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US: Medicaid reform allows hospital collaboration

By  |  April 13, 2017

New York health-care providers are working together under a Medicaid waiver program that looks to improve care, reduce costs and potentially provide cover from federal antitrust laws.

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    Just how much the health of Medicaid beneficiaries will be improved and how much antitrust law protection the providers will enjoy remains to be seen. Early indications, however, support the conclusion that patients, providers and the state are satisfied that there is real clinical integration between providers that have contracted together to serve Medicaid managed care populations.

    Clinical integration is an important component of the New York program, called the Medicaid Delivery System Reform Incentive Payment (DSRIP) program, because it is one recognized vehicle for providers to collaborate to provide care more efficiently and be able to jointly contract with payers without being charged with fixing prices in violation of federal antitrust laws.

    Joseph Conte, SIPPS’s executive director, said the DSRIP program’s move from traditional fee for service to a new value-based payment structure could also lead to less overutilization of hospitals and more cooperation between providers that could drive better outcomes.

    Full Content: Bloomberg

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