All Aboard: Engaging Self-Insured Employers in Multi-Payer Reform

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.