The State Innovation Models Initiative Model Test Awards provide financial and technical support for states to test and evaluate multi-payer health system transformation models. States must implement a proposal capable of creating statewide health transformation for the majority of care within the state.
Funding Amount: Up to $65 million.
Description: Colorado’s plan creates a system of clinic-based and public health supports to spur innovation. Funding assists Colorado in integrating physical and behavioral health care in more than 400 primary care practices and community mental health centers comprised of approximately 1,600 primary care providers and establishes a partnership between their public health, behavioral health and primary care sectors. Colorado will provide access to integrated primary care and behavioral health services in coordinated community systems by:
- Applying value-based payment structures.
- Expanding information technology efforts, including telehealth.
- Implementing regional health connectors.
Funding Amount: Up to $45 million.
Description: Connecticut’s plan utilizes several statewide and targeted interventions to: (1) improve population health; (2) strengthen primary care; (3) promote value-based payment and insurance design; and (4) obtain multi-payer alignment on quality, healthy equity, and care experience measures. Connecticut will:
- Implement a Medicaid Quality Improvement Shared Savings Program (MQISSP). Primary care providers participating in the MQISSP will benefit from programs designed to enhance primary care capacity in the state, including learning collaboratives to foster continuous learning.
- Implement Health Enhancement Communities and Prevention Service Centers focused on improving population health.
- Expand inter-professional training, enhance primary care capacity through additional residency programs, and increase community health worker training to ensure the health care workforce can support the transformation efforts.
Funding Amount: Up to $35 million.
Description: Delaware will:
- Support ten community-based population health programs (Health Communities).
- Develop an IT infrastructure to support a cross-payer scorecard of core measures available to providers with related tools for patient engagement and price and quality transparency.
- Engage payers in the development of a pay-for-value model and a total-cost-of-care model for providers (including independent PCPs), with the goal of attributing all Delawareans to a primary care provider during the performance period.
- Offer technical assistance to providers focusing on models of integrated, team-based care and transition to value-based payment models.
- Implement workforce development strategies to build competencies and address the current workforce and will also develop educational programs to address the needs of model participants.
Funding Amount: Up to $39,683,813.
Description: Idaho will achieve state-wide health care system transformation that will deliver integrated, efficient and effective primary care services through patient-centered medical homes (PCMH). Idaho will:
- Build 180 Nationally Recognized PCMH practices, including 75 Virtual PCMHs, by the end of the Model Test.
- Support providers through expanded connectivity via electronic health exchange
- Align the support of public and private payers to accelerate practice transformation.
Funding Amount: Up to $43,079,573.
Description: Iowa’s plan for health system transformation builds upon the ACO model that currently covers the state’s expanded Medicaid population, called the Iowa Health and Wellness Plan. Iowa will:
- Align with quality measures and payment methodology (shared savings and calculation of total cost of care) utilized by the Wellmark commercial ACOs.
- Work with the same data analytics contractor as Wellmark so that provider organizations have consistent and usable data to transform their practice from volume-based reimbursement to value-based reimbursement.
- By the end of the performance period, the Medicaid ACOs will be accountable for the long term care and behavioral health services of their attributed patients.
- Integrate community-based resources into the ACOs by providing technical assistance through various partners.
- Leverage and spread existing community transformation initiatives focused on the social determinants of health.
Funding Amount: Up to $69,999,580.
Description: To implement its Blueprint for Health Innovation, Michigan will:
- Create Accountable Systems of Care (ASC), which are networks of providers utilizing patient-centered medical homes supported by payment models that align incentives.
- Support ASCs through Community Health Innovation Regions (CHIRs), cross-sector partnerships that address population health and connect patients with relevant community services.
- Test whether ASCs working with CHIRs can achieve better health outcomes at lower cost for three targeted populations of patients: those with adverse birth outcomes, frequent emergency department users, and those with multiple chronic conditions.
- Deliver technical assistance, workforce training, quality improvement skills, and data analytics to providers throughout the state.
Funding Amount: Up to $99.9 million.
Description: New York will:
- Adopt a tiered Advanced Primary Care (APC) model for primary care that includes behavioral and population health, and be complemented by a strong workforce and engaged consumers, with supportive payment and common metrics.
- Institute a state-wide program of regionally-based primary care practice transformation to help practices across New York adopt and use the APC model.
- Expand the use of value-based payments so that 80% of New Yorkers are receiving value-based care by 2020.
- Support performance improvement and capacity expansion in primary care by expanding New York’s primary care workforce through innovations in professional education and training.
- Integrate APC with population health through Public Health Consultants funded to work with regional Population Health Improvement Program contractors.
- Develop a common scorecard, shared quality metrics and enhanced analytics to assure that delivery system and payment models support three-part aim objectives.
- Provide state-funded health information technology, including greatly enhanced capacities to exchange clinical data and an all-payer database.
Funding Amount: Up to $20 million.
Description: Rhode Island will:
- Implement a population health plan based on the results of community health assessments, including the integration of primary care and behavioral health.
- Expand the use of health homes by providers in the state.
- Establish a Transformation Network to provide technical assistance and analytical capabilities to payers and providers participating in the value-based models.
- Augment its HIT infrastructure to include an all-payer claims database, statewide health care quality measurement, patient engagement tools, and state data management and analytics.
Funding Amount: Up to $75 million.
Description: Ohio will transform the state’s health care system by rapidly scaling the use of patient-centered medical homes (PCMHs) and episode-based models and by developing cross-cutting infrastructure to support implementation and sustain operations. Ohio will:
- Launch 50 episodes of care.
- Geographically expand PCMHs, reaching statewide coverage by 2018.
- Incorporate population health measures into regulatory and payment systems in order to use those measures to align population health priorities across clinical services, public health programs, and community-based initiatives.
Funding Amount: Up to $65 million.
Description: Tennessee will execute multi-payer payment and delivery reform strategies. Tennessee will:
- Develop pediatric and adult PCMHs and health homes that will integrate value-based behavioral and primary care services for people with Severe and Persistent Mental Illness.
- Implement 75 episodes of care.
- Implement quality and acuity-based payment and delivery system reform for long-term services and support (LTSS), targeting nursing facility services and home and community based services for seniors and adults with physical, intellectual and developmental disabilities.
- Develop a statewide plan for improving population health in order to address disparities and state-specific population health needs.
Funding Amount: Up to $64,997,973.
Description: The Healthier Washington project will move health care purchasing from volume to value, improve health of state residents, and deliver coordinated whole-person care. Washington will:
- Implement regionally organized Accountable Communities of Health.
- Create a “support hub” for practice transformation.
- Redesign payment, through shared savings and total cost of care models in collaboration with delivery system and payer partners.
- Enhance analytics, interoperability and measurement.
- Create a public-private leadership council with a dedicated interagency team and legislative oversight.
- State Innovation Models Initiative: Model Test Awards Round Two First Annual Report (PDF)
- State Innovation Models Initiative: Model Test Awards Round Two Second Annual Report (PDF)
- State Innovation Models Initiative: General Information
- State Innovation Models Initiative: Round One landing page
- State Innovation Models Initiative: Model Design Awards Round One
- State Innovation Models Initiative: Model Pre-Testing Awards Round One
- State Innovation Models Initiative: Model Test Awards Round One
- State Innovation Models Initiative: Round Two landing page
- State Innovation Models Initiative: Model Design Awards Round Two
- State Innovation Models Initiative: Model Test Awards Round Two