By DAVID CRUZ

Vital Stats: $438 Billion – Costs of Medicaid nationally. (Source: Center of Budget and Policy Priorities.)

Hospitals across the Bronx have begun receiving an infusion of federal monies aimed at a plan that ensures Medicaid-covered patients stay on top of their health to avoid a costly emergency room visit. The plan is aligned with a larger goal of shrinking Medicaid spending, officials from St. Barnabas Health System (SBH) announced.

The Belmont hospital is part of a new state system called Delivery System Reform Incentive Program (DSRIP), where managed care professionals look after a patient’s health and social needs to avoid a visit to the ER. Montefiore Health System, the largest hospital network in the Bronx, has also received DSRIP funds. The plan became operational early this year.

The program is the result of negotiations between New York State Department of Health and the federal government, who acknowledged that a volume-based, fee-for-service Medicaid system is severely costly and outdated. Under DSRIP, the state agreed to accept a total of $8 billion in federal funds over the next five years, disbursing it to qualified hospitals in exchange for reducing readmissions by 25 percent.

Participating hospitals and medical institutions such as SBH and Montefiore were vetted during the first quarter of 2015, presenting how each institution will help curb Medicaid cuts while increasing access to care. The state awarded $2.3 million in design grants to both so far.

SBH and Montefiore created a Performing Provider System (PPS) to execute the projects aimed at redesigning patient care. Total monies for SBH will be $384 million.

Montefiore Health System was another recipient of federal DSRIP monies, which will total $249 million over the next five years. The hospital plans to focus on system transformation, which includes hospital infrastructure. It will also focus on improving behavioral health and management strategies for cardiovascular and asthma patients. A third component, Population Wide Project, which includes smoking cessation and access to high quality, chronic disease prevention and care management.

Len Walsh, executive vice president and chief operating officer at SBH, said PPSs have developed the profile of the frequent ER visitor, noting a correlation between the busy patient and their health status.

“In order to transform healthcare, we have to connect the social determinants of health, to the clinical determinants,” said Walsh. “And in order to do that we need to partner with different community-based organizations. They’re ranging from housing, to behavioral health providers, to substance abuse providers. And this whole thing is about coalitions forming coalitions.”

SBH plans to team up with more than 200 community-based organizations to help keep track of patient needs. It’s also partnered with three of borough’s other PPS programs to assist in reaching their 25 percent ER reduction goal.

The state recognized 44 so-called “projects” were in need of improvement. SBH, as the lead applicant, agreed to take on 10 projects, including improving asthma and cardiovascular disease conditions. To ease congestion at the ER, SBH is slated to hire a team of managed care navigators tailored to a sufferer’s needs. Intervention and education are some of the models the PPS will utilize to ensure patients, such as diabetics, will stay out of the hospital.

“One of the key indicators is keeping track of a patient’s A1C, which is blood levels,” said Walsh. “So one of the requirements of diabetes project is that any or all diabetics have an annual A1C to make sure their blood is being monitored correctly.”

For patients, an emergency room visit is often the last resort. But it’s also expensive. A report by the National Institute for Health found the average cost for non-covered emergency room patients is $2,168, substantially lower than the average cost of urgent care centers, where prices vary according to treatments needed. For Medicaid recipients, costs fall under the state and federal governments, who’ve spent $438 billion in Fiscal Year 2013, according to a report by the Center of Budget and Policy Priorities.

Qualified patients will be identified based on how frequent they’ve made primary care-related visits to the ER.

“Many of our patients utilize the emergency departments because it’s one-stop shopping. Everything is there, so if they have to take a day off from work or if they go, they know if they need lab work they’ll get it that day, if they need an x-ray they’ll get it that day, if they need a consult from a specialist they’ll get it that day, rather than needing to go back and forth over multiple days,” said Walsh. “So by improving access to primary care, improving access to urgent care and less expensive settings, yes it will have that impact of reducing heavily burdened emergency rooms. It will save the system a lot of money, so it’s a win-win.”