NY Medicaid overhaul envisions combined outpatient care

Using an estimated $8 billion as incentives, New York is overhauling Medicaid, pushing providers to establish more outpatient clinics, reduce hospital beds, use electronic records and enable low-income patients to see doctors and psychologists in the same visit.

Medicaid now covers almost one-third of all 19 million New Yorkers. Half this year's $62 billion budget is paid by the federal government. 

The so-called $8 billion Medicaid waiver, approved last year, will apply projected federal savings over five years to improved outpatient care. The goal is to cut avoidable hospital admissions by 25 percent. In a letter last week, the federal Centers for Medicare and Medicaid Services extended approval of New York's plan for at least 13 more months.

"If you get upstream and start treating people sooner and more effectively, we'll have downstream savings," said Jason Helgerson, state Medicaid director. The state goal is to cut avoidable hospital admissions in half over the next decade, he said.

New York hospitals and thousands of doctors and other providers have organized into 25 groups that have since received approval for taking specific new approaches expected to improve care and cut long-term costs. Five-year financial awards are expected this month.

Failure to achieve goals will halt the federal money.

"It's going to be hard," said Dr. Ferdinand Venditti at Albany Medical Center. It will require changing provider and patient behavior, he said.

Albany Med is the leader in a five-county provider network with 170 organizations and more than 4,000 individual providers. It already has three urgent care clinics outside Albany, consistent with the new approach, and plans to open a fourth next month in suburban Colonie where doctors trained for the hospital emergency room can provide a higher level of care than typical walk-in clinics. They operate daily from 9 a.m. to 9 p.m. The average time for patients to get treated is 30 minutes.

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