New York

The health payer industry and the federal government including the Centers for Medicare & Medicaid Services (CMS) have positioned hospitals, clinics, and medical practices to adopt necessary healthcare payment reform. Alongside accountable care organizations, bundled payments, and value-based care reimbursement, the patient-centered medical home stands as a real boon to healthcare payment reform.

Community health workers who help patients navigate the health care system and work to address their social and economic needs have rarely been fully integrated into care teams. This issue reports on health care organizations that have integrated community health workers into multidisciplinary teams, which appears to be a factor in their success. 

The New York Assembly voted 89-47 on Wednesday for legislation to establish publicly funded universal health coverage in a so-called single payer system.

All New Yorkers could enroll. Backers said it would extend coverage to the uninsured and reduce rising costs by taking insurance companies and their costs out of the mix.

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. 

For a generation, doctors in New York’s economically depressed neighborhoods have been the ugly ducklings of the medical hierarchy. Many are foreign born and foreign trained, serve mostly minority and immigrant patients, and often run high-volume practices to compensate for Medicaid’s low rate of payment.

Now these doctors are in the vanguard of an experiment to transform New York’s health care services for the poor from a disorganized hodgepodge into coordinated networks of doctors, hospitals and other practitioners.

Advocates for primary care were in Albany this week making the case that Governor Andrew Cuomo is cutting Medicaid reimbursements at the same time the state is trying to emphasize its importance.