Reimbursement Reform and Cost Management Project
Expanding Health Care Coverage
November 15, 2007
WebsiteSEE GRANT OUTCOMES
A large share of Medicaid costs can be attributed to spending on patients with serious and/or chronic illnesses.
While the State has sought to improve the care of chronically ill patients through implementing a managed care program, approximately 25% of Medicaid beneficiaries still remain in the unmanaged fee-for-service (FFS) program. Many of these managed care exempt and excluded beneficiaries are among the most seriously medically ill and often have behavioral health co-morbidities. Under this grant, John Billings of New York University’s Robert F. Wagner Graduate School of Public Service (NYU Wagner) assisted the New York State Department of Health’s Office of Health Insurance Programs (OHIP) to develop and implement the Chronic Illness Demonstration Project (CIDP), an approximately $30 million initiative to improve health outcomes and contain the cost of caring for a subset of these vulnerable FFS Medicaid beneficiaries. This grant helped to provide key analytics to inform a large State investment in testing better and less costly models of care for Medicaid’s highest-need beneficiaries.
This project was part of a larger NYHealth authorization that funded a series of quick-strike analyses to help the New York State Department of Health’s (NYSDOH’S) Office of Health Insurance Programs find ways to streamline and expand its public health insurance programs.
Read an NYHealth special report that contains a summary of findings from this authorization.
Dr. John Billings, Director, Center for Health and Public Service Research at New York University’s Wagner School of Public Service, will provide technical assistance and policy analysis for the New York State Department of Health’s Office of Health Insurance Programs (OHIP) on reimbursement reform and cost management.
Reimbursement, particularly in the realm of long-term and primary care, remains one of the fundamental problems for New York State’s health care policy. Fee-for-service reimbursement for health care services delivered by providers has often been labeled a poor reimbursement model that fails to encourage proper treatment methods. Moreover, the low reimbursement rates that are systemic in some sectors, such as primary care, are changing the demographics of the physician population, encouraging new and older physicians to move toward specialty practice.
With a grant from the New York Health Foundation, Dr. John Billings will provide technical assistance and policy analysis for the New York State Department of Health’s Office of Health Insurance Programs (OHIP) on reimbursement reform and cost management. The project will involve discovering the best strategies for managing high need patients and anticipating which patients could or will become high-need. Dr. Billings will also suggest reimbursement reforms that can encourage reductions in costs, as well as improve the health of patients.
This project is funded under the NYHealth authorization: Medicaid Reform in New York State: Supporting Analyses to Expand, Simplify and Reform the System.