Sixteen states received Model Design awards under the first round of the State Innovation Models Initiative. States will use Health Care Innovation Plans to inform their applications for a Model Test Award or another Model Design Award under the second round of this initiative.
Round One Model Design Awardees
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.
Funding Amount: The State of California received up to $2,667,693 to develop their State Health Care Innovation Plan.
Description: California utilized 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 involved a broad range of advocacy groups that addressed its diverse and geographically spread population in order to develop a model that reflected California’s complex health care and financing environment.
Funding Amount: The State of Connecticut received up to $2,852,335 to develop its State Health Care Innovation Plan.
Description: Connecticut collaborated with public and private stakeholders to design a transformed health care delivery system that incorporated 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 advanced 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.
Funding Amount: The State of Delaware received up to $2,485,118 to develop its State Health Care Innovation Plan.
Description: Delaware proposed 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 designed a model to accelerate the adoption of payment and service delivery models across public and private payers; enhanced health data collection and analytic capacity to support care coordination and outcomes-based payment models; and integrated workforce planning, behavioral health and public health initiatives.
Funding Amount: The State of Hawaii received up to $937,691 to develop its State Health Care Innovation Plan.
Description: Hawaii proposed to develop a state innovation model informed by accountable care arrangements, patient-centered medical homes and bundled payment methodologies. Specific planning initiatives included 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 incentivized standardized efficiency, accessibility, and quality outcomes.
Funding Amount: The State of Idaho received up to $3,000,000 to develop its State Health Care Innovation Plan.
Description: Idaho sought 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 addressed 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 resulted in a plan that served as the blueprint for integrating Idaho’s patient-centered medical homes and moved the state towards an accountable, integrated and sustainable health care delivery and payment system.
Funding Amount: The State of Illinois received up to $2,088,530 to develop its State Health Care Innovation Plan.
Description: Illinois aimed to develop a plan that built 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 included the development and integration of three models: a Provider-Driven Model; a Plan-Provider Partnership Model; and a Plan-Provider-Payer Model. These models featured robust coordination among health plans, providers, and payers with the goal of enhanced care management and expanded payer base.
Funding Amount: The State of Iowa received up to $1,350,711 to develop its State Health Care Innovation Plan.
Description: Iowa sought 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 establish incentives to move towards value-based purchasing and unified quality outcomes. Specific activities included expansion of the multi-payer ACO methodology to address integration of long term care and behavioral health services; designing strategies that encouraged personal health and well-being; and assured an adequate workforce. The goal of Iowa’s model was to hold total health care cost growth to less than two percent, and reduce total cost of care for those participating in integrated models.
Funding Amount: The State of Maryland received up to $2,371,299 to develop its State Health Care Innovation Plan.
Description: Maryland sought to create a model that both integrated patient-centered medical care with community-based resources through a statewide expansion of Community-Integrated Medical Homes (CIMH), and enhanced 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 engaged both public and private payers to establish the governance structure for the CIMHs and set programmatic standards. Simultaneously, the state facilitated the participation of local health improvement coalitions to refine the tools and resources necessary to rapidly implement the new model.
Funding Amount: The State of Michigan received up to $1,653,705 to develop its State Health Care Innovation Plan.
Description: Michigan’s design process focused 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 facilitated alignment of program elements and outcome metrics across payers, prioritized investments in health information exchange and data analytic capacity, incorporated commitment to population health in line with the National Quality Strategy, and identified policy and other levers to support future implementation. Michigan developed the infrastructure to prepare the state for rapid testing, roll-out, and monitoring of the plan following the design period.
Funding Amount: The state of New Hampshire received up to $1,605,378 to develop its State Health Care Innovation Plan.
Description: New Hampshire’s plan layed 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 targeted 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 was 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 leveraged ongoing activities in the development of the new system and aligned the ongoing state and national quality initiatives with the new system.
Funding Amount: The State of Ohio received up to $3,000,000 to develop its State Health Care Innovation Plan.
Description: Ohio developed a plan to improve overall health system performance through statewide implementation of innovative payment and delivery models. Ohio proposed a planning process that engaged 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 was 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.
Funding Amount: The Commonwealth of Pennsylvania received up to $1,560,135 to develop its State Health Care Innovation Plan.
Description: The Pennsylvania plan built upon private and public sector payer and provider initiatives to advance new care delivery models and payment methodologies. The plan placed 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 aimed 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 also motivated alignment of patient, provider, and payer interest through gain-sharing models. Infrastructure to support the model design incorporated 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.
Funding Amount: The State of Rhode Island received up to $1,631,042 to develop its State Health Care Innovation Plan.
Description: Rhode Island intended to develop a model that built upon the patient-centered medical home initiative and focused on a community-centered delivery system. The model leveraged the opportunities provided by the state's Health Benefits Exchange and Medicaid initiatives. Planning activities facilitated a multi-stakeholder process to review current state payment and delivery system reform initiatives; identified data sources and baseline data for outcomes measures and financial analysis; and identified policy lever changes that were available and needed to effectuate the State Health Care Innovation Plan. The resulting plan defined strategy and mechanisms for moving Rhode Island’s health care delivery system to a value-driven, community-based, and patient centered system.
Funding Amount: The State of Tennessee received up to $756,000 to develop its State Health Care Innovation Plan.
Description: Tennessee proposed to develop and integrate specific and scalable purchasing strategies into the TennCare Medicaid managed care model. Specifically, the design process aimed 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 identified evidence-based payment and service delivery models and decided how one or more of these models could best be used in Tennessee towards the effectiveness of patient-centered medical homes, ACOs, and other integrated care models.
Funding Amount: The State of Texas received approximately $2,895,219 to develop its State Health Care Innovation Plan.
Description: Through this Round One Award, the Designing the Texas Innovative Health Care Model project, Texas sought 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 addressed included 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 worked towards aligning various initiatives taking place across the state to transform the delivery and payment of health care. Texas planned to leverage the resources and activities of additional quality-improvement initiatives that were underway including: the Texas Institute of Health Care Quality and Efficiency established through 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.
Funding Amount: The State of Utah received up to $942,458 to develop its State Health Care Innovation Plan.
Description: Utah proposed 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 convened a multi-stakeholder group that addressed 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.
Under the first round of the State Innovation Models Initiative funding was provided 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 were broad based and focused 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).
CMS anticipates awarding up to $30 million during the Second Round funding opportunity to fund up to 15 Model Design cooperative agreements. States interested in developing transformative payment and delivery reforms are invited to apply for Model Design awards. Eligible states includes states that did not participate in Round One, as well as current Round One Model Design states that require additional time to continue developing their state innovation plans. More information about the Round Two funding opportunity can be found on the State Innovation Models Initiative Model Design Round Two web page.
- State Innovation Models Initiative: General Information
- State Innovation Models Initiative: Model Test Awards Round One
- State Innovation Models Initiative: Model Pre-Test Awards Round One