DSRIP: What You Need To Know!

  • Presentation is also available in Portable Document Format (PDF)
Jason Helgerson, Medicaid Director

Office of Health Insurance Programs
NYS Department of Health

FIVE KEY THEMES OF DSRIP

  1. Collaboration, Collaboration, Collaboration!!!
  2. Project Value drives
    1. Transformation → # and types of projects
    2. # of Medicaid members served (attribution)
    3. Application Quality
  3. Performance Based Payments
  4. Statewide Performance Matters
  5. Lasting Change
    1. Long–TermTransformation
    2. Health System Sustainability

Five Years in the Future

How The Pieces Fit Together: MCO, PPS & HH
Other Providers
MCO* → ROLE:
  • Insurance Risk Management–Payment Reform
  • Hold PPS/Other Providers Accountable
  • Data Analysis
  • Member Communication
  • Out of PPS Network Payments
  • Manage Pharmacy Benefit
  • Enrollment Assistance
  • Utilization Management for Non–PPS Providers
  • DISCO and Possibly FIDA/MLTCP Maintains Care Coordination
PPSs → ROLE:
  • Be Held Accountable for Patient Outcomes and Overall Health Care Cost
  • Accept/Distribute Payments
  • Share Data
  • Provider Performance Data to Plans/State
  • Explore Ways to Improve Public Health
  • Capable to Accept Bundled and Risk–Based Payments
HH #1

HH #2

Other PPS Providers		 → ROLE:
  • Care Management for Health Home Eligibles
  • Participation in Alternative Payment Systems
*Mainstream, MLTC, FIDA, HARP & DISCO

We want to hear from you!

DSRIP e–mail:
dsrip@health.state.ny.us

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http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm

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