Improving the Financial Success of a DSRIP Program with “Near Real Time” Measures Reporting
Posted December 5, 2016
Managing a DSRIP program is a complex undertaking encompassing multiple partnering provider types including hospitals, stakeholders in ambulatory care, sub-acute care, home care, health homes, community based organizations, FQHCs, substance abuse / de-addiction centers, and behavioral health facilities. Tracking the performance of these partners and their contribution to the overall achievement of the projects is critical for the success of DSRIP program. Early feedback to non performing providers can lead to remediation & improvement in a timely manner.
Measuring the success of a DSRIP program entails tracking Domains, Projects and finally ,at a granular level, measures. A PPS in New York State (on average) needs to track and improve Domains 1, 2, 3 and 4 representing 9-12 projects with 70-90 measures. Improving the “Achievement Value” of the measures selected will result in improved performance and earning of the greatest possible financial incentives from NY State Department of Health (DOH). Therefore, tracking of measures, especially P4P measures and “High Performance” measures in Near Real Time, is important for performance improvement.
NY DOH is planning to provide analytics and dashboards to the PPS’ after Medicaid claims have been adjudicated with a possible lag of 6-9 months. These dashboards will provide insights into how the PPS has performed in the prior reporting period, but will, in all likelihood, not be adequate for the PPS’ to improve performance on a regular basis. Without more timely data (every month) it would be difficult to realize the maximum “Achievement Value” and thus financial incentives from the DOH for the following reasons:
- A lag period of 6-9 months is significant since it’s very difficult to make improvements with results that are greater than 3 months old;
- Performance at the PPS level only will be provided. Thus a PPS will be in the dark on how their partners are performing individually;
- Analytics will not enable drill down capabilities to the patient level to appreciate various gaps in care or utilization patterns.
According to Joseph Conte, Executive Director at the SI-PPS, “Data is Oxygen” to manage and improve care. At the Staten Island PPS, SpectraMedix is leveraging various data sets available to the PPS, including Medicaid billing data (different from adjudicated claims data) and clinical data (EMR data) of attributed patients from lead providers to calculate and report on measures in near real time. The solution is also being expanded to collect data from additional providers via billing feeds and the HIE to enable SI-PPS to have a holistic view of the performance of their participating providers on a monthly basis, allowing improvements and adjustments to be made in a timely manner.
A “Comprehensive out of the Box solution” that enables near real time calculation and reporting of DSRIP measures will allow a PPS to improve the care it provides and maximize its incentives. Therefore, it should be an integral component of a PPS’ Information Technology strategy.