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By Athena Mandros

Almost two years ago we wrote about the delivery system reform incentive payment (DSRIP) program under Medicaid, which at the time was a relatively new model (see What Is DSRIP & Why Does It Matter?). Since then we’ve seen second and third iterations of the program. Watching the evolution of this program over the years, I’ve found that the DSRIP projects being implemented across the country can serve as a guide for the performance measures that matter the most to the future of value-based purchasing.

As a quick refresher, DSRIPs use Medicaid 1115 demonstration waiver funding to pay provider organizations and hospitals for meeting milestones related to delivery system reform projects they implemented. Currently there are eight states (California, Kansas, Massachusetts, New Hampshire, New Jersey, New York, Texas, and Washington) with approved DSRIP programs, and two states (Virginia and North Carolina) with proposed DSRIP programs.

State DSRIP programs use a variety of outcome measures to gauge the success of delivery system reform projects. Generally metrics are linked to different projects and participating provider organizations must report on the metrics related to the projects they implemented. Measures can span physical, behavioral health, and social services.

These measures serve two important functions. The first is to indicate what the state and other stakeholders see as the biggest pain points and areas that need to be addressed. The second is that they represent examples of the kind of measures provider organizations will be expected to adopt under value-based purchasing arrangements. For many provider organizations, participation in DSRIP programs are the first time they have adopted pay-for-reporting and other types of alternative payment arrangements.

So what were the top five most popular measures included in state DSRIP programs?

  1. Screening for clinical depression and follow-up (six states)
  2. Initiation of alcohol and other drug dependence treatment – percentage of adults who received treatment within a certain number of days of diagnosis (five states)
  3. Tobacco and smoking cessation counseling (five states)
  4. Follow-up after hospitalization for mental illness- 7 day (five states)
  5. Follow-up after hospitalization for mental illness- 30 day (five states)

For a look at all ten of the behavioral health measures most commonly used in DSRIP programs, check out our new report, Overview Of State DSRIP Programs: The 2017 OPEN MINDS Market Intelligence Update. The report includes all the the latest information about the status of the DSRIP program, including an overview of information on total funding, the number and type of participating provider organizations, number of available projects, and whether or not the programs have an alternative payment model component. Additionally, the report includes all the information you need to know about how states are measuring performance, including an analysis of the top behavioral health measures being utilized in state DSRIP programs.

Like many performance measures currently being used in the behavioral health field, these measures don’t focus on outcomes so much as they focus on process (see Tackling The Thorny Issue Of Behavioral Health ‘Value’ and For All The Performance Measurement, Are We Really Measuring Performance?). But I do think they reflect the “state of the state” – and that Medicaid in particular and payers in general are taking performance measurement in this area.

For more on value-based purchasing, join me on September 27 at The OPEN MINDS Executive Leadership Institute for the session, “Meta-Leadership In Action: Creating Innovative Partnerships With Managed Care Plans,” led by my colleague and OPEN MINDS Senior Associate Ken Carr.

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