An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers

Gates A, Rudowitz R, Guyer J
Publication Year: 2014
Patient Need Addressed: Behavioral health, Care Coordination/Management, Chronic Conditions
Population Focus: Medicaid beneficiaries
Intervention Type: Service redesign
Type of Literature: Grey


Insights Results

Overview of article

  • This brief examines similarities and differences across key elements of DSRIP waivers. States included in the analysis are California, Texas, Kansas, New Jersey, Massachusetts, and New York. Key elements to be examined include: the program’s goals and objectives, eligible providers, projects and organization, allocation of funds, data collection and evaluation/reporting, and financing of DSRIP waivers
    Key takeaways/results
  • The overarching goal of all of the state DSRIP initiatives is transformation of the Medicaid payment and delivery system in an effort to achieve measurable improvements in quality of care and overall population health. Individual states may have additional reasons for pursuing DSRIP waivers including delivery system reform and direction of funds to hospitals/other providers
  • All evaluated states have public hospitals as eligible providers. All states, except California, have private hospitals has eligible providers. There are 2 states (Texas, New York) that have non-hospital providers as eligible
  • DSRIP waivers, and as such their organization, generally focus on 4 main areas with an increasing focus on clinical and population improvements over time: 1) Infrastructure development; 2) System redesign; 3) Clinical outcome improvements; and 4) Population focused improvements. The first 2 elements typically focus on the processes of the first few years of the waiver (these are called process metrics), while the latter years typically focus on the final 2 key elements (i.e., outcome measures)
  • System redesign projects can include redesigning primary care models, expanding medical homes, establishing patient navigation programs, expanding chronic care management models and medical management programs, integrating physical and behavioral healthcare, and creating integrated delivery systems
  • Clinical care improvements and population focused improvements are tied to measurable outcomes and metrics to address patient care and safety, and improvements in overall health. Some states determine these measures while some states give providers flexibility to determine key areas for improvement and their associated metrics. There is a lot of overlap across states between these priority areas (e.g., reduced emergency department visits)
  • Infrastructure development projects generally focus on investments in technology, tools, and human resources needed to allow a hospital or provider network to move forward with delivery system reform. For example, an infrastructure project could focus on enhancing interpretation services and culturally competent care like collecting accurate Race, Ethnicity, and Language (REAL) data, or introducing tele-medicine
  • Generally, across states, hospitals and providers must submit semi-annual reports to the state detailing progress in meeting metrics/milestones. As such, state must establish data collection and reporting requirements to adequately measures performance
  • DSRIP funding methodology varies across states, but all providers must meet certain process or outcome measures to qualify for DSRIP funding. Generally, funding allocations increase for those meeting milestones related to clinical care and population health
  • Of the 6 states examined, all 6 fund public hospitals for delivery system reform, and the majority (5) allow private hospitals to receive funding. However, only 2 states (TX, NY) allow non-hospital providers (e.g., community health centers, county health departments) to receive funding. In Texas, Regional Healthcare Partnerships, led by a public hospital or local government entity, are responsible for funding the state match in partnership with regional healthcare providers, which may include, especially for larger networks, community health centers and other non-hospital providers. New York uses its DSRIP waiver to promote coordinated networks of care organized around a lead hospital provider and component providers