Delivery System Redesign

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.

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.