NYAPRS Note: With news yesterday of the 1115 Waiver approval, all sectors that touch the health care system are looking to understand its effects on performance, contracting, and potentially lucrative new models of care. Read the final guidance documents and check back for our review per the final terms and conditions.
A How-to Manual on Approaching DSRIP
Crain’s Health Pulse; 4/14/2014
The Medicaid waiver that was finalized yesterday will distribute most of its funding through the Delivery System Reform Incentive Payment plan. The program’s main goals are to cut hospital admissions and emergency-department use by 25% over five years, as well as to ensure that Medicaid beneficiaries have access to vital health services. The program creates challenges for acute care hospitals, which must be financially viable to participate in DSRIP and transform themselves.
“We want to move to the health care system of tomorrow, and this is where DSRIP comes in,” said Joe Kuehn, a partner at KPMG’s health care advisory unit, speaking at a recent KPMG webinar on DSRIP.
The program will help providers “obtain the skill sets we need for population health and to take on risk,” he said. DSRIP is a means to develop new business models, such as taking on risk for an insured population.
DSRIP applicants will choose from 25 initiatives or they can try to submit an off-menu proposal. The program guidelines are now listed on the Department of Health website, online here. The new terms and conditions of the waiver are here.
“What is really important is that proposals have to not only be new, but ‘substantial and transformative,’ ” said Dr. Marc Berg, who heads KPMG’s Strategy and Transformation Healthcare unit. “Those words should not be taken lightly.”
DSRIP stresses a coordinated approach to health care. DOH may look at a project planning application and ask a provider to work with its neighbors “and come back with an integrated plan,” said Dr. Berg.
As these are new partnerships, Mr. Kuehn recommends that the projects have proper governance in place from fiduciary and clinical standpoints—including how the DSRIP money is shared. He also emphasized that the partnerships don’t just include heath care providers, but also have health plans and community groups as members. He recommends looking at regional service areas for gaps that need to be filled.
The key to a DSRIP project is to match a delivery system to a community’s needs. Hospitals will mainly be looking at how to transform their inpatient care to more reliance on ambulatory care. Bed buy-back programs are getting “a lot of attention,” Mr. Kuehn added.
He recommended that DSRIP applicants “be creative” in thinking about what might work, including telehealth or other innovations.
An archived webcast of the March 20 KPMG webinar is online here.