Improving Care through DSRIP 1115 Medicaid Waivers: An Analysis of the Delivery System Reform Incentive Payment Program across Six States

Johnson Cole M, Miller A, Chan-Sawin L
Publication Year: 2017
Population Focus: Medicaid beneficiaries
Intervention Type: Service redesign
Type of Literature: Grey


Insights Results

Overview of article/programs

  • This paper provides an update to a previous 2013 comparative analysis of the current delivery system reform incentive payment (DSRIP), and DSRIP-like, programs across several states and identifies a number of key decision points for states and providers who may be considering, developing or beginning implementation work for waivers with DSRIP programs
  • The publication established considerations for developing DSRIP programs through exploration of 4 established and 2 developing programs under Section 1115
  • California: Key components included early coverage expansion for low-income adults, moving seniors and persons with disabilities from Medicaid fee-for-service to managed care, state budget support and delivery system reform. The program showed high achievement rates including decreased hospitalization rates for diabetics and increased primary care. The program evolved to PRIME and Whole Person Care
  • Texas: Using the original California program as a basis, Texas developed its program with some key changes (e.g., requirement of at least one improved clinical outcome). The program achieved accomplishments, such as increased access to primary and preventive care, emergency department diversion and enhanced behavioral health services
  • New York: Built off of Texas’ program, this program organized providers into Performing Provider Systems, emphasizing collaboration among multiple types of providers
  • Massachusetts: The 2011 programs were 1) Children’s/parent’s healthcare coverage and services; and 2) The Delivery System Transformation Initiatives. The 2016 renewed program moved the program from a fee-based model to an ACO model
  • Washington (developing): Waiver initiatives include 1) Transformation through Accountable Communities of Health to reduce avoidable use of intensive services and settings; 2) Long-term services and supports to improve population health; and 3) Foundational community support services to accelerate the transition to value-based payment and ensure Medicaid per-capita cost growth is below national trends
  • Arizona (developing): Aims for this waiver include 1) Reducing fragmentation that occurs between acute care and behavioral healthcare; 2) Increasing efficiencies in service delivery for members with behavioral health needs; and 3) Improving health outcomes for affected populations

    Key takeaways/implications

    • Considerations for states considering implementing a DSRIP program include: 1) Aligning the DSRIP program with waiver goals; 2) Understanding federal administrative priorities; 3) Securing the local matching dollar; 4) Understanding the funds flow; 5) Determining DSRIP participants and eligibility; 6) Establishing and distributing available funds; 7) Incorporating improvement potential and stretch goals; 8) Using DSRIP funds to prepare for a shift to payment for value and quality and advance outcome metrics at the provider, regional and state level; 9) Understanding data and reporting; 10) Defining the network and patient population; and 11) Developing the strategy and implementation plans
    • Overall, the DSRIP program construct appears to be achieving one of its key goals of connecting healthcare quality with Medicaid financing regardless of the unique implementation requirements each state chooses to utilize
    • Including a DSRIP program in an 1115 waiver offers tremendous opportunity to alter the state’s healthcare landscape and directs the focus of its safety net delivery system during the industry’s transition toward value. Additionally, a DSRIP program can support safety net system financing