Identifying key lessons and promising practices from the first four years of New York State’s Delivery System Reform Incentive Payment program.
New York State launched the Delivery System Reform Incentive Payment (DSRIP) program in 2014 to invest in system transformation, clinical improvement, and population health projects that promote community-level collaborations, with the goal of achieving a 25 % reduction in avoidable hospital use over five years.
Under DSRIP, health and social care providers across the state formed collaborative networks called Performing Provider Systems to implement a wide range of innovative demonstration projects. The New York State Department of Health asked UHF’s Medicaid Institute to review the first four years of these efforts to identify key lessons and promising practices. The resulting report, DSRIP Promising Practices: Strategies for Meaningful Change for New York Medicaid, includes case studies of DSRIP projects across the state and an appendix of specific DSRIP measures, sorted by the outcomes that the promising practices sought to affect. It is a companion to the Department of Health’s DSRIP Stories of Meaningful Change in Patient Health, published in January 2019.
Overview of article/program
This article explores common themes across Performing Provider Systems (PPSs) in New York under DSRIP
Under DSRIP, health and social care providers across the state formed collaborative networks called PPSs to implement innovative demonstration projects focused on system transformation, clinical improvement, and population health improvement. In early 2019, the Office of Health Insurance Programs at the New York State Department of Health (DOH) asked the Medicaid Institute at United Hospital Fund (UHF) to review PPS projects, assess common themes across the projects, and identify key lessons that could inform conversations about the future of DSRIP beyond the end of the program
Methods of article
Investigation of promising practices began with a review of PPSs’ 2019 DSRIP Learning Symposium submissions and PPS projects that used an innovation fund or similar vehicle for implementation. The core source material was supplemented with a targeted review of previous DSRIP Learning Symposium presentations, PPS websites and newsletters, Medicaid Accelerated exchange (MAX) series materials, the DSRIP Best Practices in Year 3 Whiteboard Video and companion document, Project Approval and Oversight Panel materials, and Social Determinants of Health Innovation Summit presentations. In total, over 500 discretely identifiable PPS practices were examined across the core
source material and supplemental sources
After 4 years of implementation and subsequential evaluation of New York’s DSRIP program under 1115 waiver, common themes emerged: 1) Substantial infrastructure is required to support projects with sufficient scope to drive outcome improvement across large populations of Medicaid members ; 2) Projects targeting complex patients can substantially improve outcomes for small groups of patients and likely generate cost savings; 3) DSRIP has greatly accelerated the focus on social determinants of health by facilitating partnerships between healthcare providers, community-based social service organizations, and other community partners, and by producing new workflows and non-clinical workforces to address the social needs of Medicaid members; 4) For the most complex populations, substantial care management/coordination and support for care transitions appear necessary to
change patients’ trajectories; and 5) Some of the most promising practices focused on expanding access and developing new approaches to meeting patients where they are as ways to better engage them in treatment
These preliminary results suggest that broader-scale adoption could support continued progress in lowering Medicaid costs, improving access and quality, and further leveraging DSRIP investments
Project themes for the program are: 1) Core infrastructure and capacity building; 2) Social needs, community partnerships, and cross-sector collaborations; 3) Care coordination, care management, and care transitions; and 4) Transforming and integrating behavioral healthcare
More time is needed to integrate value-based payment into the program