examples of collaboration cited by Walsh include working with mental health and substance abuse care centers to encourage patients to receive preventive health care.
Another example he cited of a PPS effort is working with social service providers to encourage effective management of conditions like diabetes and asthma to reduce hospital admissions.
Conditions like diabetes and asthma are all too common in the Bronx, and Walsh said that working with people who have these conditions so they know when to use a nebulizer to control their respiratory conditions, for example, could lead to the cost reductions required under the program.
The St. Barnabas PPS effort also has a goal of reducing the number of people who use emergency departments for primary, non-emergency care instead of visiting physicians outside of this setting.
The PPS will identify patients who needlessly use the emergency department and look to explain the benefits of seeking treatment at a primary care physician, said Walsh.
“This is one of the most exciting times in health care,” he added, and said that the fee-for-service model for Medicaid, which accounts for 70% of St. Barnabas’ business, is broken.
Walsh believes that PPSs, which are being started elsewhere in New York State as a result of a deal with the federal government to reduce costs, could become a model for care even in places where commercial insurance is prevalent.
St. Barnabas will be collaborating with the Health and Hospitals Corporation on their PPS initiative.
Borough President Ruben Diaz, Jr., in a statement, called the cost saving dollars coming into the borough exciting.
“Our county has become the model of collaboration and cooperation with regards to our healthcare system and status,” stated Diaz.
He added: “I am proud of our hospitals, health centers, healthcare plans, community based organizations, neighborhood doctors, our constituents who have all joined our #Not62 campaign aimed at improving the overall health status of our borough by addressing the social determinants of health.”
With the borough ranking last out of 62 New York state counties when it comes to public health for several years, Diaz announced in his State of the Borough Speech in February the #Not62 social media campaign to encourage Bronxites to make healthy decisions.