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Aligning incentive payments with outcomes: lessons from a Medicaid Section 1115 waiver program
Summary
States are innovating Medicaid programs using Section 1115 waivers to implement Delivery System Reform Incentive Payment (DSRIP) programs. These programs withhold payment until performance metrics are met, aiming to transform Medicaid and control costs.
Area of Science:
- Health Policy
- Healthcare Administration
- Public Health
Background:
- Section 1115 waivers allow states to innovate Medicaid programs.
- Delivery System Reform Incentive Payment (DSRIP) programs are a key innovation.
- These programs aim to transform healthcare delivery and control costs.
Purpose of the Study:
- To examine the implementation and impact of Section 1115 waivers and DSRIP programs.
- To analyze the characteristics and goals of state-specific DSRIP initiatives.
- To assess the potential of these programs in transforming Medicaid and managing expenditures.
Main Methods:
- Analysis of state Medicaid waiver applications and DSRIP program designs.
- Review of federal funding mechanisms, structures, and performance metrics.
- Case study approach, exemplified by New York's Finger Lakes Performing Provider System.
Main Results:
- States are utilizing Section 1115 waivers to create diverse DSRIP programs.
- Key features include performance-based payment withholding.
- New York's DSRIP serves as a model for national Medicaid transformation efforts.
Conclusions:
- Section 1115 waivers provide a pathway for significant Medicaid program innovation.
- DSRIP programs represent a structured approach to improving healthcare delivery and financial sustainability.
- The New York DSRIP model is being closely monitored for broader applicability.
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