New York Delivery System Reform Incentive Payment (DSRIP) Program

Program Location: 
Albany, NY
Payer Type: 
Medicaid
Payers: 
Medicaid
Accreditation/Recognition: 
NCQA
Description: 

DSRIP is the main mechanism by which New York State will implement the Medicaid Redesign Team (MRT) Waiver Amendment. DSRIP's purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.

The New York Statewide Health Innovation Plan (funded and implemented through the CMS State Innovation Model Test Award)  and DSRIP can be considered synergistic. SHIP focuses on leveraging the work done with the state on the Patient Centered Medical Home (PCMH) by 5 all payers as well as the HIT connectivity being built through the Statewide Health Information Network of New York (SHIN-NY). In this context, SHIP will focus, in part, on building the Advanced Primary Care Model from the work done on the PCMH, building the All Payer Database (APD) to further build the analytics on health care in New York State, and enhancing the reach and utilization of the SHIN-NY to enhance the coordination and transparency of health care. With these three key pieces in place, quality of care can be monitored more efficiently and effectively allowing payment reform to focus on payment for outcomes/payment for performance, one other key goal of SHIP. 

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Payment Model: 

At least two times per year, Performing Provider Systems seeking payment under the DSRIP program shall submit reports to the state demonstrating progress on each of their projects as measured by project-specific milestones 42 and metrics achieved during the reporting period. The reports shall be submitted using the standardized reporting form approved by the state and CMS. Based on the reports, the state will calculate the incentive payments for the progress achieved according to the approved DSRIP project plan. The Performing Provider System shall have available for review by the state or CMS, upon request, all supporting data and back-up documentation. These reports will serve as the basis for authorizing incentive payments to Performing Provider Systems for achievement of DSRIP milestones. 

Incentive payments will be calculated based upon the progress of process milestones/metrics and outcome milestones/metrics. The value of each type of metric type is noted below. As the projects progress, less payment will be allocated to process milestones/metrics and more will be allocated to outcome milestones/metrics. Some payments will be based on submitting required reporting only (Pay for Reporting) and others will be based on attaining specific outcome targets (Pay for Performance). Click here for more information. 

"At the start, doctors will still be paid as they are now, typically with a fee for every service. The doctors will be eligible for bonuses if their teams improve the health of the patients assigned to them, who generally have used them in the past."

- The New York Times, March 2015

Last updated April 2019
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