It's up to the health care industry and local governments.
That's, broadly speaking, the plan to find savings in the state's Medicaid program, which faces a multi-billion dollar budget gap this year.
Gov. Andrew Cuomo has reconvened the Medicaid Redesign Team, a strategy used during his first term when he inherited budget woes that included steep cost increases in the health care program for the poor.
The move led to the creation of a panel that included health care executives, labor union leaders and others to find ways to stemming growth.
The work of the team at the time was largely seen as a success given the competing political interests and the scope of the Medicaid program's spending in New York.
But spending has ballooned, in part due to long-term costs that have increased.
Cuomo is turning to that plan again this year.
"Put them in a room, close the door," Cuomo said on Wednesday in an interview with WAMC. "We can't have 7 percent growth."
At the same time, Cuomo is trying to wrangle lower spending growth from local governments, which have had the state pick up the cost of increases in the local share for the program in recent years.
That's led to grumbling from New York City officials and elsewhere in the state the administration is putting the onus on them to help find a solution to a spending problem they largely can't control.
But Cuomo in the radio interview said the two-pronged approach is necessary to slow the spending, saying "it's just both ends — MRT, industry and counties saving money."
"If we want to help our hospitals and our nursing homes and our health care employees, it can't be 7 percent growth," he said. "It's just not economically feasible."