On April 1, the long year of planning and application for New York State’s Delivery System Reform Incentive Payment (DSRIP) Program came to a close and the city’s healthcare providers began the major reform efforts required by DSRIP. Here is a brief summary of what’s happening and what it means to you and your patients or residents.
What is DSRIP?
DSRIP is part of New York’s Medicaid Redesign Team Waiver Amendment, which allows the state to reinvest $8 billion in reforms that will strengthen coordination across New York’s healthcare delivery system in order to reduce Medicaid expenses and improve New Yorkers’ health outcomes over the next five years. DSRIP’s overarching goal is to reduce avoidable hospital use by 25%. To learn more about how it will work, click on the video above.
Why is DSRIP necessary?
For far too long, the United States’ healthcare system has been fragmented, reactive, and disease-oriented. As a result, we face a growing epidemic of chronic conditions and diseases that lead to a revolving-door system of care: people go to a doctor or hospital to treat a condition that gets worse again when they go home, leading to another visit to the doctor or hospital, and so on. DSRIP is part of a national reform strategy that is aiming to create a more efficient healthcare system, improve access to quality care, and generate better health outcomes.
What is avoidable hospital use?
Because DSRIP is intended to keep New Yorkers healthy, it places a great deal of importance on preventative care. Avoiding unnecessary hospital use includes more than just refraining from readmitting people to the hospital when possible. It also means reducing inpatient admissions and emergency room visits that can avoided by providing preventative care.
What is a Performing Provider System?
A Performing Provider Systems (PPS) is a regional entity responsible for creating and implementing DSRIP projects. A PPS may include a broad array of healthcare providers, including hospitals, health homes, skilled nursing facilities, ambulatory clinics, home care agencies, federally qualified health centers, behavioral health providers, and/or community-based organizations. Each PPS has a lead provider that is responsible for bringing together all the PPS partners and heading up the effort to complete a comprehensive community needs assessment, agree on strategies to address the community’s greatest needs, design and implement a DSRIP Project Plan based on the agreed-upon strategies, and monitor milestones and metrics to ensure that the plan is successful.
How will DSRIP affect my organization financially?
DSRIP is what is known as a “pay for performance” program. Payouts to your organization’s PPS will be determined mainly by how successful the PPS is in achieving the desired results in system transformation, clinical management, and population health. It will also depend in part on how well all the PPS’s in the state perform. Each PPS may allocate performance funds to its member organizations however it sees fit, as long as 95% of those payments go to safety-net qualified partners and the remaining 5% to non-qualifying safety net partners.
It’s hard to imagine what our new healthcare delivery system will look like in 2019 as a result of DSRIP. What is the vision?
No one has a crystal ball, so it’s hard to say with certainty. In alignment with meeting the state’s goal of reducing avoidable hospital use by 25%, it is quite likely that there will be a move toward more high-quality ambulatory care and less hospital inpatient and emergency department care. It is important to note that this shift towards community-based preventative care will extend beyond Medicaid members, as other healthcare payers (private insurers, Medicare, etc.) increasingly implement similar performance-based delivery system reforms. It is expected that by the end of DSRIP’s fifth year, New York’s healthcare delivery system will look fundamentally different – not only for Medicaid users, but for all New Yorkers.
What does DSRIP mean for healthcare workers?
There will be new jobs in community settings that require a great deal of flexibility and agility in addressing social needs as well as health needs. DSRIP provides funding for continued education, worker retraining, and redeployment through organizations like the 1199SEIU Training and Employment Funds (TEF).
Where can I find additional information about DSRIP?
Jason Helgerson, New York State’s Medicaid Director, describes the principles and goals of DSRIP’s reforms in this five-minute video.
More DSRIP webinars and presentations from Jason Helgerson
1199SEIU United Healthcare Workers East President George Gresham on why the union is supporting the changes mandated by DSRIP
The New York State Department of Health offers information on the DSRIP program in English and Spanish