New York State

Outgoing state Medicaid director Jason Helgerson on his record

He cut costs and emphasized outcomes.

When state Medicaid Director Jason Helgerson steps down after the state budget is finalized in the spring, he will leave a legacy of cost-savings and reform that has been widely praised, but also somewhat controversial. In an interview with City & State, Helgerson discussed his accomplishments in redesigning the state’s Medicaid system, what federal changes could mean for the state and his plans for the future.

C&S: Why did you make this decision now?

JH: Seven years is a long time, and if you add that plus my four years as Medicaid director in Wisconsin, 11 years as Medicaid director is a very, very long time. In fact, I’m the longest tenured one in the country. It’s time for a new chapter in my career.

C&S: What do you consider your greatest accomplishments?

JH: We took a program which was sort of in free fall, was a massive political liability for governors in the past, a very divisive program, and we turned it into a progressive, positive force that not only is financially sustainable but is something that is actually able to drive better care, better outcomes for all New Yorkers. I think that’s probably what I’m most proud of, is the way the program is seen today, its role – what it’s capable of is very different than it was back when we started in January 2011.

C&S: Can you give an example of how it’s shifted over the seven years?

JH: New York is driving the largest delivery system transformation in the country, one of the largest in the world, through DSRIP (the Delivery System Reform Incentive Payment program, which aims to reduce avoidable hospitalizations and help health care systems transition to value-based care). It’s galvanizing communities and providers all across the state to really focus on improving outcomes for the Medicaid population, and it’s accomplishing amazing feats. That was not, I think, even remotely thought of as possible back in 2010, but yet here we are seven years later and that’s exactly the world we are in.

C&S: Some of the programs you oversaw, like DSRIP, may take a while to see the effects. How do you know if they will be successful?

JH: We’re already seeing reductions in avoidable hospital use, which was the seminal measure, the measure where we identified back in 2011 as the statistic that New York was probably most embarrassed by, where we ranked dead last in the country in a Commonwealth (Fund) study. We’ve already reduced avoidable hospital use by about 15 percent. We’re just halfway through the initiative. And we’re on a path to exceed the initial goal of 25 percent reduction, so I think we’ve already seen positive change. Now, the bigger, more systemic changes and the changes that will come with value-based payment – it will take us a few years to see that. But I am very bullish that this vision of a more integrated, a more value-focused health care system that really responds to needs of patients and communities is coming. DSRIP is helping to bring it about.

C&S: You also instituted the global spending cap on Medicaid, which is still in place. Do you think that continues to be helpful seven years after it was implemented, and how long do you see it being a useful tool?

JH: I think it’s an exceptionally useful tool that has introduced an era of transparency and financial responsibility that did not exist in the past. We’re talking about the biggest thing that state government does is run the Medicaid program, so I think the global cap has been a boon for taxpayers. I think it’s been a boon for the program overall, and all who care about it. It’s given us opportunities to reinvest funds in years where we’re able to beat trends. We have a $100 million a year supportive housing program. We’re the only state in the country that has a program like that, where we’re paying for rent for high-need Medicaid members because it’s a cost-effective strategy for getting them better health outcomes. We can do that because of the global cap. I think it has a very powerful, beneficial legacy and I don’t see any reason why the state would want to move away from it. It’s part of the reason why the political debate, which was so vicious, has gone. And that allows us to focus on reform and transformation, and focus less on the traditional fights which have dominated previous years.

C&S: Are you concerned about changes from the Trump administration to health care spending affecting the legacy of your accomplishments going forward?

JH: The governor’s been extremely vocal in this regard, that the federal government has blatant disregard for programs like Medicaid and its essential role in ensuring health care access for millions of people, including millions of New Yorkers. Obviously, we all have to stay vigilant, and stay active, and stay focused on raising our voices when the program is at threat. But I take some solace in the fact that despite a huge amount of effort by Republicans in Washington, the program is still standing, the Affordable Care Act is still standing. I think it shows that there is a real constituency for these programs. If anything, perhaps the debate in Washington mobilized the constituency that was dormant, and that constituency isn’t going to go away. So I am more confident today than I was probably eight months ago in terms of where we’re going to be. That said, we have to stay vigilant and watch and monitor because the threats aren’t gone.

C&S: What’s next for you?

JH: The honest-to-God answer is I’m not exactly sure. Definitely going to go to the private sector, which is no small change for me. I’ve been in the government sector my entire career. I’m going to explore my options and think about it. I wouldn’t be surprised if I did multiple things instead of one thing, at least initially, to give me some freedom here to think about what’s the next best step for me. But what I want to be focused on is the future of health care, on new delivery models, on supporting organizations and providers moving to the value-based world. Those are things I’m passionate about, and so I want to figure out what’s the best way that I can fulfill and tap into that and support that passion.

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