We’re all familiar with the concept of a deadline and a reward based on performance. It’s been ingrained in us since elementary school where we were given homework to be completed the next day and the best ones got a sticker. New York’s Delivery System Reform Incentive Payments (DSRIP) is just like those elementary school assignments. Except the sticker is worth Medicaid funding.
Getting the Assignment
Even if it didn’t seem like it at the time, most school assignments are inspired by the teacher’s goals for the class. In New York, DSRIP is inspired by the Section 1115 of the Social Security Act. These 1115 waivers give states more freedom to create improvements to their Medicaid programs. The improvements must align with the overall goal of providing increased access to quality healthcare. For example, in New York, they have the Medicaid Redesign Team Waiver Amendment (MRT). ;The MRT has several goals:
- to reduce avoidable hospital use by 25% in 5 years
- to reinvest in healthcare infrastructure
- to have the freedom to innovate
- to prepare for implementation of national healthcare reform.
The MRT could result in significant federal savings as well as general enhancements to the healthcare system and improved patient outcomes.
Medicaid redesign initiatives like DSRIP is one of the ways states hope to achieve the goals set forth by the 1115 waivers. Just like students receiving stickers on an assignment, clinics will receive incentive money if they achieve predefined results in the healthcare system’s transformation, clinic management, and the population’s overall health. This funding is allocated using pre-determined formulas unique to each state.
New York created DSRIP to have five program principles: patient centered, transparent, collaborative, accountable, value driven. Providers must keep these goals in mind when creating their program goals and initiatives. To participate in DSRIP, providers need to work together. They are required to form Performing Provider Systems (PPSs) which are regional entities that are responsible for the health of the population in their specific service area. Each PPS then chooses five to ten projects to focus on from a list of DSRIP projects and domains.
The Other Kids in the Class
Many states are creating programs similar to DSRIP to push their Medicaid redesign forward. The first initiatives stemming from the 1115 waivers were in California, Texas, Massachusetts, New Jersey, and Kansas. Once included in these programs, states are given a certain amount of time to achieve specific goals. If they achieve the goals by their end date, they can be renewed. Since these five states started their programs, these states successfully completed their goals and have been renewed to receive more funding.
These five states are now joined by New Hampshire, New Mexico, New York, Virginia, and Washington. Some states are new, while others have been renewed for a second time. Each state has different goals and different timelines to complete them. For example, New York and Texas are two of the few who earmark funding for behavioral health initiatives while other states just allow behavioral health programs to be implemented without setting aside funding for them.
Getting the Sticker on the Assignment
Medicaid redesign is complicated. Achieving goals within the healthcare system takes a lot of time, energy, and thoughtful planning. Though this process might seem daunting at first, it is possible. There are just a few things to remember.
- Be sure to capture data before achieving your metrics. Father of management Peter Drucker wrote, “what gets measured gets improved.” This is easily applicable in a clinic setting. It’s important to know where your clinic currently stands in relation to the goals you’ve set. By having the ‘before’ data available, you’ll be able to compare your progress to this data and show how much you’ve improved. Once you’ve collected your data, you can represent it using bar graphs, pie charts, or another appropriate graph.
- You need to have a good understanding of the benchmarks unique to your state. Once you understand what is expected of you and your organization, you can compare what you need to do to what you’re already doing. This makes it easier to figure out what you need to learn and what areas of your organization you need to change. You may find that some of your processes are effective and in compliance with the requirements, but you won’t be sure until you fully understand the benchmarks.
- This is a strategic endeavor. Make sure you are thoughtfully planning your years under the program. You’ll be asked to produce graphs showing your progress and overall results which can be complicated with the many regulations. However, if you thoughtfully plan and are strategic, you will be successful.
Medicaid redesign is not simple, but it is not impossible. While it may be tempting to give up because it is hard or time-consuming, you can manage it by capturing your data, understanding the benchmarks, and being strategic. By keeping this in mind, you’ll have no problem getting your sticker-I mean, Medicaid funding.