NYS Medicaid Reform Efforts Can Improve Health Care Outcomes Well Beyond 2020

New report on DSRIP promising practices spotlights payment and delivery innovations started after federal waiver

NEW YORK, NY—July 16, 2019—Four years into a groundbreaking overhaul of its Medicaid program, New York has laid the groundwork for improving health care access, quality, and costs well beyond 2020 if it continues to expand on the practices implemented to date, according to a report released today by United Hospital Fund (UHF) and funded by the New York State Department of Health. 

The State launched the Delivery System Reform Incentive Payment (DSRIP) program in 2014 to invest in system transformation, clinical improvement, and population health projects that promote community-level collaborations, with the goal of achieving a 25 percent reduction in avoidable hospital use over five years. 

As the State plans for next steps when the current DSRIP program ends on March 31, 2020, the Department of Health asked UHF’s Medicaid Institute to review the first four years of the effort to identify key lessons and promising practices that could inform its discussions.  

“The practices covered in the report suggest that broad-scale adoption could support continued progress in lowering Medicaid costs and improving access and quality,” said coauthor Nathan Myers, director of UHF’s Medicaid Institute. “Reports from DSRIP providers suggest opportunities exist for larger improvements across Medicaid if given enough time and resources for effective expansion.”

Under DSRIP, health care and social service providers formed collaborative networks called Performing Provider Systems (PPSs) to implement a series of improvement projects. The report, DSRIP Promising Practices: Strategies for Meaningful Change for New York Medicaid, identified several key takeaways from the first four years of the PPS’ efforts to transform care for Medicaid enrollees: 

• Substantial investments in infrastructure, such as coordinated provider networks and robust information technology systems, are required to support efforts to improve health outcomes across large populations.
• Projects targeting small populations of complex patients with multiple medical conditions—who drive much of Medicaid spending—can substantially improve outcomes and generate valuable models for other projects and populations. For the most complex populations, substantial care management and coordination are important for changing patients’ trajectories.
• DSRIP has greatly accelerated the focus on social determinants of health, such as food insecurity or poor housing, by facilitating partnerships between health care providers, community-based social service organizations, and other community partners.
• Given the prevalence of individuals in Medicaid with behavioral health needs, some of the most promising practices focused on expanding patients’ access to treatment and their ongoing engagement with those services.

The report also considered whether emerging value-based payments, in which providers are reimbursed for quality of care rather than quantity, were ready to support broader adoption of the promising practices but concluded that more time is needed for payment reform to fully support the still-transforming delivery system. 

“New York State is a national leader in leveraging Medicaid to transform the payment and delivery systems,” said Chad Shearer, a coauthor and UHF senior vice president for policy and program. “The practices highlighted in our report are a bold start at making Medicaid a more effective program for all New Yorkers, and we hope that they will help inform all Medicaid stakeholders as they endeavor to extend and expand their efforts.” 

The report includes case studies of DSRIP projects across the state and an appendix of specific DSRIP measures, sorted by the outcomes that the promising practices sought to affect. It is a companion to the Department of Health’s previously published DSRIP Stories of Meaningful Change in Patient Health, released by the state in January, which highlights a handful of case studies where DSRIP efforts improved outcomes by emphasizing patient needs.

In addition to Nathan Myers and Chad Shearer, this new report was coauthored by Gregory C. Burke, recently retired as UHF director of innovation strategies; Misha Sharp, UHF senior research analyst; and Matlin Gilman, former UHF health policy analyst. The full report can be downloaded from UHF’s website here. 

About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at www.uhfnyc.org and follow us on Twitter.