New York State’s DSRIP Must Deliver on the Primary Care Promise

Five Principles for Primary Care Success 

More than two million New York State residents lack sufficient access to primary care. The Delivery System Reform Incentive Program (DSRIP) is our best opportunity to strengthen and expand primary care, which is central to achieving better health for patients and communities, and lower costs for everyone. New York State and its 25 DSRIP Performing Provider Systems (PPS’) have committed to this vision, including ensuring every primary care provider in their network is a high-performing Patient-Centered Medical Home (PCMH)/Advanced Primary Care (APC) practice. Our expectation is that New York’s DSRIP will substantially improve primary care, such that:

• The vast majority of New York State residents currently without primary care will have regular and unfettered access
• Most primary care providers will be practicing as true PCMHs/APCs
• Primary care spending as a proportion of total health spending will at least double from current levels
• Evidence of primary care value to health care quality, outcomes and costs will be clearly demonstrated and reflected in value-based payment models

To ensure DSRIP delivers on this Primary Care Promise:

1. Every PPS should have a Primary Care Plan.
   Primary care plans should specify how the PPS will ensure access to quality primary care for their population. All plans should include:
   • An assessment of current primary care capacity, performance and needs, and a year-by-year plan for addressing those needs;
   • How primary care expansion and practice and workforce transformation will be supported with training and technical assistance;
   • How primary care will play a central role in an integrated delivery system;
   • How value-based payments will enable primary care to achieve quality outcomes and cost savings;
   • How these efforts will be supported financially throughout and beyond DSRIP.
2. Measure true primary care access and quality throughout DSRIP implementation.
   Access metrics should determine:  ratio of patients to providers and exam rooms, panel size and payor mix, physicians accepting new Medicaid/uninsured patients, timeliness and availability of appointments (including same-day), hours of operation, use of telemedicine and other non-facility based engagement and cultural competencies that reflect the needs of their communities.  Quality metrics should determine: impact of primary care, care coordination and care management on health care quality, outcomes, utilization, and cost.
3. Meaningfully represent primary care in PPS governance.
   Given the central role of primary care in a transformed health care system, those with clear experience in and commitment to advanced primary care models must have tangible influence at all levels of the PPS, including its Steering Committees, Clinical Governance Committees, Project, Finance, and Budget Committees.
4. Prepare the workforce to support new care models.
   True PCMH or APC require fundamental change in the skills, competencies and deployment of the health care workforce. Workforce development plans should demonstrate how the PPS will ensure the health care workforce can fill new job categories, work in multidisciplinary teams and participate meaningfully in the management of patient and population health.
5. Ensure sufficient resources for primary care impact.
   Less than 6% of the health care dollar is now spent on primary care. PPS budgets should clearly identify up-front and ongoing resources dedicated to expanding and transforming primary care. This includes practice transformation and workforce support, DSRIP incentive payments, value-based reimbursement and capital funding for expansion and modernization.