Delivery System Redesign

Delivery System Reform Incentive Payment (DSRIP) initiatives are part of broader Section 1115 Waiver programs and provide states with significant funding that can be used to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries.  While they originally were more narrowly focused on funding for safety net hospitals and often grew out of negotiations between states and HHS over the appropriate way to finance hospital care, they increasingly are being used to promote a far more sweeping set of payment and delivery system reforms. This brief examines similarities and difference across key elements of DSRIP waivers in six states – California, Texas, Kansas, New Jersey, Massachusetts, and New York.
 

Youth with complex behavioral health needs face a range of challenges and often receive services from multiple agencies that do not always coordinate services and care plans. Care Management Entities (CMEs) are designed to coordinate services provided by state agencies, and ensure services are comprehensive and not duplicative. This new Implementation Guide provides information about the CME design process for states interested in implementing or improving CMEs for youth with complex behavioral health needs. The guide focuses on experiences of the three CHIPRA quality demonstration states, Maryland, Georgia, and Wyoming, who are using funds to implement or expand CMEs.
 

Narrow networks contain a smaller number of providers and in-network facilities than traditional provider networks, typically resulting in lower premiums. This paper assesses the benefits and risks of a range of policy and regulatory options available to federal and state policy-makers on these narrow networks. The development, review and oversight of health plan networks involves trade-offs between premium costs and consumers’ access to and choice of providers. This paper makes clear that there is no current regulatory approach that can satisfy all stakeholders, but with the right balance between consumer choice and cost containment, consumers can receive quality care at an affordable price through narrow networks.

The Institute of Medicine (IOM) and 11 health systems have developed a checklist to help health systems provide high-value health care — better results with lower costs

This report finds that America's health care spending varied widely across the country in 2009, with New England and the Midwest having the highest personal spending per capita and the Rocky Mountain and Southwest regions recording the lowest.