DSRIP: Will Governance Issues Stymie Real Healthcare Transformation?

By Patrick Pilch and Arthur Webb

The New York State Health Department’s DSRIP (Delivery System Reform Incentive Payment) program is an ambitious and comprehensive $6 billion Medicaid health reform initiative that is set to transform New York’s healthcare safety net system over the next five years. The details of the program can be found in our earlier blog post.

But how likely is it that real change will occur?

It’s very likely, in our opinion. This initiative stands out from the pack in our 40-plus years of working in New York State. In addition to getting deep support from all of the right places, including Governor Cuomo and the Department of Health, it also encourages real collaboration to work toward a better model of care.

DSRIPs are breaking down silos among doctors and physician groups in primary care, behavioral health and hospitals, so that they work together to organize care for the whole person. The program creates an environment where problem-solving conversations are taking place among peers and, in some cases, competitors.

The energy and potential is high, but challenges persist. Collaboration results in significantly different roles and models for most participants, which can make things uncomfortable, as is common with change.

The powers being given to DSRIP aren’t detailed in state law or regulation, which raises many questions:
  • Where does DSRIP fit into the legal spectrum?
  • How will accountability be ensured?
  • Is it sustainable without some greater clarity on legal structure?
Charles Luband, a partner in Dentons U.S. LLP, raised many of these questions in his presentation at the New York State Bar Association’s Health Law meeting in October. He posits that DSRIP is an authorized legal entity under Special Terms and Conditions of a Section 1115 Waiver granted to the New York State Department of Health by the Centers for Medicare and Medicaid Services.

Governance and accountability concerns linger that will need to be addressed as the DSRIP program evolves and the public has a greater stake in the sustainability of reform:
  • Who will control the system of care that is expected from DSRIPs?
  • How will decisions be made?
  • Who will have the authority to enforce these decisions?
The potential for DSRIP is undeniable for real transformation in healthcare. For it to achieve its full potential, we must encourage frank and open conversations about accountability and governance to keep things moving in the right direction.