How are states engaging partners in their laboratories of health policy innovation? Today, states are in the throes of implementing major coverage, delivery system, and payment reforms to improve health care access, quality, and cost-effectiveness for the millions of individuals served by Medicaid. Engaging key ‘lab partners’ is an essential first step in building successful and sustainable reforms.
Stakeholders typically involved in reform efforts include consumer advocates, payers, providers, other state agencies (including the governor’s office), as well as academics and trade associations. Through Minnesota’s transformation activities and the Center for Health Care Strategies’ work with states across the country to advance reform goals, we have identified five key steps that states can take to maximize stakeholder engagement:
- Develop stakeholder engagement goals and messaging. Broad-based agreement on shared principles, mission, vision, and goals should be the initial activity of any stakeholder engagement process. With the passage of the Affordable Care Act (ACA) in 2010, states need stakeholder “buy-in” on a slew of topics, including Medicaid expansion; marketplace implementation; benefit design; renewals; information technology infrastructure; payment and delivery system reform; and physical/behavioral health integration efforts. To help with messaging and make its State Innovation Model (SIM) stakeholder engagement process concrete, Minnesota developed an accountability matrix. The tool is designed to help guide key stakeholders’ efforts for achieving the long-term goals of the Minnesota Accountable Health model. Through its SIM grant, Colorado established stakeholder engagement processes for each of its workstreams for the Colorado Health Care Innovation Plan. Colorado is engaging payers, providers, consumers, and researchers through a variety of channels to support its multi-faceted payment reform, behavioral health/primary care integration, and improved health information technology initiatives.
- Promote public meeting transparency. In implementing its Coordinated Care Organization (CCO) program, Oregon has a public meeting process that puts engagement and transparency front and center. In advance of meetings, documents such as agendas and meeting resources are made available to the public online in accessible formats. During meetings, the state uses call-in phone lines, live video streams, and webinar technology to ensure that individuals unable to participate in-person can follow along and contribute to the discussion. In addition, the state encourages public testimony – including from patients and families.
- Conduct listening sessions to inform ongoing technical assistance needs. After Oregon’s CCOs were launched in 2013, the Oregon Health Authority (OHA) conducted listening sessions with each of the CCOs. The listening tour sought to identify the priorities and needs of the CCOs to guide OHA in designing relevant technical assistance and supports. A second set of listening sessions in spring 2014 focused on enhancing communications, especially around operations. Leadership from OHA and the CCOs participated in the sessions. As a result of the many listening sessions, Oregon established a Transformation Center, which serves as a ‘bureaucracy busting’ resource to assist CCOs in quickly addressing hurdles and accelerating efforts to transform care delivery. In addition, as part of its waiver agreement with the Centers for Medicare & Medicaid Services (CMS), Oregon developed a statewide CCO Learning Collaborative to facilitate peer-to-peer learning and networking.
- Consider mandating provider participation in certain programs or processes. In Arkansas, provider participation in Episodes of Care is mandatory, which has allowed the state to shift resources away from engaging providers about the need to sign up for the program and toward communicating about implementation. More specifically, the state has broken down its provider engagement efforts into three core areas: (1) front-line support to answer provider questions; (2) proactive outreach and servicing to help providers better understand the new payment model and their own performances (provided by two outside vendors); and (3) guidance on how to make practice pattern changes (focused on fostering a community of peer-to-peer learning). Arkansas is also in the process of identifying a full-time position to coordinate provider engagement across its Episodes of Care initiative.
- Consider outside facilitators to support SIM workgroups. An outside facilitator can serve as a neutral party to expedite and mitigate the consensus-building process. Maryland contracted with an outside organization to facilitate its SIM design model task forces. Likewise, Minnesota engaged a contractor to facilitate two SIM task forces: Consumer Advisory and Multi-Payer Alignment. These two workgroups are seeking to create a network for information exchange and strategic deliberation on how best to advance Minnesota’s SIM model. Using an outside facilitator allows the state to participate in model development discussions as a stakeholder, since the state has multiple roles representing payer, provider, and regulator.
States across the country are in innovation mode — experimenting and refining ways to reform the Medicaid delivery system to improve health care access, quality, and cost-effectiveness. States need to get buy-in and build relationships with ‘lab partners’ who are equally committed to addressing challenges and identifying mutually agreeable pathways to reform.