09 Feb Insights from the NY DSRIP Mid-Point Assessment
Areas of Focus, Improvement, and the Path Forward
Fahad Rahman, Principal, DSRIP, Care Redesign & Management Advisors, xG Health Solutions, February 10, 2017
We’re in exciting times in the evolution of New York’s Delivery System Reform Incentive Payment (DSRIP) program. Three important things are converging right now, simultaneously:
- The Project Approval and Oversight Panel (PAOP) held its public hearings with all of the Performing Provider Systems (PPS) last week – and they were interesting!
- The state is finalizing the Mid-Point Assessment (MPA) results and recommendations for submission to CMS next month. The final MPA can be found here.
- On April 1, PPS’s will make the first major transition to Pay-for-Performance (P4P) as they begin DSRIP Year 3 (DY3)
The MPA – how are we doing? Where are we going?
The Independent Assessor (IA) did a great job of explaining the approach and methodology to the MPA that each PPS underwent. This intensive process led to identification of risks and clear recommendations by the IA to the PPS’s, which the latter used to develop remediation plans. As one would expect, there was wide variation in the PPS’s performance, with each PPS receiving anywhere from zero up to twenty-one recommendations.
Below are a few key insights that stood out:
The money is flowing. PPS’s attained almost all of the money available through the end of DY1; over 99% for performance funds under the Waiver and Equity Programs ($834 million under the Waiver and $1.2 billion in the Waiver and Equity programs). As a positive outcome, this “seed capital”, as envisioned by Jason Helgerson (NY Medicaid Director) is being pumped into the PPS’s.
Continue engaging your network partners. The IA was serious about evaluating Partner Engagement as a core component of each PPS building out a comprehensive and interoperable care delivery network for DSRIP in the near-term and for Value-Based Payments (VBP) down the road. Improvement recommendations in this area were given for almost every PPS with the majority of PPS’s behind their goals at this point in the program. Additionally, PPS’s were advised to ensure efficient funds flow down to key partners to keep them engaged, ensure network-wide incentive sharing, and support partner financial sustainability.
Don’t forget about the patients. Patient engagement and activation is a core component to meet key performance-based measures, especially as funding shifts to P4P. The IA used this as a proxy risk indicator for the successful implementation and completion of many DSRIP goals. PPS’s were advised to continue efforts and intensity on this area as P4P will account for increasingly larger shares of incentives over the coming years.
Keeping an eye on VBP. Even though a full three years are left in the DSRIP program, the IA is tasking the PPS’s to prepare for a post-DSRIP world. The PPS’s are not demonstrating sufficient partner education and engagement to support a viable move to VBP. Over two thirds of the PPS’s need to develop and implement action plans on Financial Sustainability and VBP for their provider networks.
Initial thoughts on DY3
The middle installment of a trilogy. Audiences love trilogies, which revolve around an exciting first installment and a conclusive final installment. For producers, the middle segment is tough to do well and a great job is scarcely recognized. However, a poorly done second installment can be detrimental to teeing up the end game. Only in retrospect do the producers and audience recognize a well or poorly done job. In many ways, DY3 is the second installment of the DSRIP trilogy. We know it is a key transition year for the program and the PPS’s as incentives transition from Pay-for-Reporting (P4R) to P4P. However, much like a movie, key foundational elements in the form of Project Milestones will still account for 40% of incentives in DY3, as is seen in the figure below from the Commonwealth Fund report on DSRIP. Successful completion of goals and attainment of outcomes in DY3 will put PPS’s on a path to greater success in DY4 and DY5 and put them on a solid trajectory for VBP. On the flip side, underperformance will put PPS’s at a significant disadvantage going forward.
We are definitely in exciting times in the evolution of New York’s DSRIP program, with far-reaching implications for Medicaid and healthcare delivery reform nationally. The entire country is watching this experiment.