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States Encouraging Value-Based Payment: Lessons From CMS's State Innovation Models Initiative
Stephanie M Kissam1, Heather Beil1, Christina Cousart2
1RTI International.
The Milbank Quarterly
|April 9, 2019
Summary
State policies and targeted investments drove value-based payment (VBP) models and improved care coordination. State governments can effectively shape healthcare policy through regulatory levers and strategic investments in health IT and provider support.
Area of Science:
- Health Policy
- Healthcare Innovation
- Value-Based Care Models
Background:
- Six states received federal funding through the State Innovation Models (SIM) Initiative to transition from fee-for-service to value-based payment (VBP) models.
- The initiative aimed to transform healthcare systems by leveraging state government policy and purchasing levers.
Purpose of the Study:
- To analyze how state governments implemented VBP models and influenced healthcare delivery changes.
- To identify factors contributing to multipayer alignment and enhanced care coordination.
Main Methods:
- Qualitative data analysis of state SIM Initiative implementation from 2014-2018.
- Inclusion of interviews, focus groups, and document reviews.
Main Results:
- State policies and Medicaid VBP models were key to implementation.
- Multipayer alignment was more feasible in states with fewer commercial payers or stronger state mandates.
- Investments in health information technology and provider support facilitated care coordination improvements.
Conclusions:
- State governments possess significant power to shape healthcare policy and drive multipayer alignment in VBP models.
- Targeted investments in infrastructure and support are crucial for delivery system transformation beyond VBP adoption.
Keywords:
MedicaidState Innovation Models Initiativecare coordinationhealth care reformhealth information technologyperformance-based payment modelsstate governmentteam-based carevalue-based paymentMore Related Videos
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