MergerWatch Weighs in on New York State Medicaid Redesign

As New York State begins to implement an ambitious Medicaid redesign program known as the Delivery System Reform Incentive Payment (DSRIP) program, MergerWatch is keeping an eye on how new health care partnerships that are being formed  could  affect the ability of low-income women to get needed reproductive health care services. The New York State Department of Health (NYS DOH) is currently reviewing applications for the creation of new collaborative provider networks that will implement DSRIP, known as Performing Provider Systems (PPSs), which will bring together hospitals, clinics, community-based organizations and individual health care practitioners.  The stated goal of creating these PPS entities as part of DSRIP is to deliver better quality care at a lower cost. PPS members can share financial rewards for achieving this goal.

We believe that to be successful, New York’s PPSs must engage women and women’s health organizations on an ongoing basis, so as to identify potential barriers to care and address any such  barriers promptly. MergerWatch staff examined the PPS applications to see how women’s health figures into these new networks. We looked to see how patients would be informed about having their care coordinated by these new systems, and whether better quality reproductive health care could be undermined by either cost control measures or the spread of religious restrictions from Catholic hospitals to other providers within a PPS.  On February 15^th, we took the opportunity to submit comments in advance of the PPS application review and to urge the NYS DOH to make comprehensive reproductive health care a priority in the Medicaid redesign project. See our comments here.

Our comments highlighted the importance of addressing women’s health for New York State’s DSRIP program to achieve the “Triple Aim” (improving the health of a population, enhancing the experience and outcomes of the patient, and reducing the per capita cost of care). Two-thirds of all adult Medicaid beneficiaries are women, and nearly three-quarters of them fall within the reproductive (18-44) age group. For many women of reproductive age, the point of entry into the health care system is their women’s health or family planning provider.  According to the Guttmacher Institute, 6 in 10 women view their gynecological provider as their primary care provider, and for 4 in 10 women gynecological services are their only point of medical contact. In order to maximize the benefits of DSRIP, the New York State Department of Health should require all PPSs to prioritize reproductive health care as a fundamental focus of overall health service provision.

We welcomed the opportunity to submit comments on the PPS applications to help ensure that women’s voices and needs are accounted for in the DSRIP process, and we look forward to ongoing involvement and engagement in this process at both the community and statewide levels.