Redesigning Healthcare In NYS - Unintended Consequences

I recently realized that healthcare for pets is easier to access in NYS then healthcare for people. For some reason I was surprised. Back in July I was informed that my primary care physician was retiring. He deserves it so good for him. I was provided with a list of physicians within his system of care and he made a recommendation or two. Before I left his office, an appointment was made for January with one of the providers he recommended. So far, so good. But I have a number of health issues where things can come up. I did have some symptoms that needed some follow up in August. Naturally in my mind, I thought I could just call the new provider, get an appointment and go from there. No such luck and that's when I realized things weren't going to go well.

It turns out the new provider wasn't prepared for new referrals coming into his office even though a January appointment was already made/accepted. I called numerous times and couldn't get calls returned. When I finally was able to speak to a human, I got the distinct impression that the new guy was upset about the new referrals.

Next steps - after realizing I was on my own, I began shopping around. Should I stay in the same system or move on? This requires thinking through health records, distance, insurance coverage, etc. It also requires trying to find out how good a provider and their system is - a chore in itself. I began talking to other friends and acquaintances. Results were all over the place.

After three months, I've finally got an appointment for early November with a provider I've chosen but still don't really know. We'll see how that goes. I hope well.

The reason I've gone into detail on this is because NYS is involved in a major redesign of healthcare for the medicaid population. This is happening across the nation but New York is undertaking its largest effort yet to transform the state's Medicaid health care delivery and payment system through the Delivery System Reform Incentive Payment (DSRIP) program.

New York is one of six states that has a program designed to move its delivery system from a place that’s fragmented and overly focused on inpatient care in hospitals toward an integrated system that proactively focuses on patients and the community. Organizations and agencies are working together to address the same goals and to care for the same patients.

Sounds easy. It's been talked about for years but now, how people and health systems will be paid is tied to the reforms and redesign so hospital administrators and providers are taking it very seriously. Remember though, this is for Medicaid health care delivery. What about everyone else?

Having gone through what I have recently, here's my read. NYS has over reached again and I'm not sure if they even realize the impact of this.They've forced this down to the provider level. Hospital administrators, project managers and providers as well as community agencies are spending much of their time redesigning a massive system for the Medicaid population. All of their resources are going into this effort and few, if any, are home watching the store or how the rest of the system is operating. Medicare and private pay patients are being impacted by the redesign without any real thought as to why or how this is happening.

While I wait for my appointment, I'm told to use urgent care or the emergency room if anything comes up. These are the more expensive options that are part of the target of the redesign effort for the Medicaid population. Interesting.

So back to animal healthcare. Turns out I can call the vet and get an appointment for my dog with ease (within 48-72 hours), even though my regular vet is out on paternity leave. I think we all hope for positive results from NYS's latest effort at Medicaid redesign but there are unintended consequences that need to be watched and acted on.