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Medicaid Incentive Programs: How Waivers Are Improving Outcomes

In 2010 and 2011, California and Texas became the first states to implement Delivery System Reform Incentive Payment (DSRIP) programs as part of their Section 1115 Medicaid waivers. Roughly five years later, participating hospitals are beginning to see tangible results from their improvement efforts. This represents an unprecedented opportunity to investigate such results and better evaluate the true impact of incentive programs.

This brief summarizes the results of key transformation projects implemented by Contra Costa Regional Medical Center in California and University Health System in Texas, including clinical and process oriented outcomes.

Research Brief – Medicaid Incentive Programs: How Waivers Are Improving Health Outcomes


  • Delivery System Reform Incentive Payment (DSRIP) programs consist of multiple improvement projects with associated metrics for data reporting and analysis.
  • Over time, the Centers for Medicare & Medicaid Services (CMS) has increasingly emphasized the need for rigorous DSRIP program evaluation.
  • DSRIP programs and improvement projects have resulted in considerable quality improvements and systemwide transformation.
  • DSRIP funding has been critical to support hospitals in achieving meaningful, sustainable transformation.
  • Contra Costa Regional Medical Center reported substantial improvements in ambulatory care access and quality, sepsis mortality, and hospital-acquired pressure ulcer rates through its DSRIP.
  • University Health System was able to achieve meaningful quality improvements in palliative care, medication management, and care coordination through its DSRIP.


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