Start: October 2012

End: September 2019

Funder: Center for Medicare and Medicaid Innovation


The Center for Health Care Strategies (CHCS) was part of a team led by NORC at the University of Chicago that served as the State Innovation Model (SIM) resource support contractor for the Center for Medicare and Medicaid Innovation (the Innovation Center). CHCS supported the states and the Innovation Center in designing and testing innovative multi-payer health system transformation approaches, along with NORC and the State Health Access Data Assistance Center. This support included consultation and technical assistance to states as they developed and implemented health care transformation models.

Multi-payer initiatives, as envisioned in SIM, have the potential to overcome many of the limitations associated with individual payer initiatives by focusing providers’ attention on a common set of goals, and by generating the critical mass (% of patients or revenue base) needed to make it worthwhile for providers to invest in health care delivery redesign. Generating provider participation also requires a significant effort on the part of payers in terms of outreach, education, and direct technical assistance to providers. Sharing these costs across multiple payers reduces the cost of the initiative to an individual payer.

Newly emerging multi-payer initiatives also face challenges, however, such as reaching consensus on goals and priorities, aggregating information across payers to measure impacts, and negotiating aligned payment mechanisms such as shared savings. The SIM technical assistance team is supporting the Innovation Center and the states in addressing these challenges and designing and testing multi-payer delivery and payment models to advance health care system transformation.