State Innovation Models Initiative: Model Pre-Testing Awards

Three states that will receive pre-testing assistance will use the funding to continue to work on a comprehensive State Health Care Innovation Plan. States receiving pre-testing awards under the State Innovation Models initiative will have six months to submit their State Health Care Innovation Plans to CMS.

The Participating States

There are 3 states participating in the State Innovation Models Initiative: Model Pre-Testing 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.

 

Colorado

Funding Amount: Over the next 6 months, the State of Colorado is receiving a Pre-Testing Assistance Award of $2,000,422 to further develop and refine its comprehensive State Health Care Innovation Plan. Funding will be subject to successful completion of the terms and conditions for the State Innovation Model initiative.

Description: Colorado is receiving a Pre-Testing Award from the Centers for Medicare & Medicaid Services to further develop and refine its comprehensive State Health Care Innovation Plan, building on its proposal to implement and test its Statewide Health Innovations Fostering Transformation program (SHIFT) that will integrate behavioral health and clinical health care.  This Pre-Testing Award is funded through the State Innovation Models initiative of the Center for Medicare & Medicaid Innovation.  The proposal meets the requirements set forth in the Funding Opportunity Announcement and the Centers for Medicare & Medicaid Services recommends this applicant for a Pre-Testing Assistance Award.

The SHIFT model would support the formation (at the practice level) of Integrated Primary Care Providers —developed within the framework of Colorado’s existing Medicaid Accountable Care Collaboratives using incentives and forms of payment tied to the provider’s level of readiness for risk acceptance and the level of behavioral and clinical care integration achieved.

Colorado’s primary target population for the SHIFT program is high-risk, high-cost individuals and co-occurring chronic disease and behavioral health issues (including mental health and substance abuse). In addition, Colorado SHIFT addresses population health by incorporating preventive strategies. Colorado views the integration of physical and behavioral health as a starting point for broader integration, including public health, oral health, and long-term services and supports.

 

New York

Funding Amount: Over the next 6 months, the State of New York is receiving a Pre-Testing Assistance Award of $1,000,000 to further develop and refine its comprehensive 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 state of New York is receiving a Pre-Testing Award from the Centers for Medicare & Medicaid Services to further develop and refine its comprehensive State Health Care Innovation Plan.

New York has proposed to test six different components of the comprehensive plan, including:  First Episodic Psychosis (FEP) Teams; Extended Care Transitions support; Community-Based Care Management for Older Adults; Transitioning to Community-Based Care for Institutionalized People with Developmental Disabilities; Accountable Care Organizations (ACOs); and Regional Quality Improvement Collaboratives.  

Related HIT improvements would focus on: promoting electronic health record adoption; expanding provider access to data; creating an All Payer Database for claims data; developing data-driven care management tools; and creating monitoring systems that will collect and aggregate health, quality, and cost indicators for each care model.

New York submitted a Pre-Testing Assistance Award request also to support activities related to organizing collaboration with statewide and regional stakeholders; quantifying and describing the current health care environment in New York; and completing legal, regulatory and policy and cost analyses relating to implementation of new payment and service delivery models.  The state plans to convene a series of stakeholder meetings in various regions across the state including meetings in: Buffalo, Rochester, Syracuse, New York City and Albany. Working with a consultant, the state will also collect and analyze health care pattern utilization data for public and private payers; conduct business process and systems analyses; and develop quality improvement systems, performance standards and related metrics.  The proposal meets the requirements set forth in the Funding Opportunity Announcement and the Centers for Medicare & Medicaid Services recommends this applicant for a Pre-Testing Assistance Award.

 

Washington

Funding Amount: Over the next 6 months, the State of Washington is receiving a Pre-Testing Assistance Award of $999,975 to further develop and refine its comprehensive 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 state of Washington is receiving a receiving a Pre-Testing Award from the Centers for Medicare & Medicaid Services to further develop and refine its comprehensive State Health Care Innovation Plan, building on its proposal to implement and test a model for improving maternal/infant care and managing chronic conditions through a multi-payer-supported approach to integrated care.   

Washington’s model test would create virtual Accountable Care Organizations (ACOs) that would integrate and coordinate the efforts of primary care providers, specialists, and health care facilities, redesigning care delivery and payment by shifting from fee-for-service to alternative methods that provide incentives for care integration, quality improvement, and higher value.  The model would work through the state’s quality collaboratives—the Bree Collaborative and the Puget Sound Health Alliance—to convene multiple payers, providers, and others to develop and promote the adoption of a common set of transparent, evidence-based quality and utilization metrics and evaluation criteria.

Washington also proposes to use its Pre-Testing Assistance Award to support the development of an aligned, transformative design model to include the following specific activities: leveraging and integrating Regional Collaborative community health and community prevention activities in multi-payer models; transforming public financing and payment systems to support integrated medical and behavioral health service delivery; providing change management and leadership and design support to engage multiple payers and providers; and expanding and sustaining efforts to apply evidence-based strategies for improvement in health care quality. The proposal meets the requirements set forth in the Funding Opportunity Announcement and the Centers for Medicare & Medicaid Services recommends this applicant for a Pre-Testing Assistance Award.

 

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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