Delivery System Reform Incentive Payments: Summative Evaluation Report

Delivery System Reform Incentive Payments: Summative Evaluation Report

Medicaid 1115 Demonstrations
Published: Aug 30, 2020
Publisher: Centers for Medicare & Medicaid Services
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Authors

Heather Dahlen

Christina Ribar

Natasha Reese-McLaughlin

Aaron Swaney

Key Findings
  • The evaluation focused on several key outcomes: shifting care away from acute care settings; increasing use of primary, preventive, and behavioral health services; and improving clinical care processes. Findings were mixed across and within states. For example, California saw increases in emergency department visits and no significant changes in child or adult outpatient care. But New York, which set ambitious demonstration goals related to reducing avoidable hospital use, showed that progress is possible. The state saw decreases in emergency department visits and increases in adult outpatient care, reducing reliance on care in costly acute inpatient care settings.

Medicaid Delivery System Reform Incentive Payment (DSRIP) demonstrations, implemented under section 1115 demonstration authority, encourage hospitals and other health care providers to transform the delivery system and thereby improve quality of care and patient outcomes, reduce the cost of care, and prepare providers for value-based payment. Although DSRIP demonstrations share the same broad goals and operational framework, they vary considerably across states and have evolved over time. This is the summative evaluation of four DSRIP section 1115 demonstrations in California, New Jersey, New York and Texas. The report addresses four research questions about the overall effect of the DSRIP demonstration on key outcomes related to transforming the delivery system and clinical processes in each state: 1. What is the overall effect of DSRIP demonstrations on shifting care away from emergency department (ED) and inpatient settings? 2. What is the overall effect of DSRIP demonstrations on use of primary care and preventive services? 3. What is the overall effect of DSRIP demonstrations on use of behavioral health services? 4. What is the overall effect of DSRIP demonstrations on clinical care processes?

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