WA DSRIP Relying on Community ACOs not Hospital Centric PPSs

NYAPRS Note: A number of states are on the way to implementing DSRIP (Delivery System Reform Incentive Payment) initiatives. See below for a sense of how the design that Washington state has submitted to the federal Medicaid agency (CMS) is mirroring New York’s approach with one important difference.

Their program would rely on community based accountable care organizations in contrast to New York’s reliance on hospital-centric Performing Provider Systems (PPSs). File this under there were/are other ways.

Here’s how Washington’s approach is otherwise very similar to New York’s.

NYAPRS excerpts from WA executive summary:

“Washington State proposes a five-year Medicaid demonstration waiver in partnership with the Centers for

Medicare and Medicaid Services (CMS) under Section 1115 of the Social Security Act...to provide increased flexibility in our Medicaid program and to support upfront investments to transform the health delivery system.

Over five years, Washington will demonstrate that targeted investments designed to deliver whole person care and impact the social determinants of health outside the traditional health care delivery system are critical to achieve the triple aim – better health, better care and lower costs.

Washington seeks a $3 Billion federal investment over five years to fund nontraditional services critical to achieving improved health and sustaining independence for targeted populations, along with other strategic investments that:

  • Bend the Medicaid cost curve by two percentage points below national trends.
  • Reduce institutionalization in acute care hospitals, psychiatric hospitals, and nursing facilities.
  • Improve population health.
  • Accelerate payment reform to pay providers for better health outcomes.”

The state proposes four investment domains that advance Washington’s strategies for sustainable Medicaid transformation.

These include bidirectional integrated delivery of physical and behavioral health, the alignment of care coordination and case management to serve whole person transitional care focused on specific populations, outreach, engagement and recovery supports, trauma informed approaches to address Adverse Childhood Experiences (ACES) and substance use prevention.

“Medicaid transformation will be accomplished through transformational activities at the regional and state levels. At the regional level, to coordinate delivery system reform activities, the State will leverage its partnership with Accountable Communities of Health (ACHs). These regionally organized public-private collaboratives will align priorities, actions, and investments to facilitate and support their memberships to develop and sustain more accountable and integrated care delivery—with improved overall health for Washingtonians.

At the state level, key transformational activities will be implemented, such as: supportive housing and supported employment services, investments in outreach and engagement, and activities designed to delay or reduce the need for Medicaid long term services and supports. These statewide programs will provide a foundation to improve coordination and delivery of Medicaid services. They will enhance effective linkage of coordinated physical and behavioral health, long term services and supports, and other social supports and provide access to services essential to more effectively engaging Medicaid clients in improving their health.”

One other important point: while the state seeks to rely on evidence based approaches, it recognizes that “promising practices that show potential for desirable outcomes based on a well-established theory of change or preliminary analysis” can be used where there is not sufficient data yet, e.g. for ethnic minority and Tribal communities where evidence-based practices have not been fully researched will also be considered.”

This is important because a lot of recovery focused approaches have not received anywhere near the research that other approaches and medications have. These must be similarly regarded as ‘promising practices’ and well supported financially.

Source: http://www.hca.wa.gov/hw/Documents/executivesummary_june2015.pdf