Delivery System Redesign

Seventeen states currently are implementing accountable care strategies in Medicaid or state employee health programs. State activity runs the gamut from financing accountable care models to developing state standards that certify public and private accountable care organizations, to aligning accountable care principles with the creation of new community-based organizations or Medicaid managed care organization contracts. This article describes the range of strategies taken by states to drive value-based payment mechanisms aligned with accountable care principles. It also shows the power states have to influence financing of these models in Medicaid, state employee health programs, and commercial insurers’ plans, thus creating new opportunities for furthering provider participation.

States purchase health care benefits for more than a third of all Americans — nearly one quarter of all Americans receive coverage through Medicaid and about 14 percent of working Americans are state or local government employees. Because managed care plans oversee health care services for most Medicaid beneficiaries, public employees, and those getting coverage through the marketplaces, health plans are key channels through which state purchasers can accelerate the shift away from fee-for-service reimbursement toward value-based purchasing (VBP). CHCS developed this toolkit – a brief on  Strategic Considerations for State Purchasers, an Implementation Guide for State Purchasers, and Planning Template for Value-Based Purchasing – to help state purchasers design and implement effective VBP strategies within managed care.

Federal and state policymakers are faced with the challenge of integrating services to address both the physical and behavioral health needs of the population. This brief summarizes key lessons and opportunities for federal and state alignment that surfaced during a meeting supported by The Commonwealth Fund of high-level federal and state leaders. Several case studies are featured including Arizona, Missouri and Tennessee. Opportunities discussed spanned payment models, information and data sharing approaches, as well as operational strategies for achieving integration.
 

Oregon has taken significant steps to transform its health care and early education systems. Recognizing that good health is a key component of ensuring children enter school ready to succeed, Oregon is now aligning the two systems with the ultimate goal of improving kindergarten readiness. This report describes Oregon’s approach to aligning its two innovative system transformations and highlights key strategies – including joint staffing, blended funding, and shared expectations – to elucidate lessons for policy makers seeking to bridge health care and early education.
 

The combination of fee-for-service payments and the US health care system’s standing commitment to treating existing illness discourages spending on the behavioral, social, and environmental (that is, the nonmedical) conditions that contribute most to long-term health. Pay-for-success, alternatively known as social impact bonds (SIBs), offers a possible solution. The pay-for-success model relies on an investor that is willing to fund a nonmedical intervention up front while bearing the risk that the intervention may fail to prevent disease in the future. Should the intervention succeed, however, the investor is repaid in full by a predetermined payer, such as a public health agency, and receives an additional return on its investment as a reward for taking on the risk. These efforts, supported by key policy reforms such as public agency data sharing and coordinated care, promise to increase the number of evidence-based nonmedical service providers and seed a new market that values health, not just health care.