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Health Reform: ‘The Challenge of Moving to Scale So Quickly’

Crain’s Health Pulse�� March 6, 2015

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As the ���������� health care industry heads to the home stretch in wrapping up DSRIP applications, attention is shifting to implementation. At an event sponsored by the ���������� eHealth Collaborative, a panel considered DSRIP’s next phase.

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The first impression: DSRIP is huge. Jordanna Davis, a principal of the Sachs Policy Group (and daughter of Mount Sinai President and Chief Executive Dr. Kenneth Davis), noted Advocate Community Partners has an attribution of 769,089, while HHC has 634,789.

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“These are huge,” she said. “Everyone has got to do very well, and we have a lot of eggs in a few baskets.”

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Ms. Davis asked panelist Arthur Gianelli, president of Mount Sinai St. Luke’s, whether that concentration of so many lives in a few PPSs was frightening. “Yes, that will be a real challenge,” he answered. “We should not underestimate the challenge of moving to scale so quickly.”

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Or underestimate how DSRIP is an extended marathon. “This has been an intense several months,” said Mr. Gianelli. “A five-year stint is hard to sustain. Getting into a reasonable flow, managing people’s time properly, getting into a rhythm … it is critical for success. I worry folks will be exhausted.”

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Jay Gormley, chief strategy and planning officer at MJHS, worried that small providers will feel the time pressure most. “It’s hard to keep the flow of information to a low roar. Last week I had three meetings at the exact same time,” he said.

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Courtney Burke, the state’s deputy secretary for health, offered a look at DSRIP’s future promise. For example, much of the $100 million in funding for the SHIP program is for moving to advanced primary care. When PPSs formed new partnerships with community groups or supportive housing initiatives, she said, it lay the groundwork for a shift to advanced primary care.

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“Outside the medical world, what are the supports patients need to not end up back in the hospital?” she asked. “This phase will be much trickier, because it is not what we’re used to.”

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Ms. Burke also addressed how DSRIP will help the shift to a value-based model. “As we get to DSRIP years two and three, valued-based payments will be what everyone is talking about.”

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That transition, of course, will be challenging. Mr. Gianelli noted the common thinking of how providers have a foot in two boats: fee-for-service and value-based payments.

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“At some point, you have to make a decision,” he said. “I go to one meeting on population health and reducing admissions. And the next meeting is, ‘What are my discharges? What is my volume?’ ”

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After the chuckles subsided, he added, “It isn’t sustainable. The reality is, if you are going to make the move, you have to make it. If you don’t, your decisions won’t be aligned.

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