Delivery System Redesign

Many individuals receiving care for behavioral health conditions also have physical health conditions that require medical attention, and the inverse is also true. Unfortunately, our physical and behavioral health care systems tend to operate independently, without coordination between them, and gaps in care, inappropriate care, and increased costs can result. This brief examines five promising approaches currently underway in Medicaid to better integrate physical and behavioral health care. They can be arrayed along a continuum that ranges from relatively modest steps to coordinate care between the two systems, to more ambitious efforts to implement a single integrated system of care.

This issue brief focuses on the key purchasing strategies that state Medicaid agencies and state employee health benefit purchasers can implement in order to reduce the overuse and misuse of health care services, and improve the quality and reduce the cost of care. This brief primarily focuses on actions state purchasers can take with contracted plans, providers, and other engaged purchasers to reduce overused and misused services. The research and recommendations in this issue brief were originally provided as technical assistance to a state as part of the Robert Wood Johnson Foundation’s State Health and Value Strategies project.

As part of the Agency for Healthcare Research and Quality's Infrastructure for Maintaining Primary Care Transformation initiative, NASHP worked with four states (Idaho, Maryland, Montana, and West Virginia) that sought to adapt aspects of North Carolina’s nationally recognized model of primary care practice transformation. This report summarizes the value of primary care transformation for the states, describes the North Carolina model, and outlines states' successes, challenges and lessons learned.

States and regional collaboratives are moving ahead with creating all-payer claims databases (APCDs) to support health system measurement and improvement activities. While aggregated claims databases provide an unprecedented view of care across all settings, the process of collecting claims information alone does not improve health care quality or reduce costs. To effectively utilize the APCD and realize its full potential, states have begun to produce reports and analyses based on APCD data. This paper examines the critical components of states’ APCD reporting efforts to date and suggests essential steps to creating credible and robust analytics.

The State Innovation Model (SIM) Testing Awards that HHS awarded to six states (Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont) were to support states’ work on multi-payer payment and delivery system reform. Strategies to improve the population's health were a critical aspect of the SIM awards. The SIM Funding Opportunity Announcement (FOA) required that states explain how the model would improve the population’s health in a number of areas including: health disparities, determinants of health, mental health, and substance abuse. The FOA also noted that states should describe how their State Health Care Innovation Plan integrates community health and prevention into their delivery system and payment models. This chart lays out the population health strategies the selected states plan to implement through their SIM initiatives.

The term "super-utilizer" describes individuals whose complex physical, behavioral, and social needs are not well met through the current fragmented health care system. As a result, these individuals often bounce from emergency department to emergency department, from inpatient admission to readmission or institutionalization -- all costly, chaotic, and ineffective ways to provide care and improve patient outcomes. To explore how Medicaid could best advance models for this high-need group of patients, the Center for Health Care Strategies, in partnership with the National Governors Association, hosted a Super-Utilizer Summit in February 2013. This report presents the Summit's common themes and key recommendations for building better systems of care for high utilizers.

The federal government and states are exploring new strategies for rewarding value in order to achieve better health outcomes at a lower cost. This report—the second in a series supported by The Commonwealth Fund to explore opportunities for improvement in federal and state policy— highlights relevant policy levers that can support payment reform and a number of current payment reform initiatives at the federal and state level. It also describes opportunities for federal-state alignment identified during a Commonwealth Fund-supported discourse among high-level state and federal officials hosted by NASHP.

NCQA’s 2013 State of Health Care Quality Report summarizes Healthcare Effectiveness Data and Information Set (HEDIS) results from calendar year 2012 from health plans covering a record 136 million people, or 43 percent of the US population. The 2013 report’s key findings include: stagnant or declining performance in appropriate use of antibiotics; continued improvement in childhood obesity measures; mixed results regarding childhood immunization; sustained decline in initiation of alcohol and drug treatment; and better experience of care in Medicaid HMOs.

The Federally Qualified Health Center Urban Health Network is a coalition of 10 federally qualified health centers (FQHCs) in the Minneapolis–St. Paul area that pursued an accountable care organization (ACO) through a Medicaid demonstration project with Minnesota. This case study explores: the state context under which the ACO contract emerged; origins of the coalition; the members’ motivations to participate; strategies and processes established to work toward cost and quality benchmarks; challenges faced in pursuing accountable care; and the organizational strengths that facilitated the health centers’ shift from competition to collaboration.

As part of the Agency for Healthcare Research and Quality (AHRQ)'s Infrastructure for Maintaining Primary Care Transformation initiative, NASHP worked with four states (Idaho, Maryland, Montana, and West Virginia) that sought to adapt aspects of North Carolina’s nationally recognized model of primary care practice transformation. This report summarizes the value of primary care transformation for the states, describes the North Carolina model, and outlines states' successes, challenges and lessons learned.