Some $7.3 billion will be divided among 25 networks of health care providers in New York state to use in overhauling the delivery of care and cutting unneeded hospital visits, according to state officials.
Hospitals, physician groups and other providers allied in geographic networks are getting parts of the state's so-called Medicaid waiver to apply projected federal savings over five years.
Each group proposed measures meant to provide more effective upfront care and reduce more expensive emergency room visits, inpatient stays and hospital beds. They include more outpatient clinics, using electronic patient records and enabling low-income patients to see doctors and psychologists in the same visit.
Funding ranges from $1.2 billion for the network led by New York City Health and Hospitals Corp. to $187 million for the Adirondack Health Institute Inc., a regional collaborative.
Meanwhile, state officials said average spending for New York's Medicaid patients has declined to $8,233 annually, its lowest level in more than a decade. That's attributed to earlier measures to redesign the state's health care program for low-income residents, including a movement from fee-for-service reimbursement to managed care plans.
Medicaid now covers about 6 million New Yorkers, nearly one-third of the state's population. In the last two years, enrollments rose by 500,000 partly from efforts to reach the uninsured through New York's health exchange and the federal Affordable Care Act.
"Billions of taxpayer dollars have been saved thanks to the work of our Medicaid redesign team," Gov. Andrew Cuomo said. The goal over the next five years with the Medicaid waiver funding is to reduce avoidable hospital use by 25 percent.
Each of the 25 systems submitted plans.
After initial checks go out shortly, the recently formed provider systems will be required to meet various benchmarks, particularly reductions in avoidable hospital use. However, this first year will be focused on getting organized.
Some groups cover large upstate geographies, such as the Adirondack Health Institute for the eastern half of the Adirondacks, and another led by Samaritan Medical Center in Watertown for another large swath of northern New York. Within New York City, there are several separate groups.
Each was asked to first examine its existing services and capacity, and the actual need in its communities, to determine what's financially sustainable. Their assessments and proposals have been posted online, and several projected reductions in hospital beds.