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:

  1. 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!
  2. 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.
  3. 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.

For more information about xG Health Solutions and our DSRIP Solutions, contact Fahad Rahman at

Rocky Edmondson RN, BSN, MBA, CCRN
Senior Director, Bundled Payments, Care Redesign and Management Advisors, xG Health Solutions

Rocky Edmondson is the Senior Director of Bundled Payments for Care Redesign and Management Advisors at xG Health Solutions. Rocky has been involved in workflow redesign, program implementation, and analytic evaluation of Bundled Payment Programs across the country, and he coaches Hospitals, Health Systems, Post-Acute Providers, and Physician Groups on how to successfully implement care redesign in the Bundled Payment for Care Improvement (BPCI) and CJR Programs.

Rocky’s passion is helping people to understand the intricacies of Bundled Payment Programs. He has a talent for teaching people how to cut through all the noise and just do the things that matter to be successful in these programs.

Rocky holds an Associate’s Degree in Nursing from the University of Hawaii Maui, and a Bachelor’s Degree in Nursing and a Master’s Degree in Business Administration (MBA) from Boise State University.

Prior to joining xG Health Solutions, Rocky was the Southeast Region Director of Clinical Operations for Remedy Partners, overseeing program design, implementation and analytic evaluations for Bundled Payment Programs. Prior to embarking on a career in Bundled Payments, Rocky was a Registered Nurse for 18 years, working in a number of positions within Critical Care. Before becoming a Nurse, Rocky was an Institutional Broker at Merrill Lynch and advised a number of healthcare systems and large corporations on cash management strategies. In addition, Rocky has started several businesses and provided consulting for small business startups. Rocky served in the U.S. Marine Corps as a Recon Marine.

Janet Comrey RN, BSN, MHSA
Director, Population Health Solutions, Geisinger Health System

Janet Comrey, RN, BSN, MHSA has over 30 years of diversified nursing and leadership experience at Geisinger Health system and currently serves as Director of a small department embedded within Population Health. One of her key roles is managing the Bundle Payment for Care Improvement (BPCI) program since January 2014 earning an overall positive net payment reconciliation to date. Janet also serves as the coordinator for Project Achieve at Geisinger which is a national PCORI funded study related to patient’s perceptions of transitions of care.

Janet received her nursing education through Geisinger’s diploma program, her BSN through Bloomsburg University, and later earned her graduate degree from Marywood University. During her tenure at Geisinger she taught quality improvement methodology and facilitated improvement teams the Geisinger Quality Institute. She is currently enrolled in the Institute for Healthcare Improvement Advisory program.

Professional memberships include Sigma Theta Tau, Phi Kappa Phi, American Society for Quality.

Andrew Blackmon, MBA, MHS
Chief Sales and Business Development Officer

Chief Sales and Business Development Officer Andrew Blackmon, MBA, MHS, has more than 18 years of experience in healthcare product sales, marketing, and strategy.

Before joining xG Health, Andrew was vice president of sales for population health and risk management solutions at McKesson. He came to McKesson through acquisition of MedVentive, an early population health vendor. Before MedVentive, he served as vice president of enterprise solutions development at MedAssets. He is a past president of the Georgia chapter of HIMSS, and he has held strategy and planning positions at PricewaterhouseCoopers and Orlando Health.

Andrew has an MBA and a Master’s of Health Science from the University of Florida Warrington, College of Business, and a Bachelor of Arts degree in Psychology from Rollins College.

Holly Barbella, RN, MBA

Risk Coordinator, Geisinger Health System

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Earl P. Steinberg, MD, MPP
Chief Executive Officer

Earl P. Steinberg, MD, MPP, is a nationally recognized expert in healthcare quality improvement and serves as xG Health’s chief executive officer. Earl also is an adjunct professor of Medicine and of Health Policy and Management at Johns Hopkins University and a member of Blue Cross/Blue Shield Association’s National Medical Advisory Panel.

Before joining xG Health, Earl was executive vice president of Innovation & Dissemination, and chief, Healthcare Solutions Enterprise at Geisinger Health System.

Before joining Geisinger, he was senior vice president for Clinical Strategy, Quality & Outcomes at WellPoint, Inc., the largest commercial health insurer by membership in the US, and president and CEO of Resolution Health Inc. (RHI), a leading healthcare data analysis company that provides innovative quality improvement and cost reduction services to health plans, employers, pharmacy benefit managers, and disease management companies.

Before joining RHI, Earl spent six years as vice president of Covance Health Economics and Outcomes Services Inc., director of its Quality Assessment and Improvement Systems Division, and co-director of its Outcomes Studies Group. He also spent 12 years on the full-time faculty at Johns Hopkins University, where he was professor of Medicine and of Health Policy and Management and director of the Johns Hopkins Program for Medical Technology and Practice Assessment, and four years on the Federal Physician Payment Review Commission. He co-chaired the Institute of Medicine’s panel on Standards for Development of Trustworthy Practice Guidelines.

Earl has received many awards, including the Henry J. Kaiser Family Foundation Faculty Scholar Award in General Internal Medicine (1984), the “Outstanding Young Investigator” Award from the Association for Health Services Research (1988), and a Special Presidential Visionary Award from the National Kidney Foundation (NFK) (2004) for his work as the scientific director of the NKF’s landmark Kidney Disease Outcomes and Quality Initiative, which produced more than 250 clinical practice guidelines for management of patients with end-stage renal disease. He also is a fellow of both the American College of Physicians and AcademyHealth, and he has published more than 125 articles in peer-reviewed journals.

Earl received his AB from Harvard College (summa cum laude), his medical degree from Harvard Medical School, and a Master of Public Policy from the Kennedy School of Government. He performed his residency training in internal medicine at Massachusetts General Hospital.