Dive Brief:
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States that received funding from the Center for Medicare and Medicaid Innovation's State Innovation Model (SIM) Round 2 Model Test have begun aligning stakeholders toward payment reform, advanced behavioral health integration and established infrastructure for population health, according to a new report on the programs. RTI International prepared the study for CMS.
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The review looked at programs from 11 Round 2 Model Test states: Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee and Washington. CMMI awarded more than $622 million to those states in hopes of finding successful programs for potential expansion.
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The report pinpointed New York as having the most significant change, establishing a new patient-centered medical home model meeting both Medicaid and private payer standards.
Dive Insight:
CMS views states as a testing ground for healthcare system changes. Through these programs, state bodies can figure out what works and what doesn't for them, allowing other states to capitalize on those experiences and potentially implement their own programs.
One ongoing healthcare transformation being tested is the move to value-based payment programs and alternative payment models (APMs) that reward quality and cut costs. The CMMI report explored how delivery models and payment reforms connect to value-based care and APMs, lessons learned from trying out new methods of healthcare delivery and challenges to improve population health.
The study highlighted three hurdles to statewide value-based payments, including difficulty recruiting small, independent practices, shortages of healthcare workers and a lack of models to transform care delivery and payments in rural areas that have large Medicare populations. A Washington multi-payer rural reform plan is in the design phase that will include all rural payers, including Medicare, and could help determine how to improve care delivery and payment in a rural setting, according to the report.
On the plus side, the report found improvements in screening for behavioral health needs and connecting patients to care. However, practices needed to make upfront investments for behavioral health screening and coordination. There's also an issue with behavioral health specialist shortages, a problem that could be ameliorated by telebehavioral health.
The report found that more than half of the states had population health programs. Clinical and community health integration were usually used in these initiatives.
Colorado, Delaware, Iowa, Michigan, Rhode Island, Washington and Idaho all made "significant strides" in implementing population health strategies. Michigan, Iowa and Rhode Island created new infrastructure for information exchange between clinical and community-based entities to address social determinant of health factors. Providers have increasingly looked at social issues like housing and transportation when dealing with patients' health.
In these state programs,"Navigators used social determinants of health data to identify patient needs and connect them to community resources," according to the report. "In this respect, the delivery transformation and population health arms of the SIM Initiative have become mutually reinforcing."