With the healthcare industry’s transition to value-based care models, optimal health system performance is being redefined as enhancing the experience and outcome of the patient, improving the health of populations, and reducing the per capita cost of healthcare. As a result, states are designing and implementing innovative programs to reform how healthcare is delivered and paid for.
As such, Delivery System Reform Incentive Payment (“DSRIP”) Programs are becoming a critical component of the evolving landscape of Medicaid delivery service reform. As part of federal Section 1115 Medicaid demonstration waiver programs, DSRIP provides funding that states may use to support hospitals and other healthcare and social service providers in improving how they provide care to Medicaid beneficiaries. The goal of DSRIP is to improve health and transform care delivery for the state’s Medicaid population through the integration and coordination of care across provider specialties and care settings, as well as increase the quality of and access to behavioral health services.
In December 2017, the Centers for Medicare and Medicaid Services (CMS) approved a renewal of the Texas 1115 Transformation Waiver, extending the DSRIP program through September 30, 2021. As Regional Healthcare Partnerships (RHPs) and individual healthcare systems in Texas embark on DSRIP 2.0 and begin addressing DSRIP Years 7 and 8 protocols and measurement bundles, understanding the DSRIP successes and challenges from other states is critical.
Current DSRIP Programs are Improving Patient Care
As of July 2018, ten states, including Texas, are now using Section 1115 waivers to implement DSRIP initiatives. These states have enacted successful initiatives to improve population health outcomes through better care coordination, population health, and patient engagement. As Texas looks to continue to reduce unnecessary and costly healthcare utilization and improve patient outcomes through DSRIP 2.0, there are many ways that the funds can be used to drive further success. From augmenting community resources to incentivizing better care management and coordination of health services, healthcare systems are taking positive steps to improve their community’s health. While taking these steps can be challenging, the potential rewards are massive.
States further along in their DSRIP journeys are seeing great success. To date, the funds have been used to deploy care management programs, such as in the case of New York State, where providers are equipping patients with the tools necessary to take control of their care through coaching and navigation. With community referrals and care navigators, patient care is better managed and tailored to each individual’s needs.
Meanwhile, in California, project funds have already been shown to drive success in preventive care measures such as increasing cancer screening and flu vaccination rates among the older DSRIP-eligible patients. These early success indicators provide a baseline for what other states can achieve. As states such as Texas take advantage of their extended 1115 waiver, there are many possibilities for how Medicaid patients may benefit from the grants and investments provided to participating providers.
What Texas Can Do to Take Full Advantage of the Waiver
As Texas begins their DSRIP extension period, understanding what criteria is most beneficial to meet, how to meet them, and how to report on them is critical. Specifically, there are three things that Texas health systems should consider when implementing their bundles—develop data-driven insights and efficiency, engage patients in a new way, and scale care coordination.
- Develop Data Driven Insights and Efficiency: Many of the DSRIP Bundles in Texas require sophisticated data tracking, management, and seamless reporting on a variety of population health initiatives. Identifying engagement, reporting, quality, and analytics needs for tracking population-based measures and reporting on pay-for-performance measures is a critical aspect of success within DSRIP. Prioritizing and investing in integrated solutions enabling enhanced insights into quality and outcomes and meeting reporting requirements will be important to address early on in the process to support long-term measurement and improvement of clinical processes and value-based payment models.
- Engage Patients in a New Way: To encourage preventive health efforts, reduce avoidable hospitalizations and readmissions, and improve healthcare outcomes for low-income, hard-to-reach, and/or rural patients, providers need to engage patients in a new way while optimizing available resources. Enhancing communication and connectivity between patients and their care teams and improving the ability to navigate and obtain needed clinical and social services is critical for changing the Medicaid healthcare landscape. Simultaneously, it is essential that systems consider available resources (and constraints) and optimize available technologies. By embracing workflow enhancements and innovation, systems will enhance their ability to outreach and engage high and at-risk patient populations.
- Scale Care Coordination: Health systems will need to work with multiple provider types across the care continuum to optimize bundle design, implementation, and funds flow. Since care management services and providers traditionally operate in silos, health systems must establish effective integrated care management systems. This will mean needing to face interoperability issues head-on to effectively coordinate care and promote collaboration across different regional providers within and across systems. As processes are created, it is key to develop clearly-defined roles, expected activities, appropriate metrics and outcomes, and reimbursement methodology to promote interoperable communication and documentation systems.
In this era of value-based care, successful transformation of healthcare at the system and state levels requires trusted partnership across the care continuum. Healthcare organizations across Texas can make the most of the funds through the extended 1115 waiver by putting the right people, processes, and technologies in place early on. It will be exciting to see over time how DSRIP can help health systems throughout Texas improve access, quality, and coordination of care for at-risk patient populations.