We’ve had several meetings with clients who have asked us about DSRIP. For the well-informed, you can skip this blog post, but for everyone else, we offer this brief DSRIP 101 primer:

Q. What is DSRIP?
The Delivery System Reform Incentive Payment Program is a Medicaid restructuring plan that reinvests money into the health care system in an effort to transform how hospitals and providers deliver care to Medicaid recipients.

Q. Why does Medicaid need restructuring?

Q. Yes, really. What is wrong with Medicaid?
Soaring costs for the government coupled with huge cuts to providers has led to difficulty in access for the patients with Medicaid. Plus, Obamacare requires states to add an additional 20 million people to the system — mostly pregnant women, children and the elderly. Just having a Medicaid card in your wallet is far from a guarantee of care. Many physicians decline to participate citing low reimbursement and mountains of paperwork to complete. There is also evidence that Medicaid enrollees receive a lower quality of care. A study from the University of Virginia found that Medicaid patients have worse surgical outcomes than individuals without insurance, even controlling for numerous confounding factors. As Federal spending for Medicaid has gotten out of control, there have been three bailouts to the system.

Q. How much is spent on Medicaid in New York?
New York’s Medicaid program is the single largest health care payer, serving more than 6 million (one in three) residents. Total spending on Medicaid in New York is expected to reach $62 billion this year alone.

Q. What are the main DSRIP focuses in New York?
Reduce avoidable hospitalizations by 25% through a series of transformative investments in community based care, including expanded care coordination, facilitated access to care, integrated health and behavioral health, and others, and to better manage chronic health conditions.

Q. How much money is available in New York for DSRIP?
$6.42 Billion over the next 5 years.

Q. What is a PPS?
Performing Provider Systems are the groups that submit DSRIP applications. They comprise eligible public hospitals and safety net providers in each pre-existing or newly formed networks. Included are health and behavioral health care providers, social service providers and community-based organizations. Safety net partners can include an array of providers: hospitals, health homes, skilled nursing facilities, clinics & FQHCs, behavioral health providers, community based organizations and others.

Q. Is membership in a PPS is enough to receive payment from DSRIP?
To receive payment, the PPS must coordinate in order to meet predetermined benchmarks and achieve outcomes related to each project. Goals are set by each PPS in accordance with their community needs. Incentive payments are not guaranteed, but can be utilized at the discretion of the network.

Q. How many PPSs are in New York State?
There are 25 in New York. Our region is part of the the Finger Lakes PPS (FLPPS).

Q. Which states have DSRIP programs?
The program was originally introduced in California and followed by Texas, Massachusetts, New Jersey, Kansas and New York. Other states are expected to establish DSRIP programs soon as well.

Q. Is the program the same from state to state?
DSRIP differs somewhat across state borders but there are some common themes that are universal: DSRIP initiatives promote collaboration, support innovation, and bring renewed attention to social services.

Q. So DSRIP is the same as Managed Medicaid?
Not quite. While DSRIP waivers often share many of the same goals as Medicaid managed care programs – slowing the rate of growth in spending, improving care and offering greater accountability, DSRIP offers providers – rather than health plans – the opportunity to change the way that they provide care. Keeping that in mind, the relative roles of DSRIP-funded provider networks and managed care plans has not been fully defined in all situations.

Q. What does Strategic Interests have to do with DSRIP?
SI has strong relationships with several PPSs, their founding partners and members. We’ve collaborated to define vision, write grants, provide strategic planning and formulate vendor selection in alignment with DSRIP initiatives. We understand the DSRIP big picture for individual organizations up to nationwide commercial ventures and everything in between.