DSRIP in New York: Driving Toward a Value-Based Healthcare Workforce Strategy

The experience of “going to the doctor” will change radically over the next months and years as patients adapt to kiosks and telemedicine and providers adapt to value-based reimbursements.

While the “where” and “when” will be some of the most obvious changes to consumers, the “who,” “what” and “how” pose some of the greatest challenges to those leading the healthcare paradigm shift from volume to value. Current models of waiting rooms, hierarchical physician-nurse-staff relationships and access to providers are rooted in years of care history based in a volume-based payment model. With payment reform and a shift to value-based payments occurring across the country, training the future-state workforce accordingly is required. New training programs, partnering with educators, defining new care provider roles and relationships, and planning staffing models and technologies to transition to a value-based future is imperative.

It’s a challenge that shouldn’t be underestimated, and one with dramatic implications to the overall cost of care and to a community’s wellbeing.

The First Foray: New York State

The healthcare workforce strategy overhaul is still theoretical in most states, but the platform is already on fire in New York, where Performing Provider Systems (PPS) leading Medicaid reform efforts are switching gears from planning to execution, and where the Department of Health is mandating finalized, annual budget expectations for training, redeployment and new hires.

New York, therefore, will offer a first look at comprehensive, cross-continuum efforts to develop new care provider roles and evaluate and evolve traditional roles.

It’s quite the exemplar. The workforce changes implied by New York’s Medicaid reform effort, known as the Delivery System Reform Incentive Payment (DSRIP) program, must be conducted on behalf of hundreds of providers along the care continuum in each PPS region, with assumptions made on future inpatient utilization cuts and resulting bed reductions.

In New York, the PPSs leading the way on DSRIP workforce strategy are focusing on:
  • Defining the true cost of care in their target populations.
  • Understanding directionality, or where care needs to be provided and how patients can be most efficiently guided among providers along the continuum.
  • Identifying population-specific cultural considerations, such as language barriers between providers and patients or work expectations of hospital nurses as compared to home care nurses.
  • Balancing innovative workforce approaches with adherence to DSRIP workforce regulations.
  • Knowing when to request help at each stage, whether it be in using analytics to identify the variables in their own populations and the cultural competencies required to address them, researching innovative models that incentivize voluntary staff redeployment, devising the comprehensive healthcare workforce strategy itself, or recruiting, training and integrating new types of care providers.
  • Realizing this is an investment, not a “check the box” exercise to gain access to waiver funding. It requires a thoughtful and fundamental focus on post-implementation sustainability after the waiver funding is spent. Without this approach, the likelihood of failure is real.
Without a forward-looking staffing mix that is trained to communicate with both patients and providers along the entire care continuum, it won’t matter how many accountable care organizations form or how many behavioral healthcare coordinators are placed in primary care offices through DSRIP. Workforce strategy will be the glue that holds together every healthcare reform effort made in the name of the triple aim, and New York will be the state to watch as it evolves.