Over $250 million in Model Testing awards will support six states that are ready to implement their State Health Care Innovation Plans. A State Health Care Innovation Plan is a proposal that describes a state’s strategy to use all of the levers available to it to transform its health care delivery system through multi-payer payment reform and other state-led initiatives.
The Participating States
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: Over the next 42 months, the State of Arkansas will receive up to $42 million to implement and test its State Health Care Innovation Plan. Continued funding will be subject to state performance, compliance with the terms and conditions of award, and demonstrated progress towards the goals and objectives of the State Innovation Model initiative.
Description: The Arkansas model for a sustainable, patient-centered health care system is based on two complementary strategies—population-based care delivery and episodes-based payment—that are being launched statewide with the support of both public and private insurers.
Under provisions of the plan, by 2016 a majority of Arkansans will have access to a patient-centered medical home, which will provide comprehensive, team-based care with a focus on chronic care management and preventive services. Persons with complex or special needs (e.g., developmental disabilities) will also have access to health homes, which will work with their medical homes to coordinate medical, community, and social support services. Payments will include performance-based care coordination fees, as well shared savings for medical homes based on their ability to reduce total cost of care while also achieving goals for quality.
Arkansas will also continue to institute and expand its system of episode-based care delivery for acute, procedural, or ongoing specialty care conditions, using a retrospective payment approach that will reward providers who deliver high-quality, cost-effective and team-based care across an entire episode of care. Service for special needs populations will be further enhanced by payments reflecting each client’s assessed level of need.
Funding Amount: Over the next 42 months, the State of Maine will receive up to $33,068,334 to implement and test its State Health Care Innovation Plan. Continued funding will be subject to state performance, compliance with the terms and conditions of award, and demonstrated progress towards the goals and objectives of the State Innovation Model initiative.
Description: Maine will test its plan for improving the quality of health care and improving the health of all citizens by aligning benefits from MaineCare (the state’s Medicaid program) with benefits from Medicare and commercial payers to achieve and sustain lower costs for the Medicaid, Medicare and CHIP populations while maintaining access to care, improving care quality, and improving patient satisfaction.
The Maine innovation model will support the formation of multi-payer Accountable Care Organizations (ACOs) that commit to providing greater value in return for performance-based payment for high quality care. These ACOs will agree to meet established quality standards for clinical care and publically report on their performance. Through the provisions of the plan, Maine will support and strengthen enhanced primary care; support and strengthen alignments between primary care and public health, behavioral health, and long-term care; support the development of new workforce models for the transformed system; and align measures, data and analytics across providers. In addition, the State of Maine will implement payment reform across public/private payers; spread the patient-centered medical home model of enhanced, integrated primary care; and achieve transparent understanding of the costs and quality outcomes of patients across all payers statewide.
This award will support the following enhancements in health care infrastructure: the data analytic structure needed for multi-payer claims analysis, public reporting, and secure information sharing; quality improvement support, training, and collaborative learning to achieve accountable care; support for purchaser-led payment reform, including the potential for investment in performance based shared savings; patient training and tools for shared health care decision-making; support for value-based benefit design; and development of new workforce models to more appropriately support the transformed system.
Funding Amount: Over the next 42 months, the Commonwealth of Massachusetts will receive up to $44,011,924 to implement and test its State Health Care Innovation Plan. Continued funding will be subject to state performance, compliance with the terms and conditions of award, and demonstrated progress towards the goals and objectives of the State Innovation Model initiative.
Description: The Massachusetts model builds upon Massachusetts’ history of health care innovation and multi-stakeholder engagement, its work to expanding coverage, and recent legislation that commits the Commonwealth and all of its payers and providers to an ambitious transformation of the health care delivery system.
In the Massachusetts model, primary care practices will be supported as they transform themselves into patient-centered medical homes—capable of assuming accountability for cost and offering care coordination, care management, enhanced access to primary care, coordination with community and public health resources, and population health management. The Massachusetts model will strengthen primary care through shared savings/shared risk payments with quality incentives based on a statewide set of quality metrics, as well as payments to support practice transformation.
This award will be used to support public and private payers in transitioning to the specified model; to enhance data infrastructure for care coordination and accountability; to advance a statewide quality strategy; to integrate primary care with public health and other services; and to create measures and processes for evaluating and disseminating best practices.
Funding Amount: Over the next 42 months, the State of Minnesota will receive up to $45,231,841 to implement and test its State Health Care Innovation Plan. Continued funding will be subject to state performance, compliance with the terms and conditions of award, and demonstrated progress towards the goals and objectives of the State Innovation Model initiative.
Description: The Minnesota Accountable Health Model will ensure that every citizen of the state of Minnesota has the option to receive team-based, coordinated, patient-centered care that increases and facilitates access to medical care, behavioral health care, long term care, and other services.
To better integrate care and services for the whole person across the continuum of care (including health care, mental health care, long-term care and other services), the Minnesota Accountable Health Model will test a comprehensive, statewide program to close the current gaps in health information, create a quality improvement infrastructure, and provide the workforce capacity essential for team-based coordinated care. In addition to strengthening clinical health care, the Minnesota model for health system transformation will emphasize community health, preventive services, behavioral health, and other support services.
Minnesota will increase the kinds of care offered through ACOs, including for the first time long-term social services and behavioral health services. It will create linkages between the ACOs and Medicare, Medicaid, and commercial insurers, aligning payments to provide better care coordination, wider access to services, and improved coverage. Minnesota also plans to work with community organizations to create “Accountable Communities for Health” that will integrate medical care with behavioral health services, public health, long-term care, social services, and other forms of care, share accountability for population health, and provide care centered on the needs of individuals and families.
This award will enable Minnesota to expand its health information exchange and health information technology infrastructure, develop a workforce of community health workers and care coordinators, and support primary care physicians who wish to transform their practices into Patient-Centered Medical Homes to improve their patients’ overall health.
Funding Amount: Over the next 42 months, the State of Oregon will receive up to $45 million to implement and test its State Health Care Innovation Plan. Continued funding will be subject to state performance, compliance with the terms and conditions of award, and demonstrated progress towards the goals and objectives of the State Innovation Model initiative.
Description: The Oregon Coordinated Care Model (CCM) proposes to use the state’s purchasing power to realign health care payment and incentives, so that state employees, Medicare beneficiaries, and those purchasing qualified health plans on Oregon’s Health Insurance Exchange will have high quality, low cost health insurance options that are sustainable over time. The Coordinated Care Model will focus on integrating and coordinating physical, behavioral, and oral health care; shifting to a payment system that rewards quality care outcomes rather than volume; aligning incentives across medical care and long-term care services and supports; reducing health disparities and partnering with community public health systems to improve health.
Oregon will begin implementing its model test in Medicaid through its system of Coordinated Care Organizations (CCOs)—risk-bearing, community-based entities governed by a partnership among providers of care, community members, and entities taking financial risk for the cost of health care – and use the State Innovation Models Initiative funding to foster the spread of this new model of care to additional populations and payers, including Medicare and private plans, such as those covering state employees. CCOs have the flexibility, within model parameters, to institute their own payment and delivery reforms to achieve the best possible outcomes for their membership. They are accountable for the health and care of the population they serve and are rewarded for improving both the quality of care and health care value. CCOs will transition payment for care from a fully-capitated model to payment that is increasingly based on health care outcomes. To accelerate the transition, the Oregon Health Authority plans to create a Transformation Center that will disseminate best practices among CCOs and other health plans, support rapid cycle improvement, and spread the model across payers and into the qualified health plans of the health insurance exchange in 2014.
Funding Amount: Over the next 42 months, the State of Vermont will receive up to $45,009,480 to implement and test its State Health Care Innovation Plan. Continued funding will be subject to state performance, compliance with the terms and conditions of award, and demonstrated progress towards the goals and objectives of the State Innovation Model initiative.
Description: The state of Vermont proposes to develop a high performance health system that achieves full coordination and integration of care throughout a person’s lifespan, ensuring better health care, better health, and lower cost for all Vermonters. The Vermont model for health system transformation will: increase both organizational coordination and financial alignment between clinical specialists and Vermont’s Blueprint for Health advanced primary care practices; implement and evaluate value-based payment methodologies; coordinate with other payment reforms on developing a financing and delivery model for enhanced care management and new service options for Vermonters eligible for Medicare and Medicaid; and accelerate development of a learning health system infrastructure that will support delivery system redesign and state evaluation activities.
Vermont will achieve these goals through three models: a shared-savings ACO model that involves integration of payment and services across an entire delivery system; a bundled payment model that involve integration of payment and services across multiple independent providers; and a pay-for-performance model aimed at improving the quality, performance, and efficiency of individual providers. In addition to supporting implementation of the models described above, the award will fund the following enhancements in health system infrastructure: improved clinical and claims data transmission, integration, analytics, and modeling; expanded measurement of patient experience of care; improved capacity to measure and address health care workforce needs; health system learning activities essential to spreading models and best practices; and enhanced telemedicine and home monitoring capabilities.
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).