SOMOS Testifies At MRT Public Comment Day Regarding Medicaid Waiver Agreement

October 25, 2019

SOMOS – a non-profit, physician-led network of over 2,500 health care providers primarily serving immigrant communities in New York City – testified today at the Downstate MRT Public Comment Day in support of extending and renewing the Medicaid Waiver. At the hearing, SOMOS expressed its support for the extension and renewal of the waiver, which has led to the creation of transformative programs like the New York State Delivery System Reform Incentive Payment Program (DSRIP). The group has been a continuous advocate of Governor Andrew Cuomo’s effort to get the Trump administration to extend the Medicaid waiver, which is crucial to creating innovative programs to bridge critical health care disparity gaps.

During the testimony by SOMOS Founder and Chairman of the Board, Dr. Ramon Tallaj, and Ricardo Rivera, SOMOS’s Chief Development Officer, the group called for the extension of DSRIP for a year to match the end of the waiver; and the 3-year waiver renewal from April 2021 to March 31, 2024. In August 2018, SOMOS was designated an Innovator under Medicaid’s Value-Based Payment (VBP) Roadmap, a key component to the DSRIP Program, making them the first physician-led group in the state to reach VBP Innovator status. The designation allows SOMOS to continue to aggressively pursue innovative methods to address persistent health challenges experienced by the most vulnerable and, until now, underserved populations. SOMOS is one of the only three VBP Innovation designations in the entire state of New York.

SOMOS is unique and different in our approach delivering culturally competent health care for our immigrant populations, and the extension of this waiver would be critical to continuing the services we provide to our patients,” said Dr. Ramon Tallaj, SOMOS Founder and Chairman of the Board. “We have made incredible progress over the last five years, and we cannot stop now if we are to continue building these critical relationships and building on the progress we have made so far.”

“Five years ago, New York embarked on the most radical transformation in the history of Medicaid, and SOMOS embraced the challenge because we believed it was the right thing to do,” said Ricardo Rivera-Cardona, SOMOS Chief Business Development Officer. “Through DSRIP, SOMOS has improved the quality of care for those who need it most and achieved close to $300 million in savings from preventable hospital admission and readmissions. However, many things still need to be enhanced such as increasing behavioral health access, improving social determinants of health, integrating work with CBOs, and absorbing and managing risks, among others. We need to lock in our current achievements and create a path forward that we can count on for longer-term success.”

“Working with such a large network of primary care physicians, we thought it was important to view the relationship between primary care to a large system like Montefiore as a doable possibility,” said Stephen Rosenthal, Senior Vice President of Population Health Management at Montefiore Health System. “We agree more time is necessary to support DSRIP 2.0 and continue to sustain operations to work with primary care networks like SOMOS to fulfill the integration opportunities.”

“Asian Americans are the fastest-growing population in New York City and although our greatest strength is in our diversity, sometimes it’s also our greatest challenge,” said Jo-Ann Yoo, Executive Director of the Asian American Federation. “AAF continues to work with SOMOS, who provides access to Asian American doctors, where through this partnership, we have frontline allies to talk about what is happening in our community and how best to serve our most vulnerable communities.”

As the premier health care provider that serves over 600,000 Medicaid patients throughout New York City, SOMOS has exceeded the DSRIP mandates helping marginalized communities become healthier and navigate the health care system through a model of culturally competent care. SOMOS has successfully:

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  • Reduced potentially preventable admission by 20.4 percent
  • Reduced potentially preventable readmission by 25.7percent
  • Achieved $300 million in savings in preventable admission and readmission
  • Remained one of three Innovation designations
  • Persevered obtaining six out of 12 value-based payment pilot programs

The MRT waiver is an agreement between the federal Centers for Medicare and Medicaid Services (CMS) and New York State that allows the State to use a managed care delivery system to deliver benefits to Medicaid members, create efficiencies in the Medicaid program, and enable the extension of coverage to certain individuals who would otherwise be without health insurance.

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As a trusted provider in delivering culturally competent care, since 2015, SOMOS has become a leader in DSRIP and is one of the highest performing Accountable Care Organizations (ACO) in New York. The organization has also achieved the unique Innovator Status in the fast-growing value-based payment system.

The size of SOMOS’s network gives the organization access to the full range of options and enables them to maximize financial performance.

SOMOS is a non-profit, physician-led network of over 2,500 health care providers serving over 700,000 Medicaid beneficiaries in New York City. Launched in 2015 by its Chairman Dr. Ramon Tallaj, SOMOS is the largest and only physician-led performance provider system participating in the New York State Delivery System Reform Incentive Payment Program (DSRIP). The SOMOS network includes providers delivering culturally competent care to patients in some of New York City’s most vulnerable populations, particularly Latino, Asian, African-American and immigrant communities throughout the Bronx, Brooklyn, Manhattan and Queens.

Photo credit: SOMOS care conference in Harlem.

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