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Leveraging DSRIP to Improve Clinical Outcomes and Shift Toward Value-Based Payment

  • M. Johnson

By Mallory Cole

Background

In 2013, the Texas Legislature created The University of Texas Rio Grande Valley (UTRGV) to increase educational opportunities in the surrounding Rio Grande Valley area, located at the state’s southernmost point along the Mexican border.1 The Rio Grande Valley has an estimated population of about 1.5 million residents.2 In conjunction with the school’s founding, the UTRGV School of Medicine was established to provide “health care to a region that has historically been burdened by health disparities.”3 Today, the UTRGV Medical School offers residency opportunities for six hospital-based training programs including family medicine, internal medicine, obstetrics & gynecology, preventative care, psychiatry and general surgery.4 Both attending physicians and residents are directly responsible for performance reporting for Delivery System Reform Incentive Payment (DSRIP) measures with the intention to elicit quality outcome improvement. According to DSRIP records, it is also estimated nearly 60 percent of the patient population at UTRGV are Medicaid/low-income/uninsured enrollees.

 

The Partnership

UTRGV sought to utilize DSRIP funding as a way to encourage their providers and residents to provide culturally competent, high-quality care and a means to possibly support the transition to value-based purchasing (VBP) as well as to train future providers to be successful in this environment.

UTRGV engaged COPE Health Solutions in the fall of 2018, and the two organizations partnered to streamline DSRIP reporting efforts within a month’s time. After stakeholder discussion and rapid current state review, COPE Health Solutions performed an analysis of remaining DY6 milestones and facilitated project management teams to assist in the completion of all necessary deliverables by the reporting deadline, resulting in a drawdown of over $3 million for DY6 alone. Additionally, COPE Health Solutions assessed claims data and measured baseline reports to ensure the on-time reporting of clinical baselines and other reporting requirements for DY7 resulting in an additional $6.6 million draw down.

After capturing Category C baselines, work shifted in the spring toward the development of a Clinical Improvement Strategy for a subset of UTRGV’s clinical quality measures (Category C). Historically, the Rio Grande Valley region has been called one of the “unhealthiest areas in America” with high rates of cervical cancer, obesity, nutritional deficiencies and diabetes.5,6 The UTRGV DSRIP measure selection strategy was tailored to the region’s patient population, including measures like C2-106 cervical cancer screening, C1-113 comprehensive diabetes care and C1-147 preventative care through BMI screenings. COPE Health Solutions provided further reporting assistance for April DY8 period, thus furthering UTRGV’s goals in improving reporting capabilities, care quality and access.

 

Looking Forward

COPE Health Solutions continues to partner with UTRGV to help support their success with the DSRIP program as an initial first step in moving toward more advanced value-based purchasing (VBP) performance. While VBP appears more complex when compared to traditional fee-for-service (FFS), through increased efficiencies, administrative burden and overall cost of care will be diminished overtime.7 Similarly, enabling performance measurement is an integral part to the success of VBP, improving reporting and data analytics capabilities and performance improvement on clinical outcomes is a critical outcome of DSRIP program participation. Performance measurement can be enhanced through increased data sharing and analytic capabilities, as well as transparency in methods of measurement.8 Together, enhanced efficiencies and data driven decision making, along with other VBP principles like rewarding success through risk sharing and partaking in engagement from multiple stakeholder groups, will facilitate a culture of patient-centric care, producing optimal health care outcomes and improving the overall patient experience.

 

Endnotes

1 https://www.utrgv.edu/en-us/about-utrgv/history/index.htm

2 https://valleycentral.com/news/local/report-rio-grande-valley-population-hits-13-million

3 https://www.utrgv.edu/school-of-medicine/our-story/index.htm

4 https://www.utrgv.edu/som/gme/training-programs/index.htm

5 https://www.utrgv.edu/bho/diabetes-registry/statistics/index.htm

6 http://www.nbcnews.com/id/5820571/ns/health-health_care/t/rio-grande-valley-among-unhealthiest-areas/#.XKZezJhKiUk

7 https://hhs.texas.gov/sites/default/files/documents/laws-regulations/policies-rules/1115-waiver/waiver-renewal/1115-waiver-revised-draft-vbp-roadmap.pdf

8 https://hhs.texas.gov/sites/default/files/documents/laws-regulations/policies-rules/1115-waiver/waiver-renewal/1115-waiver-revised-draft-vbp-roadmap.pdf

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