February 25, 2010

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Frescatore’s presentation

Since 2008, New York State has been actively revamping the way its public health insurance programs serve its residents, aiming to provide coverage to more of its residents and improve outcomes for those in the system. While the State is still a couple of years away from full implementation of reforms, some accomplishments to date include:

  • enrollment in New York’s public insurance programs (Medicaid, Family Health Plus, and Child Health Plus) has grown by 400,000 people since January 2008, bringing total enrollment to approximately 4.9 million people;
  • investments in primary care have led to increased focus on chronic diseases, like asthma and diabetes, and also helped establish one of the largest medical home demonstrations in the country—the Adirondack Medical Home; and
  • reimbursement reform has led to the standardization of rates for many critical services.

However, there is still much to be done, and Frescatore said the State expects to continue moving forward with reform over the course of the next year despite current economic hardships. Building on a series of streamlining and simplification initiatives already completed, the State will soon eliminate the face-to-face requirement for Medicaid eligibility screenings, which will ease a key barrier to enrollment among potential Medicaid beneficiaries. The State also plans to consolidate all public program call centers into one statewide Enrollment Center, allowing public insurance beneficiaries a way to address all enrollment issues in one phone call.

Key to the success of these initiatives will be a new information technology platform the State is developing, called “HEART.” The automated HEART program will assess all the factors contributing to a person’s eligibility and provide a determination for renewed eligibility while an individual is on the phone. Once fully implemented, the Enrollment Center should further simplify enrollment and annual recertification processes. The State Department of Health expects to pilot HEART later this year.

Some additional improvements the State will pursue, Frescatore said, include: the expansion of Doctors Across New York, by adding more than 100 slots to the program; reducing potentially avoidable hospital readmissions; improving services for individuals with dual diagnoses; implementing further value- and episode-based reimbursement reforms; and continuing to invest in and expand primary care.

Frescatore said that while the reforms passed this year may not be as striking as those from 2008 or 2009, they will be equally important to the overall restructuring of the system. New York’s efforts could get a further boost by the passage of federal health reform.

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