November 20, 2012

Health Planning Committee of the Public Health and Health Planning Council Proposes Significant Certificate of Need Redesign

The Health Planning Committee of the Public Health and Health Planning Council is proposing a significant Certificate of Need (“CON”) redesign. The Committee and Council are expected to make twenty-two (22) recommendations to the Department of Health next week, affecting the CON process.  Five of the recommendations refer to an initiative to shift towards regional planning for CON applications.

New entities – called Regional Health Improvement Collaboratives (“RHICs,” pronounced “Ricks”) – would be responsible for increasing patient experience of care, decreasing the per capita cost of care, reducing the disparities in coverage, and more effectively managing the health of New York’s citizens. 

These RHICs would be neutral entities tasked with health and health care collaborative planning on a region-wide basis.  Because the State must be engaged in overseeing and encouraging policy changes, the State needs a “common data set” to achieve this.  The RHICs would be tasked with collecting, analyzing, and displaying regional data in a neutral manner for State review.  The proposal is to direct the RHICs to pay special attention to the financial stability of the delivery system.

The recommendation divides New York State into eleven (11) regions, and proposes there be one RHIC per region.  The Committee and Council did recognize the impossibility of creating perfect regional boundaries for health planning purposes, particularly because health care and disease do not have boundaries.  But the Committee and Council cited “stakeholder” information and recommendations in drafting the boundaries.  “Stakeholders” were defined in the presentation as consumers, local public health officials, providers, payers, businesses, unions, community organizations, and related entities.

The RHICs’ responsibility as to the health of populations is to be selected by that region’s shareholders and based on the region’s needs.  The RHIC would then work to address the health disparities identified by the stakeholders.  This approach is intended to allow individuals affected by adverse public health conditions to have more control and direction over what the Department of Health focuses their attention on, via the RHICs.

As for the “triple aim” of patient experience of care, the RHICs are proposed to be charged with measuring the overall quality of health system performance within their region.  This should be the impetus for the RHICs to initiate more quality collaborative to improve the regional health system performance.  The Committee and Council also suggested that the RHICs look for evidence-based patient engagement strategies to improve the quality of care with more patient input.  All of this should be summed up into an analytical data format for the State to review periodically.

Most importantly, the RHICs’ major responsibility is to look at the per capita cost of care and help to reduce it by also providing the State with analytical data and technical support from their region’s patients and stakeholders.  More pointedly, the RHICs are intended to create strategies to help reduce preventable utilization; conduct health care needs assessments; propose multi-payer, value-based payment and benefit design initiatives; publish quality, cost, and spending data; and generate collaborations that improve efficiency and financial stability of the essential providers within the regional.  Undoubtedly, this is the most daunting task that the RHICs will be faced with.

As part of the mission to overhaul the State health planning process to create a more effective and streamlined approached, the Committee and Council’s proposal of RHICs is a drastic change in the way the process currently works.  While prior regional planning strategies before have failed, Karen Lipson—Director of the Division of Policy of the Office of Health Systems Management—said this plan differs from all prior ones since the main focus would be to improve population health and to reduce costs.