Our View: What to Know About the DSRIP Extension, and How You Can Help Shape It

Nora OBrien-Suric

by Nora OBrien-Suric, President

As advocates for better health care for all residents of New York, we encourage our colleagues to join us in playing a role in the development of an important statewide initiative that could have an impact on many of the communities we serve: the DSRIP extension.

In 2014, the New York State Department of Health embarked on an ambitious program to improve the way care is delivered to Medicaid beneficiaries and low-income, uninsured individuals—the Delivery System Reform Incentive Payment program, or DSRIP. DSRIP is the main mechanism for implementing the New York State Medicaid Redesign Team Waiver by using community-level collaborations to help prevent unnecessary hospitalizations, improve outcomes and reduce costs.

The state has requested $8 billion from the Centers for Medicare and Medicaid Services (CMS) to extend its DSRIP program for another four years.

We encourage our community partners and fellow advocates for health care transformation to review the proposal and share your input via public comment. Written public comments on the proposal are being accepted via email through November 4. See full instructions on submitting public comments here.

Some key goals of the extension, many of which are aligned with health care priorities at the federal level, include:

  • Building on current progress made in transforming Medicaid to a value-based payment system, which ties payments to quality of care (versus the previous fee-for-service model)
  • Expanding efforts to address social determinants of health
  • Continued workforce investment that includes non-traditional, non-clinical care providers such as community health workers and patient navigators
  • Building on existing progress in addressing the opioid epidemic

What’s New This Round: Focusing on Social Determinants of Health
The extension includes a few notable additions, including a new focus on the social determinants of health. These social, economic and environmental factors—such as food, housing and transportation—play an integral role in our overall wellbeing, and are an important consideration in any effort to improve health outcomes.

The proposal aims to address these issues by creating Social Determinants of Health Networks (SDHN). SDHNs will be networks of community-based organizations with the goal of collectively using evidence-based interventions to address issues related to housing, nutrition, interpersonal safety and toxic stress.

These efforts reflect a larger national trend of community-based organizations partnering with health care systems to improve care coordination, reduce unnecessary hospitalizations, and provide comprehensive programs that address the social determinants of health. One local example is the WNY Integrated Care Collaborative (WNYICC), a multi-county network of governmental agencies and community-based organizations that was created with support from the Health Foundation and the John A. Hartford Foundation. WNYICC is strategically positioned to respond to and capitalize on regional opportunities to advance community-based integrated care.

Our hope is that this statewide and national trend will continue, as evidence mounts that these partnerships and collaborations are a more effective and efficient way of addressing the root cause of health issues and improving outcomes.

According to the proposal, DSRIP’s SDHNs will focus on Medicaid members with complex health and social needs, and children or families with children experiencing, or at risk of, significant and multiple adverse childhood experiences. We applaud this effort, as recent research led by the Health Foundation through our Co-Creating Well-Being project demonstrated the current lack of training, coordination and services on trauma-informed care for children and families in western and central New York.

Addressing Three High-Priority Needs
Another aspect of the proposed program extension would include the creation of value driving entities, or VDEs. VDEs would bring together providers, community-based organizations working on social determinants of health, and Medicaid managed care plans to continue implementing select DSRIP projects that have shown effectiveness. These projects are known as DSRIP Promising Practices.

Additionally, these VDEs would focus on three high-need priority areas:

1) Reducing Maternal Mortality
New York has made some improvements in maternal health outcomes, but as of 2016, we still rank 30th in the nation for maternal mortality rates. In 2018, Governor Andrew Cuomo launched a multi-faceted initiative to address maternal health outcomes by focusing on racial disparities, expanding community outreach and increasing access to prenatal and perinatal care. The DSRIP amendment would enable communities with high maternal mortality and low birthweight deliveries to develop programs that build on these and other existing public health projects and incorporate promising practices from beyond DSRIP.

2) Children’s Population Health
Approximately 47% of the state’s children are covered by Medicaid. The proposed DSRIP amendment would extend successful practices for children in the areas of chronic care management, behavioral health integration, pediatric-focused patient-centered medical homes, and attention to adverse childhood experiences and social determinants.

3) Long-Term Care Reform
Between 2015 and 2040, the number of adults age 65 and over in New York State is projected to increase by 50 percent, and the number of adults over 85 will double. The proposed amendment would build on progress already made by DSRIP programs that aim to help people age safely in place with a good quality of life, while minimizing hospitalizations and acute care needs. Workforce investments will be an important part of these efforts, and the proposal notes that these needs are particularly high in rural areas.

Our team at the Health Foundation is pleased to see plans for VDEs to focus on these three topics, as our own work has shown that these are key areas of need for residents of western and central New York. You can learn more about our current and previous programming related to these issues on the Programs section of our website.

As you can see, the next stage of DSRIP could have a major impact on care delivery and health outcomes across New York. Again, we encourage you to play a role in this important process, review the proposal and submit a public comment.