Delivery System Redesign

Arkansas, Minnesota, Oregon, and Vermont are at the forefront of state efforts to coordinate value-based payment approaches across multiple public and private payers. Each is deploying some combination of payment and delivery system redesign that includes episode-based payment, patient-centered medical homes (PCMHs), and total cost of care arrangements among its Medicaid, Medicare, and commercially insured populations. This report, after describing multi-payer activity generally, examines the extent to which self-insured employers are participating in the kind of delivery system transformation envisioned by the Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) program. The report also provides a summary of current recruitment efforts in each state and synthesizes lessons learned for public officials interested in further outreach to the employer community.

States are realizing the potential benefits associated with integrating medical care and social services, and are beginning to take the first steps toward developing financing and payment models that encourage this connection. This brief reviews potential financing mechanisms to facilitate integration, with a particular focus on Medicaid. Drawing from interviews with experts across the country, it offers models ranging from one‐time seed funding for pilot projects to blended or braided financing arrangements that support comprehensive integration. The brief also highlights payment methodologies designed to influence providers to incorporate social services into their care efforts, with a focus on moving away from fee‐for‐service and toward value‐based payment strategies.

Given the often overwhelming prevalence of social needs facing Medicaid populations, including housing, transportation, and nutrition, aligning social services and supports with health care delivery is critical. Many states recognize the connection between social determinants of health and health care utilization and outcomes, and are building the infrastructure to support social service delivery through accountable care organization (ACO) programs. This brief highlights the initial efforts of seven states — Colorado, Maine, Minnesota, New York, Oregon, Vermont, and Washington — that participated in CHCS’ Medicaid ACO Learning Collaborative, and outlines key themes and considerations from these early adopters to help additional states support collaboration between ACO and social service providers.

With the support of The Commonwealth Fund, the National Association of Medicaid Directors (NAMD) brought together staff from states over a period of one year to focus on data analytics, practice transformation, and multi-payer alignment. While states were organized into different workgroups to address these issues, reform proved to be a wide-ranging topic. As these workgroups discussed their respective state’s work to drive innovation at the point-of-care for their beneficiaries, cross-cutting and coherent themes emerged. This brief reflects the discussions across the workgroups and all-state calls, and draws from state submissions to NAMD’s State Medicaid Operations Survey: Third Annual Survey of Medicaid Directors.

The primary goal of the ACA is to increase access to health care by expanding health insurance coverage, but another major thrust of the law is support for innovation in health care delivery and payment aimed at improving patient care and population health and reducing health care costs. The ACA-established Center for Medicare and Medicaid Innovation (Innovation Center) within the Centers for Medicare and Medicaid Services (CMS) is testing an array of alternative payment and service delivery models through numerous demonstration and pilot programs designed to lower costs for Medicare, Medicaid, and the Children’s Health Insurance Program while maintaining or improving the quality of care for beneficiaries. This fact sheet provides an overview of one of these programs – the State Innovation Models (SIM) initiative.