By Ted Shaw, President/CEO, Texas Hospital Association
From October 2018 to September 2019, a coalition of health care providers in southeast Texas surpassed its goal of reducing patients’ glycated hemoglobin levels, an important marker of how well a person is managing their diabetes.
With funding from the Delivery System Reform Incentive Payment program through Texas’ Medicaid 1115 Waiver, local hospital emergency departments, community paramedics, the local health department, a federally qualified health center and social service agencies partnered to provide care coordination, in-home assessments, education classes and referrals for social services to help their community better manage diabetes.
The prevalence of diabetes, heart disease, asthma, cancer, and cardiovascular disease is high among residents of southeast Texas and across the state. Chronic disease management, care coordination, and behavioral health care are statewide health care issues. But how providers best address those concerns varies based on the specific needs of the communities they serve.
Since 2012, DSRIP has injected more than $20 billion in state and federal supplemental Medicaid payments to support innovative solutions and infrastructure improvements for Texas’ health care safety net.
It incentivizes hospitals and other providers to collaborate. Through alliances known as regional healthcare partnerships, they drive transformation to meet the unique health care needs of their respective communities.
Funded by DSRIP, a clinic serving a populous urban area can extend its hours to ensure care for the large volume of patients seeking care. A rural community, on the other hand, can deploy mobile clinics to reach and treat patients who lack access to reliable transportation.
DSRIP continues to transform care delivery across Texas’ 20 regions. Texas hospitals, the state, and the many health care providers who serve Medicaid enrollees and the uninsured are identifying ways to sustain and extend these delivery system reforms before DSRIP funding ends in September 2021.
On Oct. 1, Texas’ annual DSRIP allotment decreased by $200 million to $2.91 billion. By Oct. 1, 2020, DSRIP dollars will decrease another $420 million to $2.49 billion before funding is eliminated entirely on Oct. 1, 2021.
Texas hospitals provided input on the Texas Health and Human Services Commission’s plan to transition DSRIP. The plan lays the groundwork to develop strategies, programs, and policies to sustain DSRIP successes and for emerging areas of innovation in health care.
Although the plan is a positive step forward, the state still needs to provide a clear strategy to continue services for the uninsured individuals that DSRIP currently serves. For a state that leads the nation in the number and percentage of uninsured residents, access to care for the uninsured needs to be a priority.
Without additional funding for the uninsured, hospitals have little recourse: Scaling down DSRIP-funded services or tightening their budgets to reduce costs. That only decreases access to care.
Texas hospitals’ priorities for the transition are straightforward.
- Ensure access to care for the uninsured and build DSRIP successes for Medicaid enrollees into existing Medicaid managed care structures.
- Preserve these federal payments for hospitals and other providers so they can continue providing essential care.
- Leverage successful delivery system reforms and projects that reward collaboration among local providers.
- Support new programs and initiatives, through Medicaid or other sources, to reduce Texas’ high rate of uninsured individuals.
While THHSC works with the Centers for Medicare & Medicaid Services to finalize the transition plan by March 2020, Texas hospitals need to continue identifying alternative payment sources and programs to ensure access to quality care for the state’s most vulnerable Texans.