Testing States

Colorado

Click Here for Updated State Plan
State's SIM website

  • Integrate physical and behavioral health care in more than 400 primary care practices and community mental health centers (CMHCs) with about 1,600 primary care providers. (p.1)
  • By 2016, connect an additional 555,000 Coloradans with a patient-centered medical home through the Accountable Care Collaborative. (p.5)
  • Colorado’s public health infrastructure, including CDPHE and the Colorado School of Public Health, has been a driver of the development of Colorado’s Health Extension Service (HES). The HES is a central part of our SIM model’s ability to facilitate practice transformation and community coordination statewide and will rely heavily on state and local public health agencies for support. (p.10)
  • Coordinating with social service agencies is a crucial component of ensuring SIM is successful in integrating community-based social services with clinical care. Colorado's approach to securing firm commitments from local social services agencies. Partner with existing and emerging population health transformation collaboratives (PHTCs) across Colorado, we will support them in identifying and engaging local social service organizations most appropriate to leveraging SIM work and connecting with clinical care. This grassroots approach for engaging social services best suits the Colorado environment and our belief that all health is local. (p.12-13)
  • Health care delivery system transformation plan, called “The Colorado Framework” and outlined in the SHIP, leverages a strong foundation of federal, state and private sector investments in primary care transformation and integrated care. (p.14)

Connecticut

Click Here for Full State Plan
State's SIM website

  • Focus is on moving a large percentage of PCPs to Advanced Primary Care (APC) and providers participating in the new Medicaid waiver. The "Advanced Medical Home Glide Path" will move PCPs to APC designation (National Committee for Quality Assurance patient-centered medical home plus certain CT-specific indicators) using practice transformation vendors providing support for 9-18 months (p.19). A clinical integration team will help practices integrate behavioral and oral health, address community prevention and health equity issues, medication therapy management, e-consults, team-delivered care, community linkages for wrap-around supports and identification of super-utilizers.
  • Emphasis on moving primary care practices to be accountable for quality, care experience and costs through shared savings programs. This is aligned with Medicare's ACOs, in which few FQHCs or small practices currently participate. Insurance plans are encouraged to promote value-based insurance designs. The plans will be conducting an independent evaluation of the outcomes of VBID. Insurance plans were assessed $3.2 million/year to support the SIM project management office. (p.39)

Delaware

Click Here for Full State Plan
State's SIM website

  • Plan emphasizes the role of primary care in the system and prioritizes integrated care (including behavioral health) for high-risk individuals and more effective diagnosis and treatment for all.
  • Flexible framework to support independent providers and health systems in adoption of existing models including: co-location of services, population-specific care coordination, Patient Centered Medical Homes, Accountable Care Organizations. (p. 10)
  • Specific components of plan: voluntary participation, practice transformation support, expansion of learning collaboratives, transition to value-based payment, care coordination support paid by payers to PCPs, improved access to information, engaging clinical leaders around clinical best practices, engaging patients. (p. 13-15)

Idaho

Click Here for Full State Plan
State's SIM website

  • Deliver integrated, efficient, and effective primary care services through the patient-centered medical home (PCMH), which is integrated within the local Medical Neighborhood. (p. 1)
  • The broader healthcare system is organized at the regional level as a robust Medical Neighborhood, integrating a spectrum of ancillary healthcare providers with primary care. (p. 1)
  • Create a virtual PCMH to bring high quality healthcare to extremely rural communities (p. 2). Develop 75 virtual PCMHs. (p. 5)
  • Build 180 PCMH primary care practices with 900 primary care providers serving 1.3M Idahoans (80% of state population). Idaho’s new PCMH model builds on the activities of the Idaho Medical Home Collaborative (IMHC), but expands from the current 27 PCMH pilot sites to statewide primary care provider engagement. The Model Test will also expand the PCMH model to all patients, not just those with chronic conditions. (p. 4)
  • Establish 7 Regional Collaboratives to support the integration of each PCMH with the broader Medical Neighborhood. At the local level, Idaho’s 7 Public Health Districts (PHDs) will serve as Regional Collaboratives (RCs) which will support practices as they transform to a PCMH and support existing PCMHs as they further expand their capacity and enhance their performance. (p. 5)

Iowa

Click Here for Full State Plan
State's SIM website

  • ACOs - organically-derived from local communities and are able to leverage the diversity & strengths of each local delivery system. (p. 3)
  • Population Health Initiatives Table (p. 4)
  • Clinical interventions focused on obstetric adverse events; healthcare associated infections; diabetes. (p. 11)
  • The SIM Initiative will provide significant support for ACOs and public health/primary care integration. the SIM Initiative will expand these quality improvement processes to the entire spectrum of care offered through the ACOs. This process will focus on aligning resources toward a common vision that expands current healthcare delivery into the community setting, developing local champions to serve as faculty of best practice, and aligning measurement strategies to track community progress toward population health initiatives. Community Care Teams provide an opportunity to partner with hospitals or physician clinics not contracted in an ACO, to ensure smaller providers are able to participate in new care models. (p. 12-13)

Michigan

Click Here for Full State Plan
State's SIM website

  • Health care delivery transformation plan is central to innovating service delivery. (p.5-7)

New York

Click Here for Full State Plan
State's SIM website

  • In 5 years, goal is for 80% of New Yorkers to receive care in an APC; 80% of care is paid for through value-based agreements and consumers will be more engaged with cost and quality information. (p. 11)
  • 3-tiered levels of APC with curriculum and assessment tool and will fund locally-driven practice transformation (~$20,000/yr/practice X 3 years) to achieve goal of ~75% practices achieving APC status from baseline of ~25% (p.6)
  • Will establish policies to increase the primary care workforce, its distribution and scope of practice. It is expected that APCs will move from fee-for-service to graduated levels of value-based payment. NY State will use all available levers (Medicaid and state employee contracts, commercial insurance rate reviews) to promote value-based payment, insurance design and common scorecard and quality reporting. (p.9)

Ohio

Click Here for Full State Plan
State's SIM website

  • As result of SIM Design Process, adapted Southwest Ohio’s Comprehensive Primary Care Initiative (CPCI) for a statewide rollout of Patient-Centered Medical Homes in 2015. (p.10)
  • Ohio Healthcare Delivery System Transformation Plan. (p. 6)
  • Patient Centered Medical Homes model that is flexible to meet the needs of providers and targeted capacity-building support (e.g., EHR implementation, performance measurement education) with increased emphasis on total cost of care accountability (e.g., shared savings) over time. (p. 9-11)
  • Episode-Based Payment Model encourages high quality, patient-centered, cost-effective care by holding a single provider or entity accountable for care across all services in a specific episode; aligns provider incentives and discourages under-utilization. (p. 11)
  • Governor’s Office of Health Transformation working with private payers, health plans, and providers to accelerate the adoption of PCMH and episode-based payment models. (p. 13)

Rhode Island

State's SIM website

Click Here for Full State Plan

  • Rhode Island’s Population Health Plan and Healthcare Delivery System Plan will be consonant. They will both focus on transforming the health care delivery system to the Value-Based Care Paradigm described in the State Health Innovation Plan. Rhode Island envisions a new system of care that supports lifelong health for the state’s populations. (p. 6)
  • There are six fundamental characteristics to our vision of value-based care (Value-Based Care Paradigm): an orientation to outcomes and population health management, effective provider relationships, person seeking care is active and engaged, alternatives to fee-for-service payment models, and effective use of health information technology.(p. 7)
  • We will use this grant to impact payment and service delivery models by expanding existing models and supporting provider organizations to meet the Value-based Care Paradigm. Existing and new models (PCMH, Health Homes, ACOs, etc.) will need to highlight how they will respond to a person’s behavioral health needs. (p. 8)
  • Our proposal seeks funding for the following projects we believe will directly impact our progress in healthcare transformation: Practice Assistance, Community Health Teams, Patient Centered Medical Home Expansion, Child Psychiatry Access Program, Advanced Illness Care Initiative, and Behavioral Health Transformation. (p. 10)

Tennessee

Click Here for Full State Plan
State's SIM website

  • Reach over 80% of the state’s population with value-based payment and delivery models. (p. 2)
  • Primary Care Transformation: care coordination, closing the gaps in care; shifting focus toward prevention, health maintenance, and proactive management of chronic conditions (p. 4)
  • Multi-payer Patient Centered Medical Home approach: require 3 managed care organizations to participate in joint PCMH program, will build up to statewide aligned and Medicaid PCMH program. A Technical Advisory Group (TAG) of Tennessee clinical experts to advise on the clinical details of the multi-payer PCMH program. (p. 5-6)
  • Pediatric Patient Centered Medical Homes (p.6-7)
  • Total cost of care accountability with reporting and financial incentives. (p.27)
  • Episodes of care – continuing to build on existing initiative, adding additional episodes every six months with a goal of implementing 75 episodes within five year. (p. 8)

Washington

Click Here for Full State Plan
State's SIM website

  • The State Health Department will lead the Practice Transformation Support Hub to help clinicians move from encounter-to value-based care (p.3). Will work in concert with the ACHs, including links to social and housing support, school-based nursing, and long term care. Requires enhanced patient engagement, measured by adoption of "decision support aids" for maternity, joint replacement and palliative care (see financial analysis p.3)
  • Legislature authorized common measures and quality framework for Medicaid and public employees benefits purchasing. (see p.2 of financial analysis)


Design States


American Samoa

More to come...

Arizona:
Click Here for Full State Plan
State's SIM website

  • Improving access and coordination of care identified as one of three overarching priorities in the assessment, and includes facilitating a team-based approach to care. (p. 2)

California

More to come...

District of Columbia

More to come...

Hawaii:
Click Here for Full State Plan
State's SIM website

  • Patient-centered medical homes (PCMH) provide the necessary platform for developing behavioral care enhancements, and is a dominant model for Hawaii's primary care practices. (p. 3)
  • Health Care Delivery System Transformation Plan. (p. 5-9)

Kentucky
Click Here for Full State Plan
State's SIM website
  • Kentucky intends to provide a detailed roadmap for more effective measurement of quality and quantifiable improvement in clinical outcomes for all state citizens. (p. 14)
  • LHDs are already working toward integration of the public health and health care delivery systems through programs such as Community Health Workers (CHWs) (per Section 5313 of the ACA), public health dental hygienists, school health programs, and local diabetes education and prevention programs. (p. 4)
  • The guiding vision of Kentucky’s health care delivery system transformation plan is to achieve the Triple Aim – improved value, patient care and population health outcomes – in the context of an interconnected and comprehensive health care ecosystem. (p. 5)
  • Three broad goals for delivery reform and important strategies to support each: 1) Increase access; 2) Increase integrated and coordinated care models; 3) Expand HIT infrastructure. (See Figure 2, p. 6)

Illinois

Click Here for Full State Plan
State's SIM website
  • Illinois began implementing the following programs in 2013 to accelerate the development of integrated delivery systems and reformed payment models in Medicaid: Care Coordination Entities (CCEs), Accountable Care Entities (ACEs), CountyCare (Cook County). (see p. 8 for more details)
  • Specific integrated delivery systems will serve as Model Test Pilots and will be identified through an application process during the pre-implementation year. They will encompass broad geographic and demographic diversity in the populations covered. In their applications, integrated delivery systems will be evaluated on both their current state of progress toward, and their ability to achieve during the Model Test period, a list of ten characteristics. (see p. 9 for this list).
  • Realistic measures and targets, including both quality and value metrics, will be set during the pre-implementation period for each Pilot based on the current Alliance work group process. Pilots will be required to demonstrate how they will achieve cost savings over the Test period. Quality metrics will incorporate HEDIS measures and those already established for Medicaid care coordination programs, including well-child and adolescent well-care visits, medication management for people with asthma, and frequency of prenatal care. Examples of value metrics are ambulatory care follow-ups after an emergency department visit or inpatient discharge, and inpatient psychiatric 30-day readmission rates. (p. 12)
  • Tobacco use, diabetes, and obesity and their underlying social determinants are key drivers of poor health outcomes and rising health care costs. Performance improvement related to these three priority areas will be tracked. Team-based health care will foster redesigned workflows for patient care and referral management, better transitions of care, and increased family and patient involvement. (p. 4)

Maryland:
State's SIM website

More to come....

Montana

More to come...

Nevada
Click Here for Full State Plan
State's SIM website

  • Based on Governor Sandoval 's priorities and the State's overall health care objectives, Nevada will work with a broad range of stakeholders to transform health care delivery in the state. DHCFP has identified guiding principles for transforming health care delivery, many of which are consistent with CMS' characteristics of a transformed system. Models considered for this initiative will apply these guiding principles. (see p. 5 for list of principles)

New Hampshire:
Click Here for Full State Plan
State's SIM website

  • Incorporate psycho-social determinants of health, health outcomes, patient experience of care, and population health into clinical practice. (p. 8)
  • DHHS-funded grants to hospitals, health systems, and/or community providers to form pilots related to improving the delivery and coordination of treatments and services and improving population health. (p. 16)

New Jersey

More to come...

New Mexico
Click Here for Full State Plan
State's SIM website

  • Patient-centered care that features enhanced roles for health care paraprofessionals and expansion of services to rural and underserved populations; development
    and utilization of multi-disciplinary community health teams that focus on evidence-based care and connecting patients with social services. (p. 4)
  • New Mexico will enhance the patient experience of care by increasing physician and patient awareness of community resources, encouraging patient engagement in care through care coordination and technology, and coordinating with providers to implement policies that encourage self-management. (p. 4)

Commonwealth of the Northern Mariana Islands

More to come...

Oklahoma
Click Here for Full State Plan
State's SIM website

  • The scope of work for the outside consultants will encompass research and analysis for the development and selection of alternative multi-payer, outcomes-based health system delivery model(s) that fairly compensate providers for care, incentivize healthy behaviors, and reinforce quality, value and evidence-based best practices. Health Access Networks (HANs), Coordinated Care Organizations (CCOs), Health Homes, Patient-Centered Medical Homes (PCMHs), Comprehensive Primary Care (CPC) initiatives, and others will be assessed with a focus on the defined health topics. (p. 8)
  • The OSIM design will integrate healthcare and public health, with an emphasis on chronic and co-morbid conditions, and the reduction of preventable hospitalizations, avoidable readmissions and inappropriate emergency department utilization. (p. 8)

Pennsylvania
Click Here for Full State Plan
State's SIM website

  • To meet our target of 65% of PCPs having attained specified PCMH skills by the end of 2018, 2000 additional practices need to transform the way they deliver care. (p. 6)
  • To provide the knowledge, expertise and peer learning opportunities needed to achieve transformation, a principal component of Pennsylvania’s SIM Model Test initiative is a Health Care Transformation Support Center (Transformation Center). The Transformation Center will be a multi-faceted resource to build organizational and professional capacity in support of a wide array of providers and thereby accelerate delivery system transformation. (p. 6)
  • Pennsylvania has identified four inter-related delivery models and payment methodologies that support delivery system transformation: 1. APOs with shared savings and risk assumption opportunities; 2. PCMHs with shared savings opportunities; 3. Episodes of care (EOC) with budgeted reconciled or prospective payments, and 4. Community-based Care Management Teams (CMT). (p. 8-9)
  • Pennsylvania intends to pilot four additional reforms to address other elements of the care continuum, with the potential to expand after evaluation of effectiveness: · use pharmacists to provide patient counseling to conduct medication reconciliation, increase medication adherence, reduce unnecessary poly-pharmacy, and improve transitions of care. Pharmacists may be placed on CMTs and in high-volume community health centers; · test the CDC evidence-based Diabetes Prevention Program through grants to YMCAs and other community centers, specifically for Medicaid beneficiaries; · hire registered nurses to join county mental health teams to enhance integration, and · create mobile, multi-disciplinary community care teams to provide interventions for people with high physical and/or behavioral health needs in settings where consumers live. (p. 10)
  • Pennsylvania’s HealthChoices program promotes selection of a primary care provider as part of a beneficiary’s plan selection and enrollment. In addition, under Pennsylvania’s pending Medicaid 1115 Waiver Demonstration, Healthy Pennsylvania Private Coverage Organizations will require that all newly eligible adults have access to a primary care provider. (p. 9)
  • To promote greater adoption of the APO and PCMH models, the State will utilize its health care coverage programs – Medicaid, CHIP and the pending 1115 Demonstration – to help drive system transformation. DPW, through its contractual relationship with the HealthChoices MCOs and Healthy Pennsylvania Private Coverage Organizations, will drive system transformation by incentivizing approaches tied to quality, outcomes-based performance measures. (p. 10)

Puerto Rico

More to come...

Utah

More to come...

Virginia

More to come...

West Virginia
Click Here for Full State Plan
State's SIM website

  • Stakeholders involved in the Collaborative and other initiatives will design a model that is: 1) highly effective and efficient; 2) targets the primary care system and encourages effective, patient-centered care; 3) emphasizes value; 4) is integrated at the state level to share resources such as training, expertise, devices and problem solve challenges as they arise; 5) is evidence-based; and 6) regionally-coordinated but community-based as needed to combat the rural, underserved setting while providing flexibility to providers based on local needs. (p .4)

Wisconsin
Click Here for Full State Plan
State's SIM website

  • Wisconsin will select targeted health improvement priorities for care delivery transformation, beginning with identification of health care services with the greatest variation in quality and cost effectiveness, health conditions and health care services that are major cost drivers in the state, and clinical conditions with the most severe disparities in health outcomes. (p. 3-4)
  • The DHS and the SVC LC will identify barriers to adoption of best practices and recommend evidence-based models for dissemination and adoption by providers throughout the state, while considering the needs of providers in different settings (e.g. rural, urban, independent, tribal, safety net, community.) Based on the lessons learned from current innovations, Wisconsin will also establish strategies for assisting providers in adapting clinical workflows and processes to incorporate new approaches. (p. 4-5)