There is growing consensus among national health care policy experts that aligning payment and quality improvement activities offers critical opportunities to improve health equity. Among Medicaid populations in particular, there are significant opportunities to use payment innovations to address health care disparities.
Advancing Health Equity: Leading Care, Payment, and Systems Transformation (AHE), a national program supported by the Robert Wood Johnson Foundation, is working with state Medicaid agencies, Medicaid managed care organizations (MCOs), health care provider organizations, community-based organizations, and individuals with experience being enrolled in Medicaid to identify and eliminate inequities in health and health care. Through AHE, the Center for Health Care Strategies (CHCS) is collaborating with the University of Chicago, the Institute for Medicaid Innovation, and the Justice Collective to bring together these key stakeholders to design and implement integrated delivery and payment reform initiatives to reduce health and health care inequities. The initiative is designed to:
- Determine effective ways to align payment and delivery system reform to achieve health equity and implement these reforms;
- Increase the readiness of state Medicaid directors, MCOs, and provider organizations to successfully align payment and delivery system reforms to achieve health equity by creating and disseminating tools, resources, and training processes; and
- Inform state and national level policy to improve health equity.
Originally launched in 2018, the AHE learning collaborative is assisting seven state-based teams of state Medicaid agencies, Medicaid MCOs, and health care providers in designing value-based payment and contracting models that support delivery transformation to reduce inequities in health and health care. In 2023, five additional state-based teams joined the learning collaborative adding new key stakeholders — community-based organizations and individuals with experience being enrolled in Medicaid. Both cohorts are seeking to address systemic racism, oppression, and discrimination to advance health equity, and build authentic partnerships with communities and members/patients. Participating teams include:
- Delaware – Delaware Division of Medicaid and Medical Assistance; AmeriHealth Caritas Delaware; and Nemours Children’s Health
- Illinois – Illinois Department of Healthcare and Family Services, CountyCare Health Plan; Cook County Health; Access Community Health Network; and Center for Housing and Health
- Maine – MaineCare; Community Care Partnership of Maine; Aroostook Mental Health Services; and The Maine Primary Care Association
- New Jersey – New Jersey Department of Human Services, Division of Medical Assistance and Health Services; Horizon Blue Cross Blue Shield of New Jersey; and RWJ Barnabas Health, Newark Beth Israel Medical Center
- Pennsylvania I – Pennsylvania Department of Human Services, Office of Medical Assistance Programs; Highmark Wholecare, Allegheny Health Network; and North Side Christian Health Center
- Tennessee – TennCare; UnitedHealthcare Community Plan of Tennessee; Tennessee Maternal Fetal Medicine; and Meharry College of Medicine
- Washington State – Washington State Health Care Authority; Community Health Plan of Washington; and Community Health Network of Washington
- District of Columbia – DC Department of Health Care Finance, UnitedHealthcare Community Plan, DC Primary Care Association, Medstar Health
- Louisiana – Louisiana Department of Health, TBD
- Mississippi – Mississippi State Department of Health, UnitedHealthcare, Community Health Center Association of Mississippi
- New York – New York State Department of Health, Healthfirst, Sun River Health
- Pennsylvania II – Pennsylvania Department of Human Services, Office of Medicaid Assistance Programs, UPMC for You, UPMC Health Plan, Community Care Behavioral Health Organization, UPMC, Geisinger Health Plan, Magee-Womens Hospital of UPMC, Geisinger Women and Children’s Institute, Healthy Start, Inc.
In addition to the learning collaborative, AHE is providing participating state teams with tailored equity-focused technical assistance in health care delivery and payment system design as well as diversity, equity, and inclusion and coordinating a national advisory committee. Throughout the initiative, AHE is sharing lessons learned, best practices, and policy recommendations for local and national dissemination gleaned from its work with the teams.