In December of 2011, the State of Texas requested that the Centers for Medicare and Medicaid Services (CMS) approve what is called an 1115 Waiver for our state. It was approved. This particular waiver, part of the federal Medicaid program, allows states to deviate from the prescribed Medicaid program and try different approaches to care delivery, and CMS provides funding that can be used by providers to facilitate the new approaches.

The 1115 Waiver program has two major components. One is a fund that helps with uncompensated care, and the other is called Delivery System Reform Incentive Payment (DSRIP). The purpose of DSRIP is to encourage providers to transform delivery practices and improve the quality of patients’ health, patient experiences and provide cost-effective treatments. Texas Tech University Health Sciences Center School of Medicine has developed the following six DSRIP projects here in Lubbock.

Family Medicine Accelerated Track/Resident Program/Impact Clinic
Project objective: establish/expand primary care training programs with an emphasis in communities designated as areas with a health care provider shortage

After-Hours Pediatric Nurse Call Service
Project objective: establish/expand convenient access to the appropriate level of care or medical advice to reduce emergency department use for non-emergency conditions and increase patient access to health care

Mid-Level Behavioral Health Certification Program
Project objective: expand high impact specialty care capacity in most-impacted medical specialties

Patient Intake Clinic/Clinical Decision Support Engine/Coronary Risk Evaluation Clinic
Project objectives: implement innovative evidence-based strategies to increase appropriate use of technology and testing for targeted populations

Dashboard/Data Warehouse
Project objective: design, develop and implement a program of continuous, rapid process improvement that will address issues of safety, quality and efficiency

Patient Navigation Service
Project objective: provide navigation services to targeted patients who are at high risk of disconnect from institutionalized health care

DSRIP initiatives work by providing a federal match of funds after “local” funds are provided (roughly 40/60), and providers receive the federal match when performance metrics associated with each project are met. During the early phase of a project, these metrics focus on system redesign and/or infrastructure development, and in later phases, focus on outcome measurements. I am pleased to say that we are current on virtually all of our metrics. I wish to recognize Paul Fowler for his work in overseeing these projects and in working with key TTUHSC faculty who are serving as project champions.

Our DSRIP projects have helped fill the gap in certain areas like primary care and behavioral health. The waiver expires on September 30, 2016. I personally would like to see Texas Health and Human Services Commission work with CMS to renew the 1115 Medicaid Waiver as it is demonstrating daily a good financial return and overall benefit to the citizens of Texas.