New York Medicaid tests pay-for-performance method that pairs competing providers

New York state Medicaid officials are investing more than $1 billion in an innovative five-year program that aims to transform how providers coordinate to take a more active role in caring for members' health while also compelling patients to improve their health, reported The New York Times.

Medicaid initially will pay participating doctors with a fee-for-service method, but the doctors will be eligible for bonuses if their teams boost their patients' health. Then, if the program succeeds, Medicaid solely will pay providers based on their performance in achieving certain health measures, including how well they reduce preventable, and expensive, hospital admissions.

Although many pay-for-performance models have been successful at lowering costs and boosting quality, they often fail to compel doctors to provide care to disadvantaged patients, FierceHealthPayer previously reported. But New York's model could help show that doctors caring for Medicaid patients can still achieve bonuses based on healthcare measures.

"If we succeed, patients will be more likely to get the right tests and medicine, doctors will benefit as we simplify the business side of their practices and businesses will benefit as we hold down healthcare cost growth," Department of Health and Human Services Secretary Sylvia Mathews Burwell said earlier this month during a visit in New York City, the Times noted.

Perhaps the most unusual aspect of the program is the unique pairing of competing hospitals that work together to attain common goals. For example, one of the 25 groups participating in the Medicaid program includes more than 1,000 primarily Hispanic, Asian and Jewish doctors serving different New York City neighborhoods. Those doctors have joined to create a nonprofit venture, called Advocate Community Providers, which cares for more than 770,000 patients.

"They have not turned their back on the Medicaid population; they have sort of embraced it," New York state Medicaid Director Jason Helgerson told the Times. "They speak their language. They understand their culture. They are based in the neighborhoods in which these people live."

To learn more:
- read The New York Times article