New York has officially submitted its Medicaid 1115 waiver to the federal government, requesting $10 billion over the next five years. This waiver is the result of the Medicaid Redesign Team (MRT) put together by Governor Andrew Cuomo last year, to address the increasing cost of the state’s Medicaid program and to reform other health initiatives in the state.
According to the request sent by Gov. Cuomo to the Centers for Medicare and Medicaid Services, the $10 billion reinvestment will equal $17.1 billion in savings for the federal government. In redesigning Medicaid, the state hopes to essentially redesign its health care system, by “improving quality, improving health, and reducing per capita costs.”
Out of the $10 billion, the state would use $1.25 billion to expand primary care and promote Patient-Centered Medical Homes (PCMH). These programs aim to strengthen primary care by having a physician for a patient coordinate with other practitioners to track everything from chronic care to preventative care to end-of-life care. In the end, these reforms could save under-insured patients from relying on the emergency room or higher cost services.
The Manhattan’s Physician Group (MPG) is an example of a medical group that focuses on patient-centered care. A multi-specialty health care provider, the Manhattan’s Physician Group develops “health care relationships” with their patients to make sure the care they are getting is effective and is being followed through.
Katherine Farrell Harris, a registered dietitian from Manhattan’s Physician Group, discusses the importance of eating a low sodium diet to prevent hypertension and promote weight loss. Video courtesy of Manhattan’s Physician Group.
Focusing on the patient is not a question of individual interest or being personally attentive, but of having a network of care.
“A lot of it depends on coordination and having a health care team and social workers to track what is happening to our patients,” explained John Meer, primary care physician and medical director of Manhattan’s Physician Group’s Lincoln Square location.
At patient-centered medical homes, medical care extends beyond the doctor’s office and into community involvement. The Manhattan’s Physician Group recently opened up a new, more modern facility in Harlem, an area it has served for more than 20 years, according to Darwin Davis, senior consultant at the Greater Harlem Chamber of Commerce. Last Sunday, they took part in the Harlem Health Village and the Children’s Festival part of Harlem Week, where they provided health testing and education.
The Manhattan’s Physician Group also offers various in-office educational programs for those with diabetes and weekly weight loss programs are offered at six locations. Patients can get free flu shots at any location, without an appointment.
“It’s quality health care,” said Davis. “They package health care in a way that makes it accessible and affordable.”
In a technology-driven world, digitizing medical records is a also a vital part of keeping track of patients. With 24-hour access to patient records, MPG physicians can easily track medication usage, lab screenings and communicate with pharmacies or insurance providers. Part of New York’s Medicaid 1115 waiver highlights using “telemedicine” or providing clinical health care and exchanging information databases over a network. At Manhattan’s Physician Group, IT professionals collaborate with clinical specialists so that they can create patient registries, making for easier patient management.
In the end, the patient-centered medical home model saves money because patient ER visits and hospital readmissions decrease, according to Meer. Rated as a “Level 3 Patient-Centered Medical Home” (the highest level of recognition) by the National Committee for Quality Assurance , the Manhattan’s Physician Group benefits from more compensation from insurance providers for patient visits, which allows them to treat more of those who cannot pay their bills.
To follow the patient-centered care model requires commitment and above all, a steady budget. For hospitals like the Interfaith Medical Center, which treats many Medicaid patients and a poor population in Brooklyn, changing models to save money is not a viable option without steady funding. The hospital is currently facing a large budget deficit because its Disproportionate Share Hospital (DSH) reimbursement — meant to assist hospitals that serve a disproportionate number of uninsured or low-income patients — has been cut. Administrators say it would need another $10 to $30 million to keep going, or risk not being able to pay its employees by September.
“We’re not even being compensated at the rate that the health care services cost,” said Melissa Krantz, spokesperson for the Interfaith Medical Center. According to Krantz, cutting costs through patient-centered medical homes is not a viable option when hospitals do not have the funding to keep their current services going. But this creates challenges for places like Interfaith that rely heavily and almost completely on this reimbursement.
“How do you provide services for the uninsured in an environment that will also keep the hospital healthy?” she said. “We have a lot of patients who are not even eligible for state [health insurance], and someone has to pay for that.”
The SUNY Downstate Medical Center in Brooklyn is facing a similar situation with funding and is expecting to lay off more than 1,000 employees within the next year. Karen Benker, associate dean for Community Public Affairs at the center’s School of Public Health, believes there is enough evidence that patient-centered medical homes provide better quality care with substantial cost savings, but the obstacles lie in sufficient financial and human capital.
“It takes a significant investment of money and leadership to create PCMHs,” said Benker. “Right now in Brooklyn, the major health care providers in the Downstate area are struggling to survive. There are no major stakeholders that could lead the creation of PCMHs in this region.”