With the implementation of the Affordable Care Act, Medicaid has become the largest insurer in the United States, covering almost 25 percent of all Americans. States are increasingly leveraging Medicaid's purchasing power to drive payment and delivery system reform efforts, such as with Medicaid's Delivery System Reform Incentive Payment (DSRIP) program. In April 2014, New York began implementing its DSRIP, an $8.25 billion effort to improve the way care is paid for and delivered to Medicaid beneficiaries. Centers for Medicare and Medicaid Services (CMS) officials have been clear that New York's waiver is the new baseline for states pursuing DSRIP initiatives. This fact and the magnitude of change contemplated in New York have grabbed the attention of Medicaid stakeholders across the country.

In a new issue brief prepared for The Commonwealth Fund, Manatt Health examines New York's early experience implementing its DSRIP waiver, focusing on emerging issues in areas such as governance, data-sharing and analytics, social determinants of health, and value-based payments (VBPs). The report is intended to inform Medicaid's stakeholders' efforts in designing, planning for and implementing Medicaid-led transformations. Through stakeholder interviews, the report provides a comprehensive analysis of the New York approach to the DSRIP waiver, assessing the early successes and challenges and identifying how New York's experiences can influence new state payment and delivery system reform initiatives.