State Innovation Models (SIM) Initiative Evaluation

Publication Year: 2018
Patient Need Addressed: Behavioral health, Care Coordination/Management
Population Focus: Medicaid beneficiaries
Intervention Type: Partnership, Service redesign
Type of Literature: Grey

This report presents the final summary findings from the six states that received Round 1 State Innovation Models (SIM) Initiative awards in 2013—Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont. The SIM Initiative awarded between $33 and $45 million to each state over a 3.5- to 5-year period, with the goal of testing ways that state governments could accelerate statewide healthcare system transformation. State governments engaged in such transformation by using their policy and regulatory levers and by convening public and private stakeholders whose organizational priorities influence healthcare delivery and population health outcomes. These six states used SIM funds to complement or build upon existing efforts to transform the healthcare system into one that promotes coordination across provider types, integration of primary care and behavioral healthcare, and attention to social determinants of health

Insights Results

Approaches to care

  • Engaged healthcare and community-based social service providers in improving or testing new forms of care delivery through structured educational efforts and technical assistance, performance feedback reports, or direct grants
  • Built performance data infrastructure and capacity (all states), integrated behavioral and physical health (all states)
  • One payment model, the Vermont Accountable Care Organization Share Savings Program (ACO-SSP), yielded $97 million in Medicaid savings over 3 years relative to spending for an in-state comparison group
  • All ACO models operational since at least 2014 (Maine, Minnesota, and Vermont) and one episode of care model (in Arkansas) showed comparatively lower rates of ED visits, and two Accountable Care Organization (ACO) models (Maine, Vermont) showed comparatively lower rates of inpatient admissions
  • Patterns of care delivery under new payment models that are effective in reducing utilization and cost may take time and additional resources to implement. As such, expenditures may increase in the short run; this may not necessarily indicate that the model is not working, only that more time for observable impact is needed Future considerations
  • States’ contexts shape how and where they should spend resources to accomplish the most
  • Federal and state policy making are necessary for sustaining positive healthcare transformation