The federal State Innovation Model (SIM) initiative provided funding to states to design and test payment and delivery system reforms to improve care and lower costs in Medicare, Medicaid, and the Children’s Health Insurance Program. Through the initiative’s first round, which launched in 2013, the Center for Medicare and Medicaid Innovation (CMMI) awarded over $300 million to states to design, develop, and test state health care innovation models. Given the significant investment made by CMMI, the goal was that health care reforms launched under SIM would be sustained following the initiative.

This report examines key factors that contributed to states maintaining reform activities beyond the award period. It identifies five common factors that contributed to the sustainment of SIM investments, including: (1) building on existing state and federal initiatives; (2) engaging a wide variety of stakeholders; (3) providing training and up-front capacity building; (4) investing in evaluation activities; and (5) identifying executive leadership champions. The report is based on interviews with stakeholders in six SIM states, as well as a literature review of publicly available SIM-related state materials.

The Center for Health Care Strategies was part of a team led by NORC at the University of Chicago that provided consultation and technical assistance to SIM states as they designed and tested health system transformation approaches.