Frequently Asked Questions
Q: What is DSRIP?
A: Delivery System Reform Incentive Payment (DSRIP) program. The New York State Medicaid Redesign Team (MRT) is redirecting Medicaid funds to projects that radically transform the Medicaid delivery system. These projects are part of the DSRIP program.
To implement innovative system changes, DSRIP will incentivize health care and community-based providers to form regional partnerships. DSRIP’s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.
Q: What is a Performing Provider System?
A: The entities that are responsible for creating and implementing a DSRIP project are called “Performing Provider Systems”, (PPS). Performing Provider Systems are providers that form partnerships and collaborate in a DSRIP Project Plan. PPS include both major public hospitals and safety net providers, with a designated lead provider for the group. Safety net partners can include an array of providers: hospitals, health homes, skilled nursing facilities, clinics, Federally Qualified Health Centers (FQHCs), behavioral health providers, community based organizations and others.
A PPS will be required to perform a community assessment of need, identify strategies that are most consistent with addressing that need, develop a Project Plan incorporating those strategies, implement that Project Plan and monitor milestones and metrics to ensure the implementation is successful.
Q: What is Care Compass Network?
A: Care Compass Network is the name of the Southern Tier’s Performing Provider System. Care Compass Network serves 9 counties: Broome, Tioga, Chemung, Steuben, Schuyler, Tompkins, Cortland, Chenango, and Delaware Counties.
UHS is the lead applicant for this Performing Provider System and is collaborating fully with 180 partner organizations across a nine-county region including Lourdes, Guthrie Corning Hospital, Cayuga Medical Center, Cortland Regional Medical Center, and Schuyler Hospital, as well as area nursing homes, behavioral health and substance abuse programs, social service agencies and similar entities.
Q: What is the Project Advisory Committee?
A: Each emerging Performing Provider System (PPS) is required to form a Project Advisory Committee (PAC). The PAC will advise emerging Performing Provider Systems on all elements of their DSRIP Project Plans and should include representation from each of the emerging PPS partners as well as workers and/or relevant unions. The PACs are a requirement for the DSRIP Design Grant application and are expected to be in place over the duration of the DSRIP program. During the implementation phase, the PAC will review project progress and make recommendations.
A: Member attribution refers to how Medicaid beneficiaries are assigned to Performing Provider Systems. Members are assigned to a given PPS using geography, patient visit information, and health plan PCP assignment. Additionally, patient visit information is used to establish a “loyalty” pattern based on where most of the member’s services are rendered.
Q: Can a beneficiary be attributed to more than one PPS?
A: No. A beneficiary can only be attributed to one Performing Provider System.
Q: Are DSRIP payments tied to the performance of the Performing Provider System?
A: Yes. DSRIP is specifically engineered to reward measurable outcomes. Each Performing Provider System will have process and outcome metric milestones that must be met in order to receive DSRIP payments. For some outcome metrics, success will be considered closing part of the gap of the provider compared to the goal.
Q: Where can I get more information on DSRIP?
A: Visit the New York State Department of Health website at: http://www.health.ny.gov/dsrip