New York’s MRT Waiver Amendment Delivery System Reform Incentive Payment (DSRIP) Plan. Q. Can a provider be a member of more than one PPS? A: Yes. There is no requirement in the DSRIP program stating that a provider or organization can only join one PPS. Providers that serve large geographic areas which cross medical markets may join two (or more) PPS networks to best serve their patients. However, providers who are considering joining multiple PPS should understand that there can be some drawbacks. Firstly, the attribution an organization brings to a PPS will diminish with each additional PPS the provider/organization joins.For example, if a clinic joins two PPS in the same county, the clinic’s attributed members will most likely be split between the two PPS networks it is partnered with. This could harm the clinic’s performance payment negotiations with each PPS, because the clinic will bring fewer lives to each PPS. Additionally, the clinic may see that there are greater administrative and reporting demands placed on the entity as it has to be responsive to two PPS. For more information on attribution logic, see section “Attribution” or the presentation on Attribution and Valuation found here: https://health.ny.gov/health_care/medicaid/redesign/docs/dsrip_attrib_and_ valuation_webinar_slides.pdf Q: Are providers encouraged to work together? If so, what types of providers can collaborate as partners? A: It is a requirement that eligible providers within a region/service area work together on a DSRIP project. Significant community collaboration by Medicaid providers is a key theme of DSRIP and is necessary in order to meet the performance aims of DSRIP. The state will not accept applications from single entities. Q: Will there be collaboration between PPS? A: Yes. Collaboration between PPS is critical to the overall success of DSRIP. Collaboration in general is seen as necessary for ensuring downstream providers are able to achieve clinical integration with PPS, particularly since many downstream providers may be engaged with multiple PPS. For this reason, the extent to which there is project overlap between regions with a similar patient base (based on a single community needs assessment as has been done in Westchester, Brooklyn and Long Island, for example), collaborative efforts between PPS will be a key lever to making sustainable change in a region. Also, from DY1-DY5, PPS will be required to take part in DSRIP Learning Collaboratives. These Learning Collaboratives will take place in person no less than once a year and will foster an environment of mutual assistance. PPS will be encouraged to share best practices and struggles, and receive assistance and guidance from other PPS counterparts on how to best implement and meet the objectives of their DSRIP Project Plans. This will be particularly important as starting in DSRIP DY3, CMS will be evaluating summative statewide performance on DSRIP benchmarks. There will be performance payment reductions across the board to all PPS if those statewide benchmarks are not met. For information click: https://health.ny.gov/health_care/medicaid/redesign/dsrip/webinars_presentations.htm
Posted on: Sat, 27 Dec 2014 09:51:17 +0000
Trending Topics
Recently Viewed Topics
© 2015