Long Island hospitals and thousands of local health care providers could get up to $834 million over the next four years if they succeed in improving care for low-income patients.

Nassau University Medical Center and Stony Brook University Hospital are the lead organizations on Long Island for the state's Delivery System Reform Incentive Payment program.

Part of the state's attempt to improve care for low-income patients, the payment program will allocate up to $7.4 billion in federal funds to safety net hospitals and their community collaborators statewide. The catch is they must cut avoidable hospital use among Medicaid recipients and the uninsured by 25 percent by the end of 2019. If they don't meet this goal and interim targets, they don't get the money.

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The state Department of Health determined this month that NUMC could receive up to $535.4 million -- the fourth highest allocation in the state.

Stony Brook could receive up to $298.6 million.

Both have been approved for 11 projects that strive to keep low-income patients -- especially those who underuse or don't use Medicaid -- out of the hospital by identifying and treating their health care needs before they show up at the emergency room.

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These include programs to prevent or better control chronic diseases such as diabetes, heart disease and asthma, and behavioral issues such as alcohol or drug abuse.

"If we can keep them out of the hospital, we'll make money," said Dr. Victor Politi, chief executive of NuHealth, a public benefit corporation that includes NUMC in East Meadow. "We are not talking a windfall of money. We have to earn every one of those pennies."

Joseph Lamantia, chief of operations for Population Health at Stony Brook, said the pressure is on to meet a long list of interim targets established for each year of the program. "The clock is ticking," he said.

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The undertaking is enormously complicated, requiring the close collaboration of hospitals with their erstwhile rivals into 25 performing provider systems statewide.

NUMC is working in alliance with North Shore-LIJ Health System and Catholic Health Services of Long Island as well as with 8,400 groups including clinics, social services, housing agencies, community-based organizations, health plans and doctors -- all of which get some portion of the money if targets are met.

NUMC plans to launch its first project in two months, which will try to reduce hospitalizations of nursing home residents.

Similarly, Stony Brook's provider system is working with 11 Suffolk hospitals, the county and its 20 health clinics, 46 nursing homes, more than 500 primary care doctors and a slew of behavioral health agencies, substance abuse treatment centers, community organizations and pharmacies.

LaMantia said the provider system is within weeks of launching its first project: a patient activation program geared toward identifying those who underuse or don't use health care.

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"The idea is to determine how engaged and self-aware they are of their health," he said.