Thirty-eight states are developing State Innovation Models (SIM), or new models for multi-payer healthcare payment and service delivery, funded by grants from CMS. The SIM program tests ways to lower costs of caring for Medicare and Medicaid clients while maintaining or improving quality of care. It is an experiment in payment transformation, and, as with most experiments, some trials will perform better than others. Which SIM projects are most innovative? Which are most likely to succeed?
We’ve placed our bets on four SIM projects from very different states that arrived at the same conclusion: Payment transformation is much more than designing a new payment system. It requires actionable data to help physicians and patients make good decisions about health care options.
Iowa Medicaid Enterprise serves nearly 575,000 low-income individuals and children. They received a $43 million, four-year grant to expand their ACO model and improve population health. Two things about their initiative are especially interesting. First, they designed value-based incentive payments at the provider/physician level based on a clear set of outcome measures already in use by Wellmark commercial ACOs. Second, they will reward members/patients for engagement, paying back premiums and a portion of their co-pays if they complete the health assessment survey.
Minnesota Department of Health and its sister agency, the Department of Human Services were awarded a $45 million grant to expand the Medicaid ACO demonstration to serve nearly 3 million members by 2016. The project is labeled an accountable health model, reflecting a broad scope including medical care, behavioral health, long-term care and other community-based services. The project has invested in building a community of support for the project. It has convened local health leaders, payers, government agencies, community non-profits, patient advocates, and other stake-holders in a collaborative effort, employing a task force and advisory groups to guide and supervise the project. At the heart of the project is a commitment to measuring and sharing useful, reliable data to encourage preventative care and reward healthy outcomes.
Colorado Department of Health Care Policy and Financing, which already operates a successful Accountable Care Collaborative (ACC), is applying its $65 million grant to further integrate physical and mental health services and expand information technology, including telehealth, as part of “The Colorado Framework” to improve population health. They will apply a value-based payment structure and are expected to leverage measures for readmissions, ED visits, and high-cost imaging that have proven successful in the ACC program.
Rhode Island Department of Human Services will fortify its IT infrastructure to include an all-payer claims database, statewide quality measurements, patient engagement tools, and analytics as part of its $20 million project. The agency isn’t just building, it’s also investing in support. It will form the Transformation Network to give technical assistance and analytics capabilities to participating payers and providers.
You can learn more about the projects in Iowa, Colorado, and Rhode Island in a two-page summary of a panel discussion at the 2015 State Healthcare IT Connect Summit.
Kristine Daynes is marketing manager for payer and regulatory markets at 3M Health Information Systems.
David Wetherelt, is director, business development at 3M Health Information Systems.