- ACA Implementation & State Health Reform
- Coverage and Access
- Federal/State Issues
- Medicaid and CHIP
- Population and Public Health
- Providers and Services
- Acute Care
- Assisted Living
- Behavioral Health
- Case Management
- Child Development Services
- Chronic Care Management
- Community Health Centers
- Developmental Screening
- Early Childhood Services
- Emergency Care
- EPSDT
- Family Planning
- Federally Qualified Health Centers
- Home & Community Based Services
- Hospitals
- Long Term Services & Supports
- Mental Health
- Nursing Homes
- Oral Health
- Preventive Care
- Primary Care
- Safety Net Providers
- Quality, Cost, and Health System Performance
- Adverse Event Reporting
- Care Transitions
- Comparative Effectiveness
- Cost Sharing
- Delivery System Reform
- Fraud and Abuse
- Health Care Workforce
- Health Information Technology
- Managed Care
- Medical Homes & Health Homes
- Medical Malpractice
- Patient Safety
- Payment Reform
- Performance Measurement
- Provider Payment Policy
- Quality Oversight
- Specific Populations
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Aligning Health Information Technology and Delivery System Transformation Efforts: Themes from a Discussion Among State and National Leaders.
This State Health Policy Brief captures the main themes of an April 2012 meeting of state and national leaders to discuss their vision for a future in which delivery system transformation capitalizes on the true potential of technology to improve the health care system. It includes a description of challenges leaders identified across four dimensions of reform activity: provider and plan measurement and feedback, payment reform, care delivery innovation, and consumer engagement. The brief also describes successful strategies leading states are using to overcome these challenges and concludes with leaders’ recommended next steps to make significant progress.
October 2012» -
Issues and Policy Options in Sustaining a Safety Net Infrastructure to Meet the Health Care Needs of Vulnerable Populations
As a result of large-scale changes in insurance coverage under the Affordable Care Act (ACA), financing streams for safety net providers will shift. The law provides significant resources for further development of some safety net providers while reducing funding streams for others. The vulnerable populations served by the safety net—poor and underserved communities—may not fundamentally change, but their sources of coverage, and thus, financing for safety net providers who care for these populations, will shift dramatically. To adapt to these changing funding streams, safety net providers will need to engage in new and ongoing payment reform efforts, negotiate their roles with state Medicaid programs and qualified health plans sold through newly established insurance exchanges, and maintain an infrastructure to serve the remaining uninsured.
October 2012 -
State Innovations to Transform and Link Small Practices
Federal and state governments play a significant role in strengthening the delivery of primary care, however current efforts have disproportionally been focused on large or multi-specialty practices. This report examines the roles states are playing to reorganize the delivery of primary and chronic care to produce more efficient and effective care, particularly in small practices. Through short case studies developed via interviews with state officials and physicians the authors highlight several state-based initiatives that seek to create high performing health systems by targeting local and regional strengths. Additionally, authors identified five themes critical to enacting strategic delivery system reforms.
December 2010» -
Reforming Health Care Delivery Through Payment Change And Transparency: Minnesota’s Innovations
In 2008 Minnesota passed landmark legislation containing provisions to collect and report data to achieve price and quality transparency, as well as provisions to support care redesign and payment reform. This report illustrates several key achievements and the challenges Minnesota faces in implementing these reforms. It also derives lessons from the process of passing legislation, the content and potential impact of the package, and its replicability that are useful to other states working on similar reforms as well as in national discussions on controlling costs and improving value.March 2010» -
Evaluation
Resources on measurement and evaluation.
Also see the Measuring Results section of NASHP’s Medical Home Map and the Measurement and Evaluation section of NASHP’s State Accountable Care Activity Map.
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The Commonwealth Fund. 2013. “The Commonwealth Fund’s PCMH Evaluators’ Collaborative.”
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Evolving Medical Home Payment Models to Better Support Triple Aim Goals
Thursday, May 24, 20122:30 pm - 4:00 pmEDTRegister hereWebinar Presentation:View Webinar HereInnovative payment models can support medical homes by decreasing the cost of care, incenting and rewarding quality over quantity, and enabling practices to invest in infrastructure and supports. Many leading states have learned from early initiatives and are moving forward with new payment models that to further drive system goals, including lowered costs, improved quality and increased patient satisfaction. Join us as program leaders in Colorado, Rhode Island, and Vermont describe advances in their medical home initiatives, including where they started and where they hope to go.
Speakers:Mary Takach, Program Director, National Academy for State Health Policy
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Developing Infrastructure and Community Linkages
States are key facilitators when it comes to building community infrastructure to support multi-payer pilots, such as information technology, shared practice supports, and behavioral health integration.
Also see the Aligning Reimbursement & Purchasing section of NASHP’s Medical Home Map and the Payment section of NASHP’s State Accountable Care Activity Map.
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Community Care of North Carolina. 2013. “CCNC: Community Care of North Carolina.” https://www.communitycarenc.org/.
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- Submitted by webtemp on Fri, 01/25/2013 - 11:45
Mapping Accountable Care Activity in the States
By Mike Stanek
January 2013States are at the forefront of efforts to design and implement innovative payment and delivery mechanisms that encourage accountability for costs and quality in health care delivery. Bolstered by state legislative mandates, as well as provisions in the Affordable Care Act to re-orient federal health spending to promote accountable care, states are developing a variety of initiatives to improve value—achieving better health outcomes at lower cost—and foster accountability for the value of care provided.
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State ‘Accountable Care’ Activity Map
With the support of The Commonwealth Fund, NASHP is tracking state efforts to lead or participate in accountable care models that include Medicaid and Children’s Health Insurance Program populations. Accountable care models aim to address lack of care coordination and wide disparities in cost and quality of care in the U.S. health care system, perpetuated by the prevailing fee-for-service payment method, through shared incentives to manage utilization, improve quality, and curb cost growth.
State efforts to advance accountable care models vary considerably. However, for the purposes of this map, a set of three core characteristics and capabilities, consistent across designs, is needed:- Organizations or structures should assume responsibility for a defined population of patients across a continuum of care, including across different institutional settings.
- Participants should be held accountable through payments linked to value, emphasizing dual goals of improving quality and containing costs.
- Accountability should be facilitated by reliable performance measurements that demonstrate savings are achieved in conjunction with improvements in care.
State accountable care activity is characterized on this map along seven domains.
- Project scope refers to a range of model design characteristics, including targeted providers, targeted beneficiary population, scope of services provided, and methodology for assigning beneficiaries to the model.
- Authority refers to the specific source (e.g. legislation, executive office, cabinet or Medicaid agency) of the model’s authorization. This category also includes regulatory adjustments (e.g. changes to licensure requirements or data confidentiality rules) made by states to facilitate accountable care models.
- Governance refers to the structures by which policy decisions around the accountable care model are made, and the specific stakeholders (including patients and community stakeholders) who assume responsibility for the project.
- Criteria for participation in the accountable care activity include specific requirements set forth by the state in regulations, requests for proposals, managed care contracts, and other official policy statements. This includes patient protection requirements around notification and grievance resolution.
- Payment describes the targeted delivery system (e.g. fee-for-service or managed care) of the initiative and the design of the accountable care payment model.
- Support for infrastructure refers to a range of supports offered to accountable care projects by the state, including information technology, staff support, data feedback loops, and the convening of learning collaboratives.
- Measurement and evaluation describes performance measures that are being tracked across providers and independent evaluations of the model.
Related Publications -
Payment Reform and the Safety Net Webinar
Friday, June 29, 20123:00 pm - 4:00 pmEDTRegister hereMedicaid payment reform is needed to drive delivery system change. Moving to value-based purchasing strategies, particularly for patients with complex health needs, makes sense. Historically, however, few Medicaid programs have succeeded inmoving safety net providers away from volume-based reimbursement. This Medicaid-only webinar discussed options and possibilities for safety net providers to participate in value-based payment models. Oregon’s Medicaid Director described how safety net providers fit into the state’s new Coordinated Care Organization program, as well as the development of a new alternative payment methodology (APM) for federally qualified health centers (FQHCs). Senior staff from the Center for Medicaid and CHIP Services, CHIP, and Survey & Certification (CMCS) at the Centers for Medicare & Medicaid Services (CMS) followed with remarks on state flexibility to pursue new value-based purchasing strategies, especially through State plan amendments and 1115 waivers.
Presenters:
Carol Backstrom (CMS)
