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Snapshots from the State Innovation Models initiative
Healthcare 1 (2013) 152–153
Contents lists available at ScienceDirect
Healthcare journal homepage: www.elsevier.com/locate/hjdsi
In the News
Snapshots from the State Innovation Models initiative Jack Huang n Harvard University, 290 Eliot Mail Center, Cambridge, MA 02138, United States
art ic l e i nf o Article history: Received 2 May 2013 Available online 4 September 2013
As federal health reform works toward better health, better care, and lower costs for all of America, the State Innovation Models initiative of the Center for Medicare and Medicaid Innovation pushes states to also take a lead. CMMI's challenge to states: to develop a State Health Care Innovation Plan for delivery and payment system reform, that will control costs while maintaining quality for Medicare, Medicaid, and the Children's Health Insurance Program. “States play a critical role in determining the effectiveness of the healthcare system and the health of their population,” commented a spokesperson for the CMS. “In addition to being payers for the Medicaid, CHIP and state employee populations, states impact the delivery of care through their licensing and public health activities. States therefore are uniquely positioned to partner with CMS in testing new care and payment models.” In the first round of funding, sixteen states received Model Design awards to develop their Health Care Innovation Plans, three received Model Pre-Testing awards to refine their proposals, and six received Model Testing awards to begin implementation. A common theme through these six Model Testing proposals – those of Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont – is improving the integration and coordination of care. In Arkansas, there is a special focus on integrating populationbased with episode-based care. Medical homes will manage general health, and in case of a medical episode, will assign patients to a Principal Access Provider (PAP). The PAP will coordinate care and be accountable for overall quality and cost effectiveness during the episode, sharing retrospectively in any savings achieved beyond a “commendable” threshold. After the episode, the PAP will transfer care back to the medical home, ensuring that preparations are in place for the patient's ongoing care moving forward. The themes of coordination and integration extend beyond the walls of hospitals and clinics. Citing that 70% of health is
n
Tel.: þ 1 4848099896. E-mail address: [email protected]
2213-0764/$ - see front matter & 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hjdsi.2013.07.005
determined by “factors outside of the healthcare system,” Minnesota plans to create Accountable Communities for Health, entities that coordinate not only between acute care, primary care, mental health, and long-term care, but also with public health agencies, social services, educational institutions, and other local organizations. “It could be local communities, churches, United Way, and others working with providers and payers,” explains Minnesota Department of Human Services Commissioner Lucinda Jesson. “Our goal is to bring all these parties together to answer the question ‘What are the healthcare goals for our community?’” Implementing the proposals has not been without its challenges. “The way CMMI structured the SIM opportunity is stretching states, provider organizations and communities to come together and think in ways that are new and very different,” reflects Scott Leitz, Assistant Commissioner of Health Care for Minnesota's Department of Human Services. New collaborations within government are part of this – Minnesota's Department of Human Services is now working very closely with the state's Department of Health in developing accountable care for Medicaid recipients. “They [the Department of Health] bring the expertise in quality metrics, and we bring the expertise in Medicaid,” explains Leitz. “Together we can ensure that the metrics are both consistent with those established state-wide, and also applicable specifically to the Medicaid population.” With all the challenges of forging new collaborations between providers, community members, and government agencies, prospects for the future remain bright. Commissioner Jesson of Minnesota concludes, “I think this opportunity will enable us to lead in not only just health care, but bringing health care to all the people that we serve, and the communities that they live in.” The CMMI plans to announce a second round of Model Testing funding later this year or early next year, expecting that states given Model Design awards in the first round will now apply for Model Testing support. “While early in the process, the states have been very successful in engaging a number of broad stakeholders,” commented the CMS. What else the states will accomplish remains to be seen – with the State Innovation Models initiative, the ball of healthcare reform is now in their court (Map 1).
J. Huang / Healthcare 1 (2013) 152–153
153
Map 1. Three types of awards were given to states in the first round of the State Innovation Models initiative. Map courtesy of the Centers for Medicare & Medicaid Services.
Contents lists available at ScienceDirect
Healthcare journal homepage: www.elsevier.com/locate/hjdsi
In the News
Snapshots from the State Innovation Models initiative Jack Huang n Harvard University, 290 Eliot Mail Center, Cambridge, MA 02138, United States
art ic l e i nf o Article history: Received 2 May 2013 Available online 4 September 2013
As federal health reform works toward better health, better care, and lower costs for all of America, the State Innovation Models initiative of the Center for Medicare and Medicaid Innovation pushes states to also take a lead. CMMI's challenge to states: to develop a State Health Care Innovation Plan for delivery and payment system reform, that will control costs while maintaining quality for Medicare, Medicaid, and the Children's Health Insurance Program. “States play a critical role in determining the effectiveness of the healthcare system and the health of their population,” commented a spokesperson for the CMS. “In addition to being payers for the Medicaid, CHIP and state employee populations, states impact the delivery of care through their licensing and public health activities. States therefore are uniquely positioned to partner with CMS in testing new care and payment models.” In the first round of funding, sixteen states received Model Design awards to develop their Health Care Innovation Plans, three received Model Pre-Testing awards to refine their proposals, and six received Model Testing awards to begin implementation. A common theme through these six Model Testing proposals – those of Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont – is improving the integration and coordination of care. In Arkansas, there is a special focus on integrating populationbased with episode-based care. Medical homes will manage general health, and in case of a medical episode, will assign patients to a Principal Access Provider (PAP). The PAP will coordinate care and be accountable for overall quality and cost effectiveness during the episode, sharing retrospectively in any savings achieved beyond a “commendable” threshold. After the episode, the PAP will transfer care back to the medical home, ensuring that preparations are in place for the patient's ongoing care moving forward. The themes of coordination and integration extend beyond the walls of hospitals and clinics. Citing that 70% of health is
n
Tel.: þ 1 4848099896. E-mail address: [email protected]
2213-0764/$ - see front matter & 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hjdsi.2013.07.005
determined by “factors outside of the healthcare system,” Minnesota plans to create Accountable Communities for Health, entities that coordinate not only between acute care, primary care, mental health, and long-term care, but also with public health agencies, social services, educational institutions, and other local organizations. “It could be local communities, churches, United Way, and others working with providers and payers,” explains Minnesota Department of Human Services Commissioner Lucinda Jesson. “Our goal is to bring all these parties together to answer the question ‘What are the healthcare goals for our community?’” Implementing the proposals has not been without its challenges. “The way CMMI structured the SIM opportunity is stretching states, provider organizations and communities to come together and think in ways that are new and very different,” reflects Scott Leitz, Assistant Commissioner of Health Care for Minnesota's Department of Human Services. New collaborations within government are part of this – Minnesota's Department of Human Services is now working very closely with the state's Department of Health in developing accountable care for Medicaid recipients. “They [the Department of Health] bring the expertise in quality metrics, and we bring the expertise in Medicaid,” explains Leitz. “Together we can ensure that the metrics are both consistent with those established state-wide, and also applicable specifically to the Medicaid population.” With all the challenges of forging new collaborations between providers, community members, and government agencies, prospects for the future remain bright. Commissioner Jesson of Minnesota concludes, “I think this opportunity will enable us to lead in not only just health care, but bringing health care to all the people that we serve, and the communities that they live in.” The CMMI plans to announce a second round of Model Testing funding later this year or early next year, expecting that states given Model Design awards in the first round will now apply for Model Testing support. “While early in the process, the states have been very successful in engaging a number of broad stakeholders,” commented the CMS. What else the states will accomplish remains to be seen – with the State Innovation Models initiative, the ball of healthcare reform is now in their court (Map 1).
J. Huang / Healthcare 1 (2013) 152–153
153
Map 1. Three types of awards were given to states in the first round of the State Innovation Models initiative. Map courtesy of the Centers for Medicare & Medicaid Services.