Our new organization has been involved with discussions with leadership of both organization’s DSRIP plans (that’s the acronym for Delivery System Reform Incentive Payment). Each has selected and proposed eight to ten concepts to New York State Department of Health, which holds the role of taskmaster to keep approved these grantees which have each formed community partnerships known as Performing Provider Systems (PPS) on-course to achieve milestones which allow for payments.
What’s impressive – and representative of the greatest challenge – is each plans to partner with community health, behavioral health, and social service organizations in ways hospital-based delivery systems have never previously conceived. This is required by DoH (and CMS) in order to not only achieve better health among populations who have previously received less preventive and early intervention care, but also to move the locus of early intervention from hospital to community.
Let me provide some illustrations of the challenges ahead for all parties:
- People on fixed incomes don’t shop at Whole Foods. They have, by and large, not participated in the “boom” of health foods and the promise they hold for better long-term health. Hospitals are expert at treating later-stage impact of diabetes and some even offer wellness programs that feature the most recent nutritional lifestyle research. With barriers of disposable funds, transportation, and (frankly) habit, how do hospitals and community leaders consider behavioral changes in churches, youth groups, YMCAs, local health centers, senior citizen centers, and schools? One example: I attended a workshop at a national conference recently that discussed a SAMHSA-funded model initiative that trained church members to serve their communities as health educators (which dramatically changed the menus of the annual church picnic and holiday celebrations).
- People with behavioral health disabilities consume more than half of all cigarettes sold, resulting in well-documented disparate health conditions like respiratory and cardio-vascular diseases. Hospitals are traditionally the acute care provider who, for this group, are too often the level of care for which prevention and early intervention did not happen. Where medical expertise exists at these hospital facilities, relationships exist in community settings. DSRIPs that seek to make an impact in this area will need to think “out of the box” to synthesize both to help these smokers consider and make risk-reducing change.
- Children with Adverse Childhood Experiences: SAMHSA and NIH funded multiple studies of ACEs for many years since the initial work done by Kaiser Permanente and the Centers for Disease Control (CDC). These have demonstrated, among other things, a disproportionate incidence of chronic health conditions – and hospital/ER use – for ACE survivors. How will hospital and community health experts partner in early intervention and prevention for these children and young adults to “flatten the curve” of high-cost, institution-based intervention?
So, congratulations are in order for our leading Long Island hospitals. But, the real test is not getting the award of initial funds — it’s their wherewithal to “think out of the box” knowing that five years down the road, there will be less revenue for providing care within their own walls.