Key Themes From Delivery System Reform Incentive Payment (DSRIP) Waivers in 4 States

Appendix A: List of Expert Interviewees and Interview Guide

 

California:

Toby Douglas, Mari Cantwell, Neal Kohatsu, California Department of Health Care Services (November 17, 2014)
Peter Harbage, Harbage Consulting (November 13, 2014)
Erica Murray, California Public Hospital Association (November 24, 2014)

Massachusetts:

Amanda Cassel Kraft, Laxmi Tierney, Taya Mashburn, MassHealth (December 12, 2014)
Brian Rosman, Health Care For All (November 12, 2014)

New York:

Jason Helgerson, New York State Department of Health (November 14, 2014)
Andy Cohen and Chad Shearer, United Hospital Fund (October 23, 2014)
Elisabeth Benjamin, Community Service Society of New York (October 28, 2014)
Melinda Dutton and Patricia Boozang, Manatt Health (November 3, 2014)

Texas:

Lisa Kirsch and Ardas Khalsa, Texas Health and Human Services Commission (December 11. 2014)
Melissa Rowan, Texas Council of Community Centers (December 1, 2014)
Anne Dunkelberg, Center for Public Policy Priorities (December 2, 2014)
Maureen Milligan, Teaching Hospitals of Texas (December 10, 2014)

High Level Questions

1. What are the strengths of your State’s DSRIP waiver?
2. What are the weaknesses?
3. What are the biggest challenges and barriers related to implementation of your DSRIP program/to delivery system and payment transformation?
4. What would you tell CMS or others States to do differently in future DSRIP waivers?
5. How does the DSRIP initiative relate to other delivery system reforms in your State?

For State Officials

1. Why did your State pursue DSRIP?
2. What was your role in the design and/or implementation of your State’s DSRIP waiver?
3. What are the key features of your State’s DSRIP waiver? What distinguishes your initiative from other States’?
4. How did your State approach transparency and opportunities for public input? Were these activities focused at the State level, the provider level, or both?
5. What are the two or three top goals your waiver is meant to achieve?
6. How did you decide which providers could receive DSRIP funding?
7. How is funding tied to waiver goals and how are funds allocated across providers?
8. What are some of the key metrics to demonstrate progress in meeting goals? Are there some DSRIP projects or initiatives that have proven to be more successful than others and why?
9. What oversight and evaluation processes do you have in place to measure progress in meeting goals? Do you think the evaluation/oversight mechanisms, from a State perspective, are sufficient?

• What has been the experience in providers meeting metrics?

10. How does your DSRIP waiver relate to the current delivery system infrastructure and other delivery system reforms (i.e., managed care, pay for performance, SIM grants, etc.)?
11. What are the biggest challenges you’ve faced implementing DSRIP (operationally, administratively, etc.)?
12. How do you see the DSRIP waiver playing out over the next 5 years?
13. Do you think this model is sustainable in the long run? What changes would you make for a renewal?
14. What can you say about how DSRIP is affecting outcome measures (i.e., population health, clinical improvements, access to primary care, etc.)?
15. What is the effect of the Affordable Care Act and the Medicaid expansion on DSRIP?

Financing

16. What are the allowable uses of DSRIP funding in your state?
17. How do you control how DSRIP money is spent?
18. How does DSRIP fit in to the aggregate budget neutrality calculations for the waiver? What challenges arose in establishing budget neutrality? How are you ensuring budget neutrality over the course of the waiver?
19. What did you use as State matching funds?
20. What have been the financial implications of implementing DSRIP in your State?

For Providers

1. Please tell us a little about your organization—how big are you, who are your key patient populations, what is your service area?
2. Please tell us about your participation in your State’s DSRIP waiver:

• Are you leading an application, or partnering with a leading hospital? What were the criteria for participation in your State’s waiver?
• What governance structures are in place between the different partners in your program? How closely are you working together on program planning and implementation?
• What are the goals and focus areas of your DSRIP program?
• How many enrollees do you expect it will reach?
• How much funding are you expecting to get or have you received?
• How far along are you in planning and/or implementation?
• What are the major metrics being used to evaluate your program’s performance? How are those metrics tied to DSRIP funding?

3. Are there specific DSRIP initiatives or projects that have proved to be more successful than others?
4. What actions were necessary to implement DSRIP (i.e. new systems, staff training, new staff, coordination across stakeholders, etc.)?
5. What have been the major challenges and opportunities with DSRIP?
6. How do you think your practice will be impacted when DSRIP funding ends? How are you preparing for this?
7. What is the effect of the ACA and the Medicaid expansion on DSRIP?

For Advocates

1. What are the implications for beneficiaries regarding DSRIP waivers in your State?
2. What opportunities have you had to participate in the decision-making process concerning implementation?
3. From a beneficiary’s perspective, what are areas that are working well and what could be changed to make DSRIP work better?
4. How do you see DSRIP connecting with other delivery system reforms in your state?
5. What additional tools do you think advocates need to ensure DSRIP waivers help beneficiaries? How much access and how easy to understand are the reports on meeting various metrics?
6. What is the effect of the ACA and the Medicaid expansion on DSRIP?

For Texas Stakeholders

1. How does the DSRIP waiver intersect with Texas’s decision to not expand Medicaid?
2.  How do you think this decision will play out in the long run?