The following blog post was written by Karen Joncas, a Healthcare Transformation Coordinator at RMS.


Across the country, health care and community resource providers have joined together to transform our health care delivery systems, reducing the upward cost curve of Medicaid spending while ensuring access to appropriate, quality care. States have been given the opportunity to reinvest federal savings in programs, which at the highest level, are designed to meet the triple aim objectives set by the Institute for Healthcare Improvement (IHI) of improving population health, improving patient experience of care and reducing per capita cost. One key approach being implemented here in New York State is the Delivery System Reform Incentive Program (DSRIP), which specifically targets how healthcare is provided to Medicaid patients.

New York State has structured its DSRIP initiative to promote coordinated community networks of care called Performing Provider Systems (PPS). Performing Provider Systems combine providers of hospital care, primary care and community resources that service a community’s Medicaid population. Each PPS submitted an application to New York State, identifying transformational initiatives based on its Community Needs Assessment, which would meet the primary goal of reducing avoidable hospital care by 25% over five years. This process took place in 2014. Avoidable hospital use includes reducing preventable emergency room use, reducing preventable hospital re-admissions, and focusing on preventive care. Funding for eligible providers is paid throughout the five-year transformation DSRIP program and is based on the PPS’ progress in meeting milestones toward achieving stated goals. At several points over the five-year period of the program, PPS must supply the State with metrics and benchmarks to assess their progress. Now that PPS’ across the country are firmly entrenched in DSRIP, there are additional roles for market research firms to assist in evaluating performance or other assistance in meeting their goals. Specific research roles include community engagement activities and patient experience measurement.

Throughout the DSRIP process, stakeholder and community engagement is critical to the overall success of the program. Stakeholders include 1) patients uninsured or insured by Medicaid, 2) healthcare workers and providers that serve the Medicaid community, 3) representatives from community resource organizations and 4) community residents with commercial health insurance. The processes used to engage these stakeholders include individual in-depth interviews (IDI’s), focus groups, and surveys. One unique way to engage community stakeholders in “real time” is by using a pre-qualified, on-line panel recruited and managed by the market research firm. These methods allow for benchmarking and longitudinal tracking required to report performance against stated goals.

At the conclusion of the DSRIP program, it is expected that the health care delivery system targeting Medicaid patients, as well as ambulatory care, will provide accessible, high quality healthcare in the most appropriate setting and de-emphasize care provided in the hospital. One means of recognizing successful transformation is through receiving National Committee for Quality Assurance’s (NCQA) Patient-Centered Medical Home recognition (PCMH). PCMH recognized practices proactively engage their patients, including Medicaid covered patients, in achieving the IHI triple aim goals. To that end, it is expected that primary care practices participating in the DSRIP will become PCMH 2014 Level 3 recognized no later than DSRIP’s Year 3.

Another way to incorporate patient experience outcome metrics is through the utilization of the CG-CAHPS survey tool. The survey is administered to patients to assess any disparities in the patient experience of care. Using a certified CMS vendor to administer the survey provides benchmarks and longitudinal change information needed for improving process and optimizing patient experience.

RMS Healthcare, a division of Research and Marketing Strategies, Inc. (RMS) has a successful history of assisting practices in obtaining Patient-Centered Medical Home recognition, and is uniquely qualified to provide assistance to a PPS. For further information on services we can offer to your PPS, please contact us at 1-866-567-5422.