Welcome Back Kotter: New York ’ s next 1115 Waiver

The objectives of DSRIP 1.0 – a laundry list of HEDIS measures – made the program difficult to manage “on the ground” and too tightly tied to medical measures of success. Too many choices.  PPS were given choices about which projects they would work on – and by extension – which projects would be funded and measured. The projects were tactically expressed – and therefore too prescriptive – not just defining goals to be achieved – but presuming that DOH knew how goals would best be achieved.  In many cases – this mismatch between what to do and how it would be done was the cause of great frustration.  While DOH and CMS looked for accountability, they actually handcuffed the program by instantiating accountability as prescriptive demands that simply didn’t fit the reality on the streets.  Any innovator knows that learning and agility are imperative guiding principles.  This was largely absent from the program –  it was waterfall from the start. Too many dollars (going to the wrong places).  This is likely the paragraph that will get me in the most trouble. Here goes:  the front-loading of the DSRIP program caused dollars to go to PPS sponsors for setting up the program and for checking boxes (literally – “we had a meeting with so-and-so”) to satisfy reporting requirements and subsequent payments. These dollars were permitted to flow to sponsoring organizations (most of them medical care systems) i...
Source: Docnotes - Category: Primary Care Authors: Tags: Health Politics Technology 1115 DSRIP VBP Source Type: blogs