In 2010, California’s 21 public healthcare systems (PHS) took a bold and collective step to transform and streamline their complex delivery systems. The new federal pay-for-performance initiative was called the Delivery System Reform Incentive Program (DSRIP) and it was the first of its kind in the country. It was part of California’s 2010 Medicaid waiver titled “The Bridge to Reform.” Since then, the Centers for Medicare and Medicaid Services (CMS) has approved DSRIPs in Massachusetts, Texas, Kansas, New York, New Jersey, and New Hampshire with Washington pending review.
Why is DSRIP important to CAP members and their practices? California’s 21 PHS include county-owned and operated facilities and University of California medical centers in 15 counties where more than three-fourths of the state’s population lives. Engagement with these facilities and medical centers is part of life for CAP members.
California’s PHS serve more than 2.85 million patients annually, provide 40 percent of all hospital care to the state’s uninsured, and provide 10 million outpatient visits each year. They operate primary and specialty clinics, trauma and burn centers, and train more than half of all new doctors in the state. With such breadth and depth of responsibility, their embracing DSRIP made perfect – and courageous – sense.
PHS are transforming primary care from a reactive model, focused on patients who arrive with serious conditions, to a more proactive and preventive model. This new approach uses medical homes to coordinate care, disease management registries for systematic monitoring and management, and chronic disease management models. Throughout the course of the DSRIP, all of California PHS have decreased the rate of diabetes patients being hospitalized for short-term complications by 20 percent.
PHS are broadening the scope of care, using DSRIP as an opportunity to embrace population health by improving preventive health programs in a few specific areas, including pediatric weight screening and mammography. The program is now providing mammography services to more than 42,000 who would not have been screened otherwise.
The work of CAP members, committees, and staff on patient safety, transitions of care, the patient experience, use of technology, EHR implementation, effective communication modalities, and other areas, is aligned with DSRIP. The work reflects CAP’s sensitivity to the environments in which members practice and CAP’s leadership in producing publications and programs to support members’ practices and participation in California’s dynamic system reform and redesign.
PHS are addressing urgent improvements needed in inpatient safety through a focused effort to reduce hospital-acquired infections and complications. Central line associated bloodstream infections have averaged a 17 percent decline in PHS acute care units and a 22 percent drop in their intensive care units. The typical PHS experienced a 17 percent decrease in sepsis mortality.
All systems are required to report on the same 21 measures spanning the areas of patient experience, effectiveness of care coordination, prevention, and health outcomes of at-risk populations (e.g. blood sugar levels in patients with diabetes).
The work of CAP members, committees, and staff on patient safety, transitions of care, the patient experience, use of technology, EHR implementation, effective communication modalities, and other areas, is aligned with DSRIP. The work reflects CAP’s sensitivity to the environments in which members practice and CAP’s leadership in producing publications and programs to support members’ practices and participation in California’s dynamic system reform and redesign.
The last five years have laid the groundwork for transformation by proving that delivery system reform incentive programs work and by doing it in a way that will lead to even stronger outcomes if this momentum is maintained. The next five years are critical if the public healthcare systems are to build on this foundation and more fully transform them into high performing health systems that provide timely access to safe, high-quality, and effective care for the many patients who rely on them. On December 30, 2015, CMS approved Medi-Cal 2020, a five year renewal of California’s Medicaid waiver, designed to give public systems the incentive and opportunity to achieve their longterm strategic goals. CAP members will continue to play their part as leaders in providing safe and effective patient care.
Sources:
- California’s Delivery System Reform Incentive Program 2010-2015 Successes to Build On
- Issue Brief: The Medi-Cal 2020 Waiver and the Work Ahead for Public Health Care Systems
- California Public Hospitals and Health Systems
- California Health Care Safety Net Institute, Oakland
Carole Lambert is vice president, Practice Optimization and Residents Program Director for the Cooperative of American Physicians. Questions or comments related to this article should be directed to clambert@CAPphysicians.com.