The Texas DSRIP program: An exploratory evaluation of its alignment with quality assessment models in healthcare

Achieving Triple Aim Outcomes: An Evaluation of the Texas Medicaid Waiver

The Texas Medicaid Waiver, via the Delivery System Reform Incentive Payment (DSRIP) program, has provided a path for Texas to achieve the Triple Aim through its focus on a defined population at the project and system levels, and financial payment policy based on outcomes. Both iterations of the DSRIP program (Waiver 1.0 and 2.0) have helped define populations, created regional collaboration that sets the stage for a true integrator, and provided financial incentives for improving population health, enhancing patient experience, and controlling costs. The flexible design of project menus and measure bundles in DSRIP encouraged a variety of projects, numerous measures of success and (often) overlapping populations of individual served to achieve the ultimate goal of the Triple Aim. This research outlines the major features of Texas DSRIP and demonstrates the Medicaid Waiver effectively contributed to measurable improvements in health, suggesting Texas safety net providers are moving closer to Triple Aim achievement.

Patient safety from the perspective of quality management frameworks: a review

Patient safety is one of the overarching goals of patient care and quality management. Of the many quality management frameworks, Beauchamp and Childress’s four principles of biomedical ethics presents aspects of patient centeredness in clinical care. The Institute of Medicine’s six aims for improvement encapsulates elements of high-quality patient care. The Institute of Healthcare Improvement’s Triple Aim focuses on three aspects of care, cost, and health. Given the above frameworks, the present review was designed to emphasize the initiatives the system has taken to address various efforts of improving quality and patient safety. We, hereby, present a contemplative review of the concepts of informed consent, informed refusal, healthcare laws, policy programs, and regulations. The present review, furthermore, outlines measures and policies that management and administration implement and enforce, respectively, to ensure patient centered care. We, conclusively, explore prototype policies such as the Delivery System Reform Incentive Payment Program that imbues the elements of quality management frameworks, Hospital-Acquired Conditions Reduction Program that supports patient safety, and Hospital Readmissions Reduction Program that focuses on curbing readmissions.

DSRIP's innovation and collaboration in population health management: A cross-sectional segmented time series model

Texas Medicaid Section 1115 waiver approved Delivery System Reform Incentive Payment (DSRIP) program has four categories, namely infrastructure development, program innovation and redesign, reporting of quality improvement outcomes, and population health improvement. A metric of the fourth category, preventable hospitalization rate, was analyzed for a set of eight diagnostic conditions to assess the impact of DSRIP on participating- and non-participating hospitals over two time periods, pre-DSRIP and post-DSRIP, with the help of a cross-sectional segmented time series regression model. Texas Healthcare Information Collection database was leveraged to obtain preventable hospitalization rate data. The dependent variables were preventable hospitalization rates of eight program-specified conditions and the independent variables were time, intervention, and post-implementation intervention. The overall combined preventable hospitalization rate for DSRIP hospitals was observed to decrease by 25.73%, whereas the overall combined preventable hospitalization rate for non-DSRIP hospitals was observed to increase by 37.57%. DSRIP hospitals had invested in coordinating healthcare projects and were subsequently reimbursed by the state for healthcare improvements. The implementation of DSRIP may have had the capacity to decrease preventable hospitalization rates in regions wherein its adoption may have improved the health of the population.

Innovating patient care delivery: DSRIP's interrupted time series analysis paradigm

INTRODUCTION

Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement.

BACKGROUND

A metric of the fourth category, preventable hospitalization (PH) rate was analyzed in the context of eight conditions for two time periods, pre-reporting years (2010-2012) and post-reporting years (2013-2015) for two hospital cohorts, DSRIP participating and non-participating hospitals. The study explains how DSRIP impacted Preventable Hospitalization (PH) rates of eight conditions for both hospital cohorts within two time periods.

METHODS

Eight PH rates were regressed as the dependent variable with time, intervention and post-DSRIP Intervention as independent variables. PH rates of eight conditions were then consolidated into one rate for regressing with the above independent variables to evaluate overall impact of DSRIP. An interrupted time series regression was performed after accounting for auto-correlation, stationarity and seasonality in the dataset.

RESULTS

In the individual regression model, PH rates showed statistically significant coefficients for seven out of eight conditions in DSRIP participating hospitals. In the combined regression model, the coefficient of the PH rate showed a statistically significant decrease with negative p-values for regression coefficients in DSRIP participating hospitals compared to positive/increased p-values for regression coefficients in DSRIP non-participating hospitals.

CONCLUSION AND IMPLICATIONS

Several macro- and micro-level factors may have likely contributed DSRIP hospitals outperforming DSRIP non-participating hospitals. Healthcare organization/provider collaboration, support from healthcare professionals, DSRIP's design, state reimbursement and coordination in care delivery methods may have led to likely success of DSRIP.

LEVEL OF EVIDENCE

IV, a retrospective cohort study based on longitudinal data.