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created an additional pool of incentive payments — the Delivery System Re- form Incentive Payment Pool (DSRIP) — for participants who develop strategies to improve access, quality, and cost ef- ficiencies in delivering care to Medicaid and uninsured patients and who demon- strate those outcomes. PAD was on track to transition into a DSRIP project for Region 9 (Dallas, Kaufmann, and Denton counties), one of the waiver’s 20 designated regional health care partnerships (RHPs) through- out the state. Each RHP must develop a multistakeholder plan for meeting that community’s access-to-care needs that is led by a public hospital district — in this case, Parkland Health & Hospital System — or another governmental entity that provides the state’s share of the waiver pool funds to be matched by the federal government. The Texas Medical Association negoti-
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ated a provision in the waiver that also requires each RHP to solicit a letter of participation in its plan development from the local county medical societies, although such support is not required for state or federal approval of the projects. The Dallas County Medical Society (DCMS), which helped launch PAD, ini- tially supported the Region 9 plan after working with some original hospital partners in the charity care program to transform it into a more sophisticated medical home project, called My Medi- cal Home.
That meant expanding primary and specialty care to 6,000 patients a month, up from the 3,000 seen through PAD; linking participating physicians, clinics, labs, pharmacies, and others into a re- gional health information exchange to electronically share data and measure health outcomes; and recruiting more physicians and ultimately compensating them for the ongoing management of indigent patients. That went beyond the limited volunteer work they did under PAD, says DCMS Executive Vice Presi- dent and Chief Executive Officer Michael J. Darrouzet.
All of that necessitated additional
funding, which PAD thought it had until last November, he says. That’s when the private hospital partners cut My Medi-
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