The CMS Innovation Center invested over $250 million in Round 1 Model Test awards to support six states in implementing 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 its available levers to transform its health care delivery system through multi-payer payment reform and other state-led initiatives.
Round One Model Test Awardees
Six states were awarded Model Test Awards in Round One and are actively testing their models. (List)
Investment Amount: Up to $42 million
Description: The Arkansas State Innovation Model is based on two complementary strategies: population-based care delivery and episodes-based payment. These strategies support a patient-centered health care system and were launched statewide with the support of both public and private insurers. Arkansas’ model includes:
- Patient-centered medical homes that provide comprehensive, team-based care with a focus on chronic care management and preventive services.
- Additional health homes to coordinate medical, community, and social support services for individuals with complex or special needs (including behavioral health conditions, developmental disabilities, or long-term care).
- Episodes of care with a retrospective payment approach that rewards providers who deliver high-quality, cost-effective, and team-based care for specific conditions.
Investment Amount: Up to $33,068,334.
Description: The Maine SIM initiative, through a collaborative process, will promote the alignment and acceleration of statewide initiatives, designed to improve the health and healthcare while reducing healthcare costs for the people of Maine.
The Maine SIM is built upon these six strategic pillars and each of their 21 innovative activities are linked to one or more of these pillars:
- Strengthen Primary Care
- Integrate Physical and Behavioral Health Care
- Develop New Workforce Models
- Develop New Payment Models
- Centralize Data and Analysis
- Engage People and Communities
Investment Amount: Up to $44,011,924.
Description: The Massachusetts State Innovation Model focuses on implementation of statewide payment reform efforts that moves its health system toward seamless, patient-centered care that rewards value over volume. Massachusetts’ model includes:
- A Primary Care Payment Reform Initiative that provides prospective capitated payments for primary care services.
- Three distinct ACO models with varying levels of sophistication and risk to allow a range of providers to participate in alternative payment models.
- Development of certified Community Partners, which are community-based organizations with expertise in delivering care to members with behavioral health, long term support services, and social services needs.
Investment Amount: Up to $45,231,841.
Description: The Minnesota State Innovation Model aims to better integrate care and services for the whole person across the continuum of care (including physical health care, mental health care, long-term care, and other services) through a statewide Accountable Health Model. Minnesota’s model that includes:
- Creation of “Accountable Communities for Health” (ACHs) that integrate medical care with behavioral health services, public health, long-term care, social services, and other forms of care.
- Expansion of health information exchange and health information technology infrastructure.
- Support for primary care physicians who wish to transform their practices into Patient-Centered Medical Homes (PCMHs).
Investment Amount: Up to $45 million.
Description: The Oregon State Innovation Model uses 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. Oregon’s model includes:
- Shifting to a payment system that rewards quality care outcomes rather than volume and aligning incentives across medical care and long-term care services and supports.
- Creation of Medicaid Coordinated Care Organizations (CCOs) which are 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.
- Creation of a Transformation Center to 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.
Investment Amount: Up to $45,009,480.
Description: The Vermont model for health system transformation increases both organizational coordination and financial alignment between clinical specialists and Vermont’s Blueprint for Health advanced primary care practices. Vermont’s model includes:
- Development of a shared-savings ACO model that involves integration of payment and services across an entire delivery system, a bundled payment model that involves 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.
- Enhancements in health information technology infrastructure, including improved clinical and claims data transmission, integration, analytics, and modeling and enhanced telemedicine and home monitoring capabilities.
- 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-Test Awards
- State Innovation Models Initiative: Model Test Awards Round One first annual report (PDF)
- State Innovation Models Initiative: Model Test Awards Round One second annual report (PDF)
- State Innovation Models Initiative: Model Test Awards Round One third annual report (PDF)
- State Innovation Models Initiative: Round Two landing page
- State Innovation Models Initiative: Model Test Awards Round Two
- State Innovation Models Initiative: Model Design Awards Round Two