Innovation Center State-Based Initiatives: A Systematic Review of Lessons Learned

Publication Year: 2018
Population Focus: Dual eligible, Medicaid beneficiaries
Demographic Group: Adult, Child
Intervention Type: Service redesign
Study Design: Review
Type of Literature: Grey

While CMMI has funded many models with a state component and evaluated them individually, no systematic evaluation of findings and promising practices across evaluations has been conducted. CMMI contracted with L&M Policy Research to conduct a qualitative meta-synthesis of findings from select state-based models. We reviewed 47 evaluation reports covering 12 models that CMMI selected and categorized into three groups, based on the state’s primary role in each, as shown in Figure 1. 2

Insights Results


  • Tailored technical assistance, although resource intensive, reduces burden on participant staff and improves program effectiveness
  • Standardized participation requirements and data systems/tools may increase chance of successful implementation but lack of flexibility may prove burdensome under some circumstances
  • Payment methods that incentivize and reward a consistent set of activities, are flexible enough to allow different levels of risk and reward, and rely on transparent and predictable methodologies reduce burden and increase provider acceptance
  • Experimenting with multiple, proactive approaches to defining eligibility criteria and tailoring enrollment processes may allow organizations to identify more participants that could benefit from the model
  • States are well-suited to provide support for standardized technologies and leadership in promoting common data formats
  • Clearly defined roles, careful identification of appropriate staff, and training support help promote effective integration
  • Provider buy-in is critical: varied strategies can help overcome resistance and integrate staff into existing workflows
  • Communication involving all stakeholders is critical and facilitated by prior collaborations or proactive efforts to promote dialogue with new partners through outreach and education, inclusive governance structures, or establishing channels for seeking input