The New York State DSRIP Program:A Model for Reforming the Medicaid Delivery System The Delivery System Reform Incentive Payment (DSRIP) Program is an incentive payment model that rewards providers for performance on delivery system transformation projects that improve care for low-income patients •Funded federally via Medicaid 1115 waivers, DSRIPs shift hospital supplemental payments from paying for coverage to paying for improvement efforts • In 2010, Medicaid reform was not on the agenda • In 2011, Governor Cuomo changed the game by creating the Medicaid Redesign Team (MRT) • This was the first effort of its kind in New York State • By soliciting public input and bringing affected stakeholders together, this process has resulted in a collaboration which reduces costs while focusing on improving quality and reforming New York’s Medicaid system. • Cost Control: Reduced Medicaid’s annual spending growth rate from 13% to less than 1% • Global Spending Cap: Introduced fiscal discipline to an out of control government program; focus on transparency with monthly report on spending. • Care Management for All: Expanded existing and created new models of improved primary/coordinated care that will both improve outcomes and lower costs, moving Medicaid members from fee-for-services to managed care. • PCMH and Health Homes: Investments in high-quality primary care and care coordination through major MRT reforms such as Patient Centered Medical Homes and the creation of Health Homes. • At its core, MRT was about trying to ensure that the Medicaid program was financially sustainable. • After years of out of control cost growth the state budget was no longer able to afford Medicaid driven budget problems. • MRT and its approach to cost containment was to launch many initiatives simultaneously with the goal being to both generate immediate cost savings while also launching multiple systemic reforms designed to generate future cost savings. • To date, the MRT fiscal impact has been staggering –billions of dollars have been saved. NYS DSRIP PLAN: KEY COMPONENTS • Key focus on reducing avoidable hospitalizations by 25% over five years. • Statewide initiative open to large public hospital systems and a wide array of safety-net providers. • Payments are based on performance on process and outcome milestones. • Providers must develop projects based upon a selection of CMSapproved projects from each of three domains. • Key theme is collaboration! Communities of eligible providers will be required to work together to develop DSRIP project proposals. DSRIP ATTRIBUTION: MATCHING MEMBERS TO A PPS • Attribution is the process used in DSRIP to assign a member to a Performing Provider System (PPS). • Attribution makes sure that each Medicaid member is assigned to one and only one PPS. • Attribution uses geography, patient visit information and health plan PCP assignment to “attribute” a member to a given PPS. • Patient visit information is used to establish a “loyalty” pattern to a PPS (based on all their provider members) where most of the member’s services are rendered. DSRIP DESIGN GRANT OVERVIEW • Funds are to be used to support development of emerging Performing Provider Systems (PPSs) • Develop specific and comprehensive DSRIP Project Plans: • Community Needs Assessment • Stakeholder Engagement • Planning of specific projects • Awards have been split over two equal payments • Second payment was conditional on deliverables To download the slideshow click: chcs.org/media/CHCS-DSRIP-Presentation-Slides.pdf …
Posted on: Sun, 18 Jan 2015 18:50:10 +0000
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