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  • Integrated Health Association (IHA) to lead incubation of payment reforms centered on pay for performance (P4P)

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  • Summary of short and long-term legal barriers to behavioral health/primary care integration (p. 178-182)

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  • Interesting graphics to evaluate community vs. clinical interventions, utilization and costs (p. 46, 48, 49)
  • Graphic derived from Institute of Medicine (IOM) analysis of sources of healthcare waste. (p. 123)

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  • The Plans goal is to maintain continuous quality improvement throughout the health system.
  • Governor's Office of Health System Transformation comprised of senior health policy advisor, Office of Health Information Technology, agency heads, and an academic partner to establish Innovation and Transformation Center which provides technical assistance to agencies and partners to accelerate information technology, rapid-cycle feedback, and economic modeling for payment innovation.

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  • Asserts 2 unique features of Maryland's plan: (1) The state’s unique hospital waiver, approved by CMS, which creates strong financial incentives for hospitals to increase quality, not quantity and (2) leadership for SIM planning is with the state public health agency.

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New Hampshire:
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New York:
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  • System level goals: achieving top quartile performance among states in prevention and public health; greater than 20 percent improvement in avoidable admissions and readmissions; and 2 percent annual cost reduction against trend resulting in $5-10 billion in cumulative savings over 10 years.
  • State will use Rate Review process as a core mechanism to encourage payer innovations & investments in implementation of advanced primary care (APC) models developed in collaboration with participating providers.

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  • Prevention strategies include - help expecting mothers have healthy pregnancies through perinatal interventions to reduce low birth weight. (pg. 22)

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  • Overarching goal of plan to connect activities (including current reform activities) towards a common goal of reducing delivery system fragmentation and improving delivery system coordination thereby improving population health – so plan focused on:
    1. Care transformation support
    2. High Risk Care Management
    3. Medicaid as a value based purchaser
    4. Standardized, transparent performance measurement

Rhode Island:
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  • Rhode Island Transformation and Innovation Center (RICTIC) provide technical assistance (TA) to providers and community-based organizations. (pg. 67 )

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  • The Texas State Health Care Innovation Plan (SHIP) proposes five innovation models to achieve the long term goal meet the state’s goals for health care delivery and payment (pg. 1)
  • Establish SIM Council to coordinate with the Texas Institute for Health Care Quality and Efficiency objectives of improving the quality and efficiency of health care delivery but particularly, drive transformation and innovation in the areas of EHR and HIE Expansion, Clinical Care Transformation and adoption of best practices, community based public health and multi-payer engagement and alignment (pg. 128-130)

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  • Four Aims of Plan:
    • AIM 1: To adapt to and perform well in a value-based purchasing environment (value = quality outcomes/cost).
    • AIM 2: To facilitate end-of-life preferences for Utah citizens so they receive care with dignity, respect and efficiency.
    • AIM 3: To increase access to primary care and behavioral health.
    • AIM 4: To create community-clinical linkages and healthful environments.

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  • Recognizing that health and health care are influenced by local needs, the State and regional leaders (including counties) will work together to determine regional service areas that drive increased collaboration between clinical and population health efforts. These regional service areas also will define Medicaid purchasing boundaries and make it easier to support health improvement and prevention at the local and regional levels. Most importantly, this regional approach will empower local entities, such as counties and public health jurisdictions, to shape a health and social services system tailored to the needs of their communities and aligned with key statewide priorities.