Funder: Center for Medicare and Medicaid Innovation


sim-practice-transformation

The federal State Innovation Model (SIM) initiative is seeking to achieve statewide multi-payer care delivery and payment reforms for roughly 80 percent of the population within participating states. Multi-payer health reform efforts, such as SIM, offer the opportunity to overcome many of the limitations associated with individual payer initiatives by focusing providers’ attention on a common set of goals and generating a critical mass of patients to make it worthwhile for providers to invest in health care delivery redesign.

CHCS is part of a team led by NORC at the University of Chicago that is serving as the State Innovation Model (SIM) Resource Support Contractor for the Center for Medicare and Medicaid Innovation. CHCS is supporting states in designing and testing innovative multi-payer health system transformation approaches, along with NORC and the State Health Access Data Assistance Center (SHADAC). In this role, CHCS is developing a variety of resources to help states design and implement their SIM strategies. Following are a sampling of tools:

  • Promising State Innovation Model Approaches for High-Priority Medicaid Populations: Three State Case Studies – States participating in the SIM initiative have focused mainly on testing large-scale, statewide health care delivery and payment reform. Yet many states are also designing and testing smaller, more focused initiatives for high-need population subsets. This brief describes three promising, smaller-scale SIM initiatives that can serve as valuable models for states looking to improve a particular aspect of their health systems. (CHCS and SHADAC, March 2019)
  • Aligning Quality Measures across Payers: Lessons from State Innovation Models – This brief examines the work of five SIM states to develop common measure sets that align quality measures across private and public payers — a strategy aimed at reducing administrative burdens on providers. It outlines alignment adoption strategies, measure set development, sustainability efforts, and provides a framework for other states considering quality measure alignment projects. (SHADAC, March 2019)
  • Practice Transformation Assistance in State Innovation Models – This brief describes practice transformation assistance activities and related efforts that four states are offering to their provider communities — detailing four broad areas of practice transformation assistance being used by the states. (CHCS, April 2017)
  • Advancing State Innovation Model Goals through Accountable Communities for Health – This brief reviews state efforts to develop and test Accountable Communities for Health (ACH) models within the SIM initiative, including a look at how ACHs are connected to broader population health and delivery system reform plans. (CHCS, October 2016)
  • Community Care Teams: An Overview of State Approaches – This paper provides details on Community Care Team programs in several states, including program features, governance, financing, workforce, and informatics. (CHCS and SHADAC, March 2016)
  • Value-Based Payments in Medicaid Managed Care: An Overview of State Approaches – This brief outlines five practical approaches for promoting value-based payment (VBP) goals through managed care contracts and provides guidance for developing request for proposal questions to assess managed care organization interest in and experience with VBP. (CHCS, February 2016)
  • Governance Structure – This fact sheet summarizes governance structures developed by states to oversee the SIM initiative. It also reviews common themes from SIM states and highlights SIM governance structures from five states — Connecticut, Maine, Minnesota, Oregon, and Washington. (CHCS and NORC, December 2015)
  • Fostering Provider Participation in Payment Reform Efforts – This fact sheet, based on the experiences of SIM Round One Test States, outlines strategies to maximize provider participation in Medicaid payment reform programs and offers insights on how states can encourage participation. (CHCS, December 2015)
  • Multi-Payer Investments in Primary Care: Policy and Measurement Strategies – This resource paper explores the levers states can use to advance multi-payer primary care policies and highlights state approaches for encouraging multi-payer investment in primary care. It concludes with a review of potential measures for monitoring the impacts of primary care investment policies and tracking primary care system performance. (CHCS and SHADAC, July 2014)