State Innovation Models Initiative: Model Test Awards Round One

Publication Year: 2019
Patient Need Addressed: Care Coordination/Management, Chronic Conditions
Population Focus: Medicaid beneficiaries
Demographic Group: Adult
Intervention Type: Partnership, Service redesign, Technology/innovation
Type of Literature: Grey


Insights Results

Overview of article/programs

  • This webpage provides an overview of the 6 states awarded CMS Innovation Center State Innovation Model (SIM) Test Awards in Round 1. The CMS Innovation Center invested over $250 million in Round 1 Model Test Awards
  • Arkansas – Based on 2 complementary strategies: 1) Population-based care delivery; and 2) Episodes-based payment. Includes patient-centered medical homes that provide comprehensive, team-based care with a focus on chronic care management and preventive services, additional health homes to coordinate medical, community and social support services for individuals with complex or special needs, and episodes of care with a retrospective payment approach that rewards providers who delivery high-quality, cost-effective, and team-based care for specific conditions
  • Maine – Promotes the alignment and acceleration of statewide initiatives, designed to improve health and healthcare while reducing healthcare costs for the people of Maine. The SIM is build upon 6 strategic pillars and each of their 21 innovative activities are linked to 1 or more of these pillars: 1) Strengthen primary care; 2) Integrate physical and behavioral healthcare; 3) Develop new workforce models; 4) Develop new payment models; 5) Centralize data and analysis; and 6) Engage people and communities
  • Massachusetts – Focuses on implementation of statewide payment reform efforts that moves its health system toward seamless, patient-centered care that rewards value over volume. The Massachusetts’ model includes 1) A primary care payment reform initiative that provides prospective capitated payments for primary care services; 2) Three distinct ACO models with varying levels of sophistication and risk to allow a range of providers to participate in alternative payment models; and 3) Development of certified Community Partners, which are community-based organizations with expertise in delivering care to members with behavioral health, long term support services, and social services needs
  • Minnesota – Aims to better integrate care and services for the whole person across the continuum of care (including physical healthcare, mental healthcare, long-term care, and other services) through a statewide Accountable Health Model. Minnesota’s model includes the following: 1) Creation of “Accountable Communities for Health” (ACHs) that integrate medical care with behavioral health services, public health, long-term care, social services, and other forms of care; 2) Expansion of health information exchange and health information technology infrastructure; and 3) Support for primary care physicians who wish to transform their practices into Patient-Centered Medical Homes
  • Oregon – Uses the state’s purchasing power to realign healthcare payment and incentives so that state employees, Medicare beneficiaries, and those purchasing qualified health plans on Oregon’s Health Insurance Exchange will have high quality, low cost health insurance options that are sustainable over time. Oregon’s model includes: 1) Shifting to a payment system that rewards quality care outcomes rather than volume and aligning incentives across medical care and long-term care services and supports; 2) Creation of Medicaid Coordinated Care Organizations (CCOs) which are risk-bearing, community-based entities governed by a partnership among providers of care, community members, and entities taking financial risk for the cost of healthcare; and 3) Creation of a Transformation Center to disseminate best practices among CCOs and other health plans, support rapid cycle improvement, and spread the model across payers and into the qualified health plans of the health insurance exchange
  • Vermont – Increases both organizational coordination and financial alignment between clinical specialists and Vermont’s Blueprint for Health advanced primary care practices. Vermont’s model includes: 1) Development of a shared-savings ACO model that involves integration of payment and services across an entire delivery system, a bundled payment model that involves integration of payment and services across multiple independent providers, and a pay-for-performance model aimed at improving the quality, performance, and efficiency of individual providers; and 2) Enhancements in health information technology infrastructure, including improved clinical and claims data transmission, integration, analytics, and modeling and enhanced telemedicine and home monitoring capabilities