Delivery System Reform Incentive Payment

State of Texas Overview

Texas Health and Human Services Commission (HHSC) has received federal approval of a waiver that allows the state to expand Medicaid managed care while preserving hospital funding, provides incentive payments for health care improvements (DSRIP) and directs more funding to hospitals that serve large numbers of uninsured patients (Source: Texas Health and Human Services Commission)

• DSRIP Pool Payments are incentive payments to hospitals and other providers that develop programs or strategies to enhance access to health care, increase the quality of care, the cost-effectiveness of care provided and the health of the patients and families served.
• Regional Healthcare Partnerships (RHP) help manage local DSRIP projects and promote system transformation (improved access, quality, cost-effectiveness, and coordination).
• Texas has 20 RHPs divided according to geography and population density.

Emergency Department Navigation Project

This project will provide patient navigation services in the Emergency Room to targeted patients who are at high risk of disconnecting from institutionalized health care services or are identified as not having a primary care physician and/or medical home to address their needs. This project will increase the number of people trained and deployed for innovative health services such as social workers. This project will connect patients to primary and preventative care and increase access to care management and/or chronic care management.

Key Program Objectives

• Education to targeted patients to of appropriate ED utilization
• Connect patients with PCP (primary care provider)
• Improve overall health of high risk patients

Diabetes Management Project Overview

This project will apply evidence-based care management models for ED patients identified as having high-risk health care needs associated with diabetes. The project will develop chronic disease management education, protocols, and self-management criteria for patients through a multi-disciplinary process. These protocols will be implemented in the hospital through new outpatient and inpatient education services, through the network of primary care physicians and made available to community clinics supporting diabetic patients.

Historically, patients that do not effectively manage their diabetes tend to develop chronic diabetes complications, which leads to more expensive medical care. This program will be implemented to help those who need education on managing diabetes and providing monitoring services where they are being treated. Patients will be identified by partnering with primary care physicians, community clinics and inpatient nurse/care managers.

Key Program Objectives

• Develop engaged patient care team to address diabetic patients (nursing, physician/practitioner, finance, senior leadership, nutrition, diabetes education, pharmacy, etc.)
• Provide diabetes self-management education and support for diabetic patients managing their disease.