By shifting the focus of health care from hospitals to the social determinants of health, the New York state health care program Medicaid saved $4.6 billion in one year. “You can save a lot and provide better care by going outside the four walls of the hospital,” said Nirav Shah, M.D., New York State Health Commissioner, at a talk on campus Feb. 26.
Acknowledging the problems with the health care system, Shah said, “There’s no question that this epidemic of chronic diseases is overwhelming this system that was built for acute diseases.” He said 50 percent of the health care costs are spent on the 5 percent of patients who struggle with chronic diseases.
“Despite spending twice the average per recipient in our Medicaid program, we were not getting what we deserved,” said Shah. At $54 billion, Medicaid accounts for one-third of the state budget, yet New York was 22nd in the country in quality of care.
A Medicaid redesign team of hospital CEOs, labor representatives, consumer advocates and members of the state senate was appointed, and 4,000 ideas were received. “We ruled them down to 250, and 78 of those ideas passed the state legislature,” Shah said.
Some of those ideas included hiring people to oversee transportation through ambulances, capping the growth in health care so Medicaid will grow at a reasonable rate and creating a feedback process by making the data on health care expenditures available publicly, especially to hospitals.
Shah identified improved access to primary medical care and integration of behavioral and mental health in primary care as the top priorities of the state. “Let’s get folks into primary care and prevent the diseases in the first place,” Shah said. “High quality would keep people out of the hospital. They get to see a doctor who knows them, uses electronic medical records, refers to specialists and is available in the evening.”
The state increased investment in programs like nurse-family partnership in which a nurse visits a firsttime Medicaid mother every month through pregnancy and for two years after. Programs like these have proven to be cost-efficient because “childhood infections are avoided, juvenile justice goes down, there’s more time between pregnancies, abortion rates go down, moms go back to work sooner, ” said Shah.
In addition, Shah emphasized the need for transparency in health care. The decision to release health data to a public website won the department the first annual Health Data Liberators’ award from the Health Data Consortium. “In December, we published costs for 1,400 conditions at every hospital in New York. A hip replacement surgery that costs $15,000 at Bellevue, costs $103,000 at NYU, across the street. I don’t have the answer why.”
With medical care data publicly available, Shah called for more research and evaluation. “We do all these things, and no one ever studies it. I want to spend 5 percent of the money on evaluation to know whether it’s working or not.”
“Investing in the social determinants of health makes a real difference,” said Shah. “These kinds of changes have saved us $4.6 billion in the first year. We’re on track to save $34 billion over five years, and our Medicaid program is number two in quality in the country.”
Shah’s visit was sponsored by the Sloan Program in Health Administration in the College of Human Ecology, the Sloan Student Association and the Johnson Healthcare Biotech Club.
Sushmitha Krishnamoorthy ’17 is a writer intern for the Cornell Chronicle.