Exploration of the Evolving Federal and State Promise of Delivery System Reform Incentive Payment (DSRIP) and Similar Programs

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March 2018

Since 2010, 12 states have used Section 1115 waiver authority to implement Delivery System Reform Incentive Payment (DSRIP) programs, which direct Medicaid payments toward provider-led efforts designed to lower costs and improve quality of care and health outcomes. As of June 2017, up to $48.4 billion in state and federal funds have been approved to support eligible providers participating in DSRIP and DSRIP-like programs in 12 states.

As new DSRIP programs have been approved, the design of these programs has evolved. In 2016 and 2017, the National Academy for State Health Policy (NASHP), under contract to MACPAC, conducted a 12-month project to explore the evolution of DSRIP, examining DSRIP’s alignment with other initiatives, its financing and sustainability, and Medicaid’s role in delivery system transformation.

This report highlights the findings of that project and explores the similarities and differences between programs approved before 2014 and those approved in or after 2014. It provides a cross-state analysis of DSRIP programs and describes implementation from a variety of perspectives, including those of federal and state officials, providers, health plans, and evaluators.

For more information, read the issue brief describing the design and structure of DSRIP programs here.

Publication Type: Contractor Reports

Tags: delivery system reform, fee for service, financing, hospitals, managed care, oversight, payment, safety net providers, Section 1115 research and demonstration project waivers, spending, supplemental payments, value-based purchasing