As our city, our state, our nation and our world are struggling
with the coronavirus pandemic, I first of all want to express my gratitude and
admiration for your work on the frontlines of caring for coronavirus victims
and protecting New Yorkers across the board. May you and your staff stay
safe—and know you have the support of the entire SOMOS organization.
As you know, the DSRIP program formally concluded on March
31, 2020. It is a great disappointment that federal and state authorities opted
not to renew the program’s mandate despite DSRIP’s many achievements. However,
SOMOS will continue it groundbreaking work on behalf of the city’s poorest
patients through SOMOS INNOVATE. It’s with an eye on that new chapter that I
have drafted these notes.
The following draws on the recommendations and observations
found in a report produced by the Helgerson Solutions Group (HSG), which
earlier this year completed a strategic audit of SOMOS, precisely to map out
its post-DSRIP future. HSG’s founder and principal is Jason Helgerson, the
former New York State Department of Health Medicaid director and visionary
behind DSRIP. He and this team know the health-care landscape intimately. It is
a landscape being radically transformed by the Value-Based Payment (VBP) model
and SOMOS INNOVATE will be our doctors’ guide and advocate.
As such, the HSG report proclaims that SOMOS INNOVATE is
“about more than just being a VBP innovator. … SOMOS has the potential to
revolutionize health and social care … and being a light in the wilderness for
physicians and physician groups around the country.” As pioneered by DSRIP, the
VBP model, a move away from the traditional Medicaid fee-for-service payment formula, allows
networks of independent physicians to bypass hospital systems and “contract
directly with insurers (or the government) and take control of the total health
care dollar and the flexibility those payment models offer to revolutionize
care.” With SOMOS INNOVATE at their
side, our doctors can continue “to rise up and take control of their own
destiny.”
SOMOS INNOVATE will continue the transformation of health
care for New York City’s most vulnerable patients by continuing to
“institutionalize cultural competence, empower patients and address the true
root causes of bad health and social outcomes.” The fact that so many of our
doctors share the same cultural background as the people they serve makes for
“an exceptional closeness to their patient base, something that is very hard to
achieve and harder to replicate by other organizations.”
To strengthen its clout and grow our network of providers,
SOMOS INNOVATE will aim to engage other IPAs. It will also put a premium on
partnerships with Community-Based Organizations to address Social Determinants
of Health, a critical component in providing patients with comprehensive,
wholistic care. Such care has the power to improve “community happiness” by
“fully embrac[ing] the health, social and economic needs of the community.”
It’s a model of care that revolves around the neighborhood-based primary care
physician as trusted community leader.
To stave off competition, SOMOS INNOVATE will consider
establishing “creative partnerships” with hospitals which might otherwise make
access to specialty care more difficult. It will also pursue VBP contracts with
Managed Care Organizations that would welcome SOMOS INNOVATION as a hospital
competitor.
SOMOS INNOVATION has been operational for some time and
continues to implement a rapid development strategy. The SOMOS Board of
Directors appointed 20-year health-care industry veteran Dan McCarthy as CEO of
SOMOS INNOVATION. An expert in value-based care, Dan has spent the bulk of the
past year building up the organization and putting in place his management
team.
The time is now, says the HSG report: “SOMOS is on the right
side of health-care history. After years of delay, the health-care world is
finally starting up really embrace value. New York State and Medicare are
continuing their push to get virtually all providers into the VBP arrangement.”
The goal is to position SOMOS INNOVATION on the forefront of publicly funded
health-care innovation, state-wide and even nationally.
Achieving that objective will be critical if SOMOS
INNOVATION is to succeed in enabling its doctors to remain competitive in a
time of rapid change and in the face of the potential challenge of the Big
Four—Apple, Google, Amazon and Microsoft—entering the arena of “technological
innovation that will revolutionize the provision of many health-care services
over the next decade,” stresses HSG.
In the form of robotics and Artificial Intelligence,
“technology may replace as much as 80 percent of what doctors currently do and
SOMOS will need to stay ahead of that curve on their physicians’ behalf.” A
premium must be put on building “productive partnerships between doctors and
machines.” Increasingly sophisticated technology will free up doctors from
“routine tasks so that they can re-focus their time and attention to supporting
their patients psychologically and helping them understand—as well as act
upon—their medical condition.” Surely, this increasingly intimate attention
paid to patients will be essential for delivering optimal value-based care.
Among the technological tools of the future will be
smartphone apps that allow for 24/7 monitoring of patients. There will be sharp
growth in the kinds of “wearable technology, biometric sensors as well as
apps,” all working in sync to create an “Internet of the body.” “Doctors in the
future will prescribe apps” allowing for patients’ self-diagnosis. Overall,
technology will drive a “long-term shift from managing sickness to preventing
it.”
The report says that in future, doctors may well be
“dispensing their advice through chatbots, instant messaging and video calls
instead of sitting in an office with a line of patients to see them.” Noting
that SOMOS doctors “already excel at some of the inter-relational aspects of
the job by virtue of being in, and of, the community in which they serve,” they
will need training in acquiring a “new basket of skills” “to make the pivot to
a more interpretative and context-providing role on its own.”
HSG notes that telemedicine, remote patient care, will have
a $130B market share by 2025; and “the healthcare artificial intelligence
market is projected to reach $19B by 2026.” All that innovation means that “the
future of medicine will be more precise, personalized, participatory and
preventive. These attributes align perfectly with SOMOS’ existing values.”
Indeed, helping and training our doctors “plan and prepare
for the technological disrup4tions of the future” will be a hallmark of SOMOS
INNOVATION. It is part and parcel of its overall commitment to empower our
providers to offer the best possible care to New York City’s most vulnerable
patients, and to bring about lasting reform of publicly funded health-care
delivery.
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