State Innovation Models Initiative: Model Design Awards

The 16 States that will receive Model Design funding will produce a State Health Care Innovation Plan. States will use these Health Care Innovation Plans to apply for an anticipated second round of Model Testing awards. States receiving Model Design awards under the State Innovation Models initiative will also have six months to submit their State Health Care Innovation Plans to CMS.

The Participating States

SIM MD awards mapped

There are 16 states participating in the State Innovation Models Initiative: Model Design Awards. (List)
To view an interactive map of this Model, visit the Where Innovation is Happening page.

Note: Descriptions and project data are estimates provided by the state and are based on budget submissions required by the State Innovation Models initiative application process.

 

California

Funding Amount: Over the next 6 months, the State of California will receive up to $2,667,693 to develop their State Health Care Innovation Plan. Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: California intends to utilize existing state and national initiatives including capitated payment models, accountable care organizations, bundled episode payments, the Coordinated Care Initiative for dual-eligible Medi-Cal and Medicare beneficiaries, and the state’s Section 1115 Medi-Cal Bridge to Health Care Reform Waiver to inform their model design. California’s design process will involve a broad range of advocacy groups that will address its diverse and geographically spread population in order to develop a model that reflects California’s complex health care and financing environment.

 

Connecticut

Funding Amount: Over the next 6 months, the State of Connecticut will receive up to $2,852,335 to develop its State Health Care Innovation Plan. Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Connecticut will collaborate with public and private stakeholders to design a transformed health care delivery system that incorporates promotion of integrated care models; use of the Health Insurance Exchange to inform and connect consumers to coverage; expanded supply of primary care physicians and other professionals; and increased engagement among regulators, providers and consumers. The resulting payment and delivery system model will advance greater alignment across multiple payers on contracting and payment strategies that promote value over volume, greater consistency in quality and other performance metrics, and expanded primary care.

 

Delaware

Funding Amount: Over the next 6 months, the State of Delaware will receive up to $2,485,118 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Delaware proposes to build upon a strong local foundation for innovation in order to develop a system-level transformative healthcare plan that can serve as a scalable model for the nation. Through the collaborative planning process, Delaware will design a model to accelerate the adoption of payment and service delivery models across public and private payers; enhance health data collection and analytic capacity to support care coordination and outcomes-based payment models; and integrate workforce planning, behavioral health and public health initiatives.

 

Hawaii

Funding Amount: Over the next 6 months, the State of Hawaii will receive up to $937,691 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Hawaii proposes to develop a state innovation model informed by accountable care arrangements, patient-centered medical homes and bundled payment methodologies. Specific planning initiatives will include examining standardized definitions and payment approaches for patient-centered medical homes and care management services; analyzing opportunities for reducing waste and eliminating unnecessary variation in administrative procedures among plans; identifying and addressing differences among plans in how licensed providers are reimbursed; and methods for reimbursing telehealth services. The resulting integrated health care model will incentivize standardized efficiency, accessibility, and quality outcomes.

 

Idaho

Funding Amount: Over the next 6 months, the State of Idaho will receive up to $3,000,000 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Idaho seeks to mature the capabilities of current health care improvement initiatives of Medicaid and other organizations such as Blue Cross, Regence BlueShield, PacificSource, Idaho Primary Care Association, Idaho Chapters of the American Academy of Pediatrics and American Academy of Family Physicians, Idaho Hospital Association, Idaho Medical Association, Governor’s Office, Idaho Legislature, Idaho Department of Insurance, the Idaho Health Data Exchange and the North Idaho Health Network. The design project activities will address the needed resources to enhance communication and coordination of care across the health care continuum; opportunities for improved patient care management through patient-centered medical homes; and mechanisms to link the local health care system through partnerships with hospitals, primary care providers, and county health and social service agencies. The multi-stakeholder development process will result in a plan that will serve as the blueprint for integrating Idaho’s patient-centered medical homes and move the state towards an accountable, integrated and sustainable health care delivery and payment system.

 

Illinois

Funding Amount: Over the next 6 months, the State of Illinois will receive up to $2,088,530 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Illinois aims to develop a plan that will build upon the delivery and payment system reforms already underway in the state, including changes implemented under Illinois' Care Coordination Innovations Project, and the CMS Coordinated Care for Medicare-Medicaid Enrollees Demonstration, as well as innovations being spearheaded by private insurers.  The planning activities will include the development and integration of three models: a Provider-Driven Model; a Plan-Provider Partnership Model; and a Plan-Provider-Payer Model. These models will feature robust coordination among health plans, providers, and payers with the goal of enhancing care management and ultimately expanding the payer base.

 

Iowa

Funding Amount: Over the next 6 months, the State of Iowa will receive up to $1,350,711 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Iowa seeks to develop a transformative health care plan by addressing mechanisms to implement integrated care delivery models, developing strategies for payment alignment among Iowa’s key health care payers, and establishing incentives to move towards value-based purchasing and unified quality outcomes. Specific activities will include expansion of the multi-payer ACO methodology to address integration of long term care and behavioral health services; designing strategies that encourage personal health and well-being; and assuring an adequate workforce. The goal of Iowa’s model will be to hold total health care cost growth to less than two percent, and reduce total cost of care for those participating in integrated models.

 

Maryland

Funding Amount: Over the next 6 months, the State of Maryland will receive up to $2,371,299 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Maryland seeks to create a model that both integrates patient-centered medical care with community-based resources through a statewide expansion of Community-Integrated Medical Homes (CIMH), and enhances the capacity of local health entities to monitor and improve population health through the use of new data tools and geographic information system (GIS) mapping capabilities. During the Model Design period, the state will engage both public and private payers to establish the governance structure for the CIMHs and set programmatic standards. Simultaneously, the state will facilitate the participation of local health improvement coalitions to refine the tools and resources necessary to rapidly implement the new model.

 

Michigan

Funding Amount: Over the next 6 months, the State of Michigan will receive up to $1,653,705 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Michigan’s proposed design process will focus on transforming service delivery and payment models in four foundational areas: Patient/family-centered health homes; coordination and accountability of the Medical Neighborhood; a care-bridge to behavioral health and long-term care; and integration between and among healthcare and community resources, including the Pathways Community Hub model. The state will facilitate alignment of program elements and outcome metrics across payers, prioritize investments in health information exchange and data analytic capacity, incorporate commitment to population health in line with the National Quality Strategy, and identify policy and other levers to support future implementation. Michigan aims to develop the infrastructure to prepare the state for rapid testing, roll-out, and monitoring of the plan following the design period.

 

New Hampshire

Funding Amount: Over the next 6 months, the state of New Hampshire will receive up to $1,605,378 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: New Hampshire’s plan will lay out a framework for aligning consumer access across delivery system “silos,” payer support for outcomes-based long term care services, and global accountability for cost-effectiveness and outcomes.  A central tenet of the transformation activities will target opportunities for improved coordination across systems for individuals who are either in need of or at-risk for needing long-term support services; this population will be targeted due to the complex health needs and the cross-cutting nature of the services and payments needed to coordinate their care. Through this process, New Hampshire will leverage ongoing activities in the development of the new system and align the ongoing state and national quality initiatives with the new system.

 

Ohio

Funding Amount: Over the next 6 months, the State of Ohio will receive up to $3,000,000 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Ohio will develop a plan to improve overall health system performance through statewide implementation of innovative payment and delivery models. Ohio proposes a planning process that engages public and private stakeholders to formalize a comprehensive plan to build upon ongoing transformation activities, with potential refinements based on learning to date and stakeholder feedback. The goal of the project will be to create a roadmap for expanding the capacity and availability of qualified medical homes to most Ohioans, and to define and administer episode-based payments for acute medical events across Medicaid/CHIP, Medicare, and commercially insured patients.

 

Pennsylvania

Funding Amount: Over the next 6 months, the Commonwealth of Pennsylvania will receive up to $1,560,135 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: The Pennsylvania plan builds upon current private and public sector payer and provider initiatives to advance new care delivery models and payment methodologies. The plan places strong emphasis on the need for innovative models on transitions of care, telemedicine and care management. Through the promotion of accountable provider entities responsible for population based care, the state aims to develop a model that deploys community-based care teams to provide more appropriate services to “super-utilizers” and enhance access to public health preventive services by better integrating the services into the provider community. The model will also motivate alignment of patient, provider, and payer interest through gain-sharing models. Infrastructure to support the model design will incorporate expanded health information technology to facilitate health record data sharing, advanced telemedicine services particularly in rural areas, and objective measurement of healthcare workforce data to make improvements to existing training.

 

Rhode Island

Funding Amount: Over the next 6 months, the State of Rhode Island will receive up to $1,631,042 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Rhode Island intends to develop a model that builds upon the patient-centered medical home initiative and focuses on a community-centered delivery system. The model will leverage the opportunities provided by the state's Health Benefits Exchange and Medicaid initiatives.  Planning activities will facilitate a multi-stakeholder process to review current state payment and delivery system reform initiatives; identify data sources and baseline data for outcomes measures and financial analysis; and identify policy lever changes available and needed to effectuate the State Health Care Innovation Plan. The resulting plan will define strategy and mechanisms for moving Rhode Island’s health care delivery system to a value-driven, community-based, and patient centered system.

 

Tennessee

Funding Amount: Over the next 6 months, the State of Tennessee will receive up to $756,000 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Tennessee proposes to develop and integrate specific and scalable purchasing strategies into the TennCare Medicaid managed care model. Specifically, the design process aims to accelerate efforts to hold health care providers accountable for both cost and quality of care by identifying and rewarding the best-performing providers in accordance with federally-recognized quality metrics. The project identify evidence-based payment and service delivery models and decide how one or more of these models could best be used in Tennessee of effectiveness of patient-centered medical homes, ACOs, and other integrated care models.

 

Texas

Funding Amount: Over the next 6 months, the State of Texas will receive up to $2,895,219 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Through the Designing the Texas Innovative Health Care Model project, Texas seeks to develop a common understanding and consensus among participants (payers, providers, and other stakeholders) around the design of innovative models as well as the elements needed to successfully implement such models.  Specific issues to be addressed are gaps in health information technology and information exchanges (HIT/HIEs), administrative, clinical and financial data sources and requirements, and performance measures needed to design and test alternative payment systems that incorporate quality-based outcomes.  Texas also will work towards aligning various initiatives taking place across the state to transform the delivery and payment of health care.   Texas plans to leverage the resources and activities of additional quality-improvement initiatives underway including: the Texas Institute of Health Care Quality and Efficiency established through recent legislation to support implementation and evaluation of innovative payment and delivery systems across payers; the formation of federally recognized accountable care organizations (ACOs) and other advanced quality-based entities around the state; and HIT infrastructure.

 

Utah

Funding Amount: Over the next 6 months, the State of Utah will receive up to $942,458 to develop its State Health Care Innovation Plan.  Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Utah proposes to design an innovative statewide initiative to facilitate improved physician/patient communication and care coordination, with the goal of improving health care quality and lowering costs. The state will convene a multi-stakeholder group that will address strategies for healthcare transformation in five key areas: expanded health information technology; adequate healthcare workforce; wellness and healthy lifestyle promotion; payment reform; and medical malpractice and dispute resolution.

 

 

Background

The State Innovation Models Initiative is providing up to $300 million to support the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. The projects will be broad based and focus on people enrolled in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

The Innovation Center created the State Innovation Models initiative for states that are prepared for or committed to planning, designing, testing, and supporting evaluation of new payment and service delivery models in the context of larger health system transformation. The Innovation Center is interested in testing innovative payment and service delivery models that have the potential to lower costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), while maintaining or improving quality of care for program beneficiaries. The goal is to create multi-payer models with a broad mission to raise community health status and reduce long term health risks for beneficiaries of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

 

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