Healthcare delivery reform is not new. The 1960s saw the creation of Medicare. The 1970s and 1980s saw an attempt at managed care. As of 2010, we’ve had a state by state adoption of the Delivery System Reform Incentive Payment Program (DSRIP). Texas (TX), California (CA), and New York (NY) are the big states overhauling their Medicaid delivery by infusing primary care, behavioral health, and pediatric services into high risk communities to reduce avoidable hospitalizations and improve patient outcomes.
Oracle and its partners are participating and investing in the NY DSRIP to implement the Medicaid Redesign Team (MRT) Waiver Amendment. According to the NY DSRIP FAQs, “DSRIP’s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health”.
Avoidable hospital use is broad in application. It’s not just the mere readmission patients. Avoidable hospital use can also include the initial admission due or emergency room visit as a result of improper preventive and primary care. For New York, these four measures evaluate DSRIP’s success in reducing “avoidable hospital use” by at least 25percent (%):
• Potentially Preventable Emergency Room Visits (PPVs)
• Potentially Preventable Readmissions (PPRs)
• Prevention Quality Indicators- Adult (PQIs)
• Prevention Quality Indicators- Pediatric (PDIs)
What DSRIP Will Accomplish
New York, Texas and California have purposefully looked at the value equation of paying for healthcare. With DSRIP and other delivery reform initiatives, these states are leading the way in transforming a volume system to a system of integrated outcomes based care where that improves the quality of lives through access and primary care services.
Healthcare is local and transformation has to start with the care provider for the patient in his/her community. It must deliver high quality and integrated primary, specialty, and behavioral services and reduce the unnecessary burden on emergent and acute services.
There are many projects to engage in this delivery reform. DSRIP’s Domains 2, 3 and 4 are typically viewed as the highest value projects for the most Performing Provider Systems to accomplish DSRIP in New York State.
- Domain 2: System Transformation Projects – Performing Provider Systems will meet the 2014 NCQA Level 3 standards by the end of Year 3 of DSRIP for Meaningful Use and Patient-Centered Medical Homes. It includes multi-discipline care, such as primary care, behavioral health, long term care, and community provider services.
- Domain 3: Clinical Improvement Projects – These include at least one behavioral health program
- Domain 4: Population-wide Projects – These cannot duplicate Domain 3 and are based on the New York State Prevention Agenda.
Solving the Problem with Technology
DSRIP is a multidisciplinary approach to transforming the care delivery to those highest at risk. Successful delivery of the domain projects above will be the synthesis of people, process, and technology. People will deliver the care, analyze patterns, and set a new process for the critical infrastructure of community- technology engagement. Actionable analytics and precise measurement can only be attained if the full 360 degree view of the citizen is available, consumed, de-duplicated, aggregated, and delivered with a minimum amount of latency to the care team, care coordinators, administrators, and executives.
Technology is necessary to support the business with the right balance of infrastructure and population health analytics. Oracle and its partners are recognized for the right blend of technology and service offerings that deliver world class data aggregation and top in KLAS population health solutions for DSRIP, delivery reform, and value based purchasing.
Oracle Health Sciences has a staff of over 2500 professionals including physicians, PhDs, nurses, and clinical informaticists who guide the technical development and product offering for the healthcare market. Its Oracle Healthcare Foundation (OHF) is a unified healthcare analytics platform for data integration and warehousing providing clinical, financial, administrative, and omics modules. Building upon OHF, healthcare organizations can deploy pre-built business intelligence, analytic, data mining, and performance management applications from Oracle and its partners. These organizations can also leverage OHF’s out-of–the-box, self-service, analytics tools to build customized analytics applications.
Oracle’s HSGBU has an active and expanding partner ecosystem that encourages pre-integration with top in KLAS population health vendors and Big 4 Healthcare advisory service providers. The partner ecosystem is active, mirrors the population health market and includes the full range of population health, evidence-based medicine, risk modeling, ACO, alternative reimbursement models, and value base contracting models (including Medicare Access & CHIP Reauthorization Act, or MACRA).
Following are some HSGBU partners that have developed successful accomplishments in the DSRIP and delivery reform space: