Medicaid Delivery & Payment Reform: An In-Depth Look at Two Leaders

WASHINGTON, D.C. and NEW YORK, NY (March 7, 2019) – An analysis released today evaluates Medicaid delivery system and payment reform demonstrations in New York and Massachusetts and concludes that a strong working partnership between Medicaid and community health centers will prove central to successful reform. The authors say that while it is still too early to evaluate these Delivery System Reform and Incentive Payment (DSRIP) projects and their impact on health care cost, quality and health outcomes, early results provide valuable insight for other states and national policymakers involved in the effort to transform the Medicaid program. Researchers at the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health (GW Milken Institute SPH) and Viaduct Consulting, LLC conducted the analysis.

DSRIP programs, carried out under the demonstration authority of Section 1115 of the Social Security Act, enable states to test new approaches to health care delivery and payment aimed at improving health care quality and cost effectiveness. Ten states have ongoing DSRIP projects; because each is unique, the researchers focused on two leaders – Massachusetts and New York. The study, conducted over the spring and summer of 2018, included background research and interviews with state officials, and in-person focused discussions with health centers and primary care association leaders.

“Community health centers have been extensively involved in payment and delivery reform efforts around the country,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH, one of the study’s authors. “Our analysis provides insight into both the local and state-level aspects of this involvement in helping states achieve lasting and deep health system change.”

Rosenbaum and her team found several key lessons from the evaluation of the DSRIP projects in New York and Massachusetts:

  • Medicaid and community health centers share a mission and are mutually dependent. This historic relationship can help bring about substantial change.  Because delivery and payment reform turn on high-value primary care integrated with social services, health centers play a key role, since from the beginning, health centers were designed to provide exactly this type of bridge.
  • Local conditions and circumstances influence the ways in which health centers become part of DSRIP experiments. Health centers in both states have assumed leadership roles, although in distinctly different ways. For example, health centers in New York have played a central role, in partnership with other providers, in advancing the state’s goals of addressing population health and integration. In Massachusetts, health centers were extensively involved in early program design and also are piloting new, primary-care centered delivery system models.
  • A strong working partnership between Medicaid and community health centers can produce important benefits relevant to payment reform, since a carefully designed policy partnership creates an opportunity to strengthen health center performance while also testing alternative payment models to Medicaid’s traditional “federally qualified health center (FQHC)” encounter-based payment structure.

“New York and Massachusetts are national leaders in delivery and payment reform,” said Vikki Wachino, MPP, principal of Viaduct Consulting, former Director of the Center for Medicaid and CHIP Services, and one of the co-authors of the study. “Their commitment to collaborating with health centers will inform state and national efforts to strengthen systems of care for vulnerable populations.”

The New York and Massachusetts case studies illustrate the importance of community health centers in distinct DSRIP approaches, and underscore the importance of comprehensive primary care and integrated service delivery in transformational payment and delivery reform models.

“Successful health care delivery transformation hinges on a strong base of comprehensive primary care. While New York and Massachusetts differ in approach, the DSRIP experience in each state illustrates the singular importance of health centers in advancing health care quality and improving population health,” said Feygele Jacobs, DrPH, President and CEO of the RCHN Community Health Foundation, which supported the study.

The analysis, “Community Health Centers and Medicaid Delivery and Payment Reform: A Closer Look at Massachusetts and New York,” can be accessed here.

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The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the Milken Institute School of Public Health at The George Washington University.

The RCHN Community Health Foundation is the only foundation in the U.S. dedicated solely to community health centers. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship.

The Milken Institute School of Public Health at the George Washington University is the only school of public health in the nation’s capital.