Setting the Agenda: Health Care

Since Andrew Cuomo took office as governor, his administration has driven much of the state’s agenda on health care, from an ambitious effort to reform Medicaid in New York to his executive order setting up a state health-care exchange.

The governor also joined Attorney General Eric Schneiderman’s successful push to pass his landmark I-STOP legislation, which aims to combat prescription drug abuse by setting up a database to track prescriptions and by instituting other measures.

Many of the changes in health policy over the past year were the result of implementing recommendations made in 2011 by the governor’s Medicaid Redesign Team, lawmakers said. A key issue is how to structure and administer the state’s long-term care system.

“I mean, there’s lots of other things, there’s over 100 recommendations, but in terms of the implications, that aspect of changing long-term care is enormous,” said state Sen. Kemp Hannon, who chairs the Senate Health Committee.

One significant legislative change passed by both houses was a bill to promote the development of accountable care organizations (ACOs), which aim to better coordinate care among multiple health providers with the goal of improving outcomes for patients.

“I think accountable care organizations are a way to help integrate all of a wide range of health-care providers, all the way from your family doctor up through highly specialized surgeons, in a payment reform system that promotes primary and preventive care, and I don’t think we know for sure whether ACOs will be the answer to a lot of our health-system problem, but I think to me they are the most promising prospect out there,” said Assemblyman Richard Gottfried, who chairs the Assembly Health Committee. “I think New York needs to be much more aggressive in promoting their development.”

One piece of legislation that stalled this past session would have legalized medical marijuana, though Gottfried said he’s hopeful it could pass in 2013.

“The Cuomo administration is actively reviewing that issue, and I hope that in 2013 there will be a version of it that the governor will propose,” Gottfried said. “I believe that if Gov. Cuomo supports a medical marijuana bill, it will most likely become law.”

Gottfried said the Legislature would also be dealing with “dual eligibles,” people who are on both Medicare and Medicaid—which in some cases offer different benefits and make it difficult to effectively manage patient care.

“If the state does help to lower their hospitalization use, the savings all go to Medicare, not to the state,” Gottfried said. “So many states have been working with the federal government to develop care management systems that will combine Medicare and Medicaid and enable the states both to effectively coordinate care and also share in the savings that the federal government will get.”

The Cuomo administration recently filed a waiver application that requested approval to implement many of the Medicaid redesign recommendations that are still in the works, and also asked the federal government to share with the state the savings that Medicaid reforms will achieve.

“So if the federal government saves a lot of money because New York has lowered the cost of Medicaid, we’re asking the federal government to give us back some of those savings to invest in the health-care system,” Gottfried said.

Gottfried said a major issue for the Legislature will also be the adoption of a basic health plan, and said he was “fairly confident” the governor will propose that next year.

“For New York that would basically mean expanding eligibility for Family Health Plus up to about 200 percent of poverty, for both families and individuals who don’t have dependent children,” Gottfried said. “If we enact that, it will save New York about $600 million to $1 billion per year because of the federal matching money it will bring in, particularly for some populations that are now covered by Medicaid where we do not currently get matching money.”

Hannon said a big task in the upcoming year is implementing the federal health-care reform legislation.

“We’ll have to address that, but the state is moving forward with not just an exchange but rather also with restructuring Medicaid administration so it would mesh with the exchange,” Hannon said. “You can imagine the exchange is going to be taking pretty much lower income and middle income; Medicaid deals with low income, and they have to mesh. Otherwise neither works well.”

What Got Done in 2012:
I-STOP legislation
Implementation of Medicaid Redesign recommendations
Executive order creating a health-insurance exchange
Passage of legislation authorizing and promoting accountable care organizations
Passage of breast cancer notification legislation
Telemedicine credentialing
Whooping cough vaccines for newborns
Shingles vaccines for older New Yorkers
Restrictions on tanning and body piercings for youths

What’s on the Agenda:
Implementation of Federal Health Care Reform
Implementation of Medicaid Redesign recommendations
Legislation setting up a basic health plan with federal matching funds
Gottfried’s legislation on state single-payer health plan

INSIGHT
Home Care Association
By Joanne Cunningham
President of the Home Care Association of New York State (HCA)
New York’s home-care system is undergoing massive change stemming from the state’s Medicaid Redesign Team (MRT) policies.

After a barrage of state and federal reimbursement cuts, home-care programs now must completely alter their approach to delivering long-term care—with little time to prepare for this transition, and with limited assurance of care continuity for their patients, many of whom are chronically ill or have disabling conditions.

In the midst of these changes, state policymakers recently submitted a federal waiver application seeking to reinvest $10 billion in Medicare dollars that the state says is saved because of the MRT efforts.

Ironically, although home care was a big focus of the MRT, the home-care system is largely ignored in this latest installment of New York’s redesign plan, now calling for dollar reinvestment in various areas of health care.

During this year’s legislative session, HCA asks that state policymakers include home care in this reinvestment opportunity. We have already offered ideas for doing so, including: home care provider care transition models that help hospitals decrease their readmissions rates, home-care disease-management technologies that reduce the need for higher-cost interventions, workforce recruitment and retention, and a range of other ideas.

These worthy initiatives would support home care’s role in the overall reform plan. Such investments are critical for home care’s transition to a new care-delivery environment, and for the success of the state’s efforts as a whole.

Healthcare Association of New York State
By Daniel Sisto
President
The transformation of the health-care system is at a critical juncture. New York State and health-care providers are changing how care is delivered to improve quality, access and efficiency.

Particularly during these times of extraordinary reform, it is critical to support new ways of delivering health care, such as health homes, accountable care organizations, patient-centered medical homes, and other population management and coordinated care models. That’s why we strongly support the governor’s efforts in securing a Medicaid waiver amendment, to provide the resources our hospitals need to truly implement health-care reform.

Hospitals and health systems statewide are committed to increasing access to care, improving quality and reducing costs. The 2013 state legislative session will offer health-care providers the opportunity to meet these goals by continuing to pursue needed reform, particularly regulatory and managed-care reform.

Providers are a willing partner in reform efforts as we transition the system to one focused on new and innovative health-care delivery models. We look forward to continuing our work with the governor and Legislature to support hospitals during this transformation, ensuring access to the essential services our hospitals provide throughout the state.

1199 SEIU/GNYHA Healthcare Education Project
The Medicaid Redesign Team (MRT) was established in 2011 to redesign and restructure New York State’s Medicaid program with the goal of improving patient care while reducing health-care costs. Both 1199 SEIU president George Gresham and Greater New York Hospital Association president Kenneth E. Raske were MRT members, and both GNYHA and 1199 SEIU continue to work with Gov. Cuomo’s office, the New York State Department of Health, and other stakeholders to implement programs to improve primary care and care coordination, and payment models that manage costs and improve quality of care.