Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Health Promotion and Behavioral Sciences

Degree Program

Public Health Sciences with a specialization in Health Promotion, PhD

Committee Chair

Wendel, Monica

Committee Co-Chair (if applicable)

Creel, Liza

Committee Member

Creel, Liza

Committee Member

Kerr, Jelani

Committee Member

Kelly-Pryor, Brandy

Author's Keywords

health policy; health service delivery; network analysis; delivery system reform; intersectoral collaboration


One challenge to improving population health in the United States is that the systems tasked with the responsibility of providing services across the continuum of care often operate in silos, missing opportunities to provide quality, coordinated care. In 2011, Texas received approval from the Centers for Medicare and Medicaid Services (CMS) for a five-year 1115(a) Medicaid Waiver Demonstration Project. This dissertation focuses on one element of the Waiver, the Delivery System Reform Incentive Payment (DSRIP) Program, which was designed to incentivize activities that support organizations’ collaborative efforts with other organizations in addressing the Triple Aim strategies. DSRIP was implemented through the formation of 20 Regional Healthcare Partnerships (RHPs) across Texas. These RHPs represent networks comprised of organizations within sectors and across sectors, including hospitals, community mental health centers (CMHCs), and public health departments among others. Three overarching research questions were posed: 1. To what extent did participation in DSRIP affect the role CMHCs had within their RHPs? 2. To what extent did the formation of RHPs impact intersectoral collaboration under DSRIP? 3. Which community-based partners did DSRIP providers perceive as critical to delivery system reform, and what types of connections were formed with such partners? 4. A non-randomized, pre-post interorganizational network study design was used to assess collaboration within each RHP, where data were collected for three time periods. The findings suggest: 1. The Waiver prioritized mental health, promoted collaboration, and allowed CMHCs to provide intergovernmental transfer funds, all of which elevated the role and power of CMHCs in their RHPs. 2. The Waiver promoted meaningful opportunities for intersectoral collaboration, particularly around resource and data sharing for service integration efforts. This allowed otherwise unintegrated organizations, such as public health agencies and CMHCs to assume more central roles in delivery system reform. 3. DSRIP-participating organizations worked extensively and uniquely with community-based partners to integrate more forcefully the social determinants of health with health care in order to address the needs of low-income populations. Future waivers should consider expanding the pool of providers to include social service and non-traditional partners who are critical to population health improvement and health service delivery transformation.