Delivery System Redesign

Policymakers at the federal and state levels are working to develop strategies to address the health disparities that persist in the U.S. and promote health equity across geographic, racial/ethnic, and socioeconomic divisions. This webinar on April 2 will discuss how state and federal policymakers can strengthen their efforts to achieve health equity by coordinating with one another to align payment models, create new partnerships, and build infrastructure and data systems to reduce health disparities. State leaders from Ohio and Louisiana will describe several initiatives supporting health equity and the federal programs they are leveraging to support their efforts. An official from the Centers for Medicaid & Medicare Services (CMS) will describe federal resources available to help states advance health equity and identify opportunities for better alignment of federal and state activities.

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.