The Affordable Care Act of 2010 (ACA) and subsequent executive actions by the Obama administration accelerated efforts to bring value-based payment to health care. Under the banner of value-based purchasing, federal officials have touted the “triple aim”—improving the quality of care and health outcomes while bending the cost curve.
In the case of Medicaid and value-based payment, Delivery System Reform Incentive Payment (DSRIP) waivers have loomed large. When we reviewed DSRIP developments in 2015, eight states had obtained Section 1115 waivers from the Centers for Medicare and Medicaid Services (CMS) to operate DSRIP or DSRIP-like initiatives. By 2018, the number had grown to 13 with the implementation timeframes for most of these waivers extending into the early 2020s. Five DSRIP initiatives cluster in the Northeast (Massachusetts, New Hampshire, New Jersey, New York, Rhode Island) and another four in the West (Arizona, California, Oregon, Washington). Three are from the south-central region (Kansas, New Mexico, Texas) and one from the Deep South (Alabama).