The Daily Dose
Why Should You Care about DSRIP?
It’s hard to keep up with the health care industry. Every day, there seems to be a new rule, law, or government mandate that dictates how you receive care. If you don’t work in the field, it’s tempting to tune it out. But if you’re a New Yorker, you may want to pay attention to a little known health care program with a big ol’ price tag.
What is DSRIP?
It’s called the Delivery System Reform Incentive Payment program – or DSRIP – and it was designed to fundamentally overhaul Medicaid, a health insurance program for low-income and disabled residents. DSRIP uses federal funding (and a lot of it) to support hospitals as they seek to improve care for Medicaid patients.
That’s $7.4 Billion with a “B”
Several states across the country have already accepted billions of dollars in federal funding to implement their own DSRIP programs. Here in New York, the program has been financed to the tune of $7.4 billion. Among its goals: cutting unnecessary hospital admissions for Medicaid by 25 percent over five years.
How Does It Work?
As part of New York’s DSRIP program, the state asked hospitals, doctors, and other health care providers to band together as so-called Performing Provider Systems (PPS) and make a case for how they would spend a piece of the $7.4 billion pie. The state received 25 PPS applications from across New York, including two – Albany Medical Center and Ellis Medicine – here in the Capital Region.
While the goals of the PPS are similar, each has its own plan of attack. Depending on the needs of the community, some groups chose to focus on cardiovascular and mental health, while others concentrated on asthma and diabetes. Their ultimate goal is to better manage chronic conditions and avoid unnecessary hospitalizations.
Over the next five years, the PPS must meet individual goals to receive funding. The state as a whole must also meet criteria set by the Centers for Medicare & Medicaid Services (CMS). If the state fails to do so, it will be required to reduce incentive payments, regardless of how well any individual PPS performs.
Go Forth and Do Great Things!
The goals of New York’s DSRIP program are laudable. If successful, the plan has the potential to save the state billions of dollars. But that’s a big “if.”
New York’s Medicaid program is the single largest health care payer, serving more than 6 million (one in three) residents. Total spending on Medicaid in New York is expected to reach $62 billion this year alone. But what happens when the DSRIP well runs dry? What is the next “carrot” that hospitals will need to improve quality, cost, and access to health care?
There is also the fundamental question about whether hospitals are up to the challenge. As a society, we have never relied on hospitals to provide preventive care, and we’re asking them to master it in a very short period of time. As one health care expert, Stephen Berger, put it, “… this is a series of high wire acts and many of the acrobats have never been off the ground …”
John D. Bennett, MD, FACC, FACP About the Author
John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.
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