What is DSRIP in NYS?
What is DSRIP?
In 2014, the federal Centers for Medicare and Medicaid Services approved New York State’s Medicaid waiver request for $8 billion over 5 years. Most of this new funding will go toward an initiative designed to achieve a 25% reduction in avoidable hospitalizations and restructure the health care delivery system, called the Delivery System Reform Incentive Payment (DSRIP) program.
DSRIP will help New York state improve the health of the population, reduce the cost of healthcare, and provide a better experience and outcome for patients.
In New York, the organizations responsible for the creation and implementation of a DSRIP project are called Performing Provider Systems (PPS).
DSRIP initiatives give states funding in order to help change how each PPS provides care to Medicaid beneficiaries. Every person enrolled in Medicaid is assigned to one and only one PPS. In New York, there are 25 PPSs across the entire state.
The Purpose of DSRIP
The first DSRIP program initiatives were approved and implemented in California, Texas, and Massachusetts in 2010 and 2011, followed by New Jersey, and Kansas in 2012. New Mexico and New York were added to this list in 2014.
New York joined the aforementioned group of states in 2014 with their own DSRIP initiative, the first effort of its kind in New York state. The overall goal of the New York DSRIP initiative is to transform the Medicaid payment and delivery system in order to reduce preventable hospitalizations by 25% over 5 years.
DSRIP aims to reform fee-for-service payments to new payment systems through technology, care coordination, policy changes, and incentives. DSRIP transitions supplemental funding to a model rewards-based payment structure contingent on achieving certain goals.
Goals
- Transform the health care safety net at the system and state levels
- Reduce avoidable hospital use and improve other health and public health measures at both the system and state levels
- Ensure delivery system transformation continues beyond the waiver period by leveraging managed care payment reform
- Near term financial support for vital safety net providers
- Create a more cost efficient Medicaid program with improved outcomes
- Assure access to quality care for Medicaid members and long-term delivery reform through managed care payment reform
DSRIP programs are just a small piece of the Medicaid delivery system reform landscape. DSRIP initiatives are part of broader Section 1115 Waiver programs and provide states with significant funding that can be used to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries.
Most DSRIP states use their DSRIP waivers for public and private hospitals; however, New York will use their DSRIP waivers for public hospitals, private hospitals, and non-hospital providers in order to promote coordinated networks of care that are organized around a lead hospital provider.
In New York, the organizations responsible for the creation and implementation of a DSRIP project are called Performing Provider Systems (PPS). There are 25 total PPSs in New York with a combined workforce of over 717,000.
DSRIP initiatives give states funding in order to help change how each PPSs provide care to Medicaid beneficiaries.
As opposed to a grant program, DSRIP is strictly performance-based. In other words, for New York to receive DSRIP funding, certain performance benchmarks must be met. If these performance benchmarks are not met, funding is reduced proportionately among each PPS.