Staten Island aligning IT for value-based model for Medicaid

LAS VEGAS - The Staten Island Performing Provider System is running into all of the challenges inherent in implementing a value-based model for Medicaid payment reform in New York State.

The Delivery System Reform Incentive Payment Program has as its goal to reduce avoidable hospital use by 25 percent over the next five years, according to Staten Island's Executive Director Joseph Conte, speaking at HIMSS16 in Las Vegas.

Asked how the program was going, Conte said, "In 11 months that's the expectation to achieve. We're not there yet. Looking at information we have from two hospitals, it's a positive trend."

Staten Island Performing Provider System is a corporation formed by Richmond University Medical Center and Staten Island University Hospital. Over 60 healthcare agencies and community-based organizations have joined Staten Island in the effort to reduce costs while increasing the quality of health for a very diverse population including 130,000 Medicaid recipients and 50,000 uninsured residents.

The big challenge, Conte said, is that timely data is not available from the state.

"It's at least a six to nine month retrospective," he said. "Everyone's in a different place as far as electronic health records."

As of October 2015, an IT assessment showed that of the 26 healthcare systems partnering with Staten Island, 92 percent had an EHR platform or were in the process of getting one and 14 of them had different EHR vendors, Conte said.

The overarching mission is to align IT strategy and execution, said Raj Lakhanpal, MD, CEO of SpectraMedix, and member of HIMSS Clinical and Business Intelligence Committee.

To this end, Staten Island will be collecting data from providers and data feeds, and integrating it to create longitudinal records. They will apply population risk assessment models to predict high-risk patients and to flag those who should be included in disease registries and to identify gaps in care.

Conte said, "Data needs to be turned into business intelligence. Everyone needs prompt, accurate performance feedback."

The partners will need to make some IT investments to connect to state, Staten Island and other health IT platforms, he said.

They're starting to realize the value of receiving real-time measures of population health, he said.

"Data six and nine months old is of zero interest to them," Conte said. "What's of interest to a doctor, (he or she) never knows that their patient is in the emergency room, or has been hospitalized."

Twitter: @SusanJMorse