In 2015, New York State launched a 5-year initiative to engage hospitals, physicians, healthcare providers and community-based organizations to improve the way that healthcare is delivered to Medicaid beneficiaries.
The project – called the Delivery System Reform Incentive Payment (DSRIP) program – is bringing providers and their community partners together around these shared goals:
- Reducing avoidable hospital admissions and emergency department visits by 25% over 5 years
- Increasing collaboration and clinical integration. Providers are expected to:
- Share information through the Regional Health Information Organization (RHIO).
- Agree to adopt clinical best practices, and receive support for achieving clinical excellence
- Improving community health consistent with New York State’s Prevention Agenda
- Strengthening the safety net by helping safety net providers move from fee-for-service to value-based payment so that they can continue to meet the needs of Medicaid beneficiaries and low-income individuals
DSRIP reinvests $8 billion in savings generated by the Medicaid Redesign Team (MRT) reforms that preceded it. The waiver funding provides support for major improvements in health care to be delivered through Performing Provider Systems (PPS). Throughout the state, 25 PPSs are responsible for implementation of DSRIP projects. The Northwell Health IPA is assisting community-based practices who have signed up with a PPS to achieve Patient Centered Medical Home (PCMH) or Advanced Primary Care (APC) status, a foundational element of care transformation.
Provider participation in DSRIP
In NYS, all Medicaid participating providers may take part in DSRIP by aligning with a PPS (Performing Provider System) via an attestation of interest, signed and submitted from the provider to the PPS. This process of alignment is currently closed but may be re-opened periodically for those providers who have not attested to PPS participation. If you are not yet aligned and are interested, please contact us.
For providers who are aligned with a PPS that Northwell participates in, ensuring access to primary care in our communities is key to improving health and reducing medical costs.
Primary care providers who participate in the DSRIP Program agree to:
- Achieve PCMH or APC recognition
- Integrate behavioral health care
- Connect to a Regional Health Information Organization (RHIO)
- Use evidence-based practices in the treatment of chronic diseases
Benefits of participating in the DSRIP Program
There are many benefits for Primary Care Physicians who choose to participate in DSRIP, including:
- Direct PPS investment in becoming a recognized PCMH or APC practice.
- Support from licensed PCMH Certified Content Experts (CCE), APC technical assistance (TA) vendor, including Northwell Health staff and consultants hired by Northwell Health to work with your practice
- Experience gained from performance measurement and improvement methodologies
- Bonus payments tied to achieving project milestones and demonstrating quality outcomes
- Participation in learning collaboratively with other physicians who are in the process of PCMH or APC transformation
- Advice on EHR modifications and RHIO connectivity from Northwell Health IT
- Preparation for your practice and staff for financial success in future value-based payment programs
The components of a PCMH or APC practice include comprehensive care, coordinated across the health system, and a focus on quality measurement and improvement. These components are intended to improve patient outcomes—including better patient experience with improved quality of care (leading to better health) and reduced costs.
Advantages to achieving PCMH or APC recognition
- Better care for patients. The components of the PCMH and APC model are intended to improve patient outcomes—including better patient experience and improved quality of care (leading to better health).
- Better efficiency for providers. By moving toward team-based care, the PCMH and APC models have the potential to improve coordination, efficiency, effectiveness, and the value of care, as well as the satisfaction of providers.
- Higher reimbursement. Medicaid Managed Care (MMC) and Medicaid Fee-For-Service (FFS) support PCMH providers. Providers can receive a MMC – PMPM payment and a FFS add-on rate per visit for Medicaid beneficiaries. New York State (NYS) is continuing to focus on reimbursement incentives for APC recognized practices. The goal is for reimbursements incentives to be across a variety of payer types.
Northwell Health has a team of clinicians and administrators who are able to support practices in achieving PCMH recognition. If you are a pediatrician, internist or family medicine physician who is interested in participating in the DSRIP program, we would like to hear from you. Please email us at DSRIP@northwell.edu for information.
- New York State Department of Health — DSRIP
- The Commonwealth Fund, “Implementing New York’s DSRIP Program: Implications for Medicaid Payment and Delivery System Reform”
- Department of Health DSRIP Webinars and Presentations
- NCQA — PCMH
- NCQA PCMH Brochure
- APC Technical Specifications
- APC Frequently Asked Questions