State Delivery System and Payment Reform Map
About health homes

Health Homes
Section 2703 of the Affordable Care Act, which created Section 1945 of the Social Security Act, authorized a new state plan option for state Medicaid agencies. Health homes are a team based model of care designed to provide whole-person care to individuals with chronic health needs or severe mental illness through six core services: Comprehensive Care Management; Care Coordination; Health Promotion; Comprehensive Transitional Care; Individual and Family Support; and Referral to Community and Social Support Services.  Once a health home state plan amendment is in effect, CMS provides enhanced federal funding (90% service match for the six core services) for eight consecutive quarters. For additional information about the health home state plan option, visit CMS’ website.

Over time, NASHP will add information on other delivery and payment transformation initiatives underway in states. Know of a state initiative we should include? Contact us.

Development and ongoing updates of the Delivery and Payment Transformation Map would not be possible without the generous support of The Commonwealth Fund.

About medical homes

Medical Homes
A medical home is an enhanced model of primary care that embraces comprehensive and coordinated patient-centered care emphasizing enhanced access, quality, and safety. First advanced by the American Academy of Pediatrics in the 1960’s, the concept gained new momentum in 2007, when four major physician groups agreed to a broader vision of the model in the Joint Principles of the Patient-Centered Medical Home. The criteria for including state programs on this map are:

• Enhanced Medicaid payments to medical homes either through Medicaid Fee-for-service payments or managed care organizations contract requirements;
• New expectations for practices to become qualified as a medical home;
• Emphasis on quality improvement through measuring outcomes of practices and the overall program.

For additional information on patient-centered medical homes, visit the Agency for Healthcare Research and Quality’s website. For information on commercial medical home initiatives, visit the Patient-Centered Primary Care Collaborative.

Over time, NASHP will add information on other delivery and payment transformation initiatives underway in states. Know of a state initiative we should include? Contact us.

Development and ongoing updates of the Delivery and Payment Transformation Map would not be possible without the generous support of The Commonwealth Fund.

About DSRIP

DSRIP
Under the authority of Medicaid Section 1115 Demonstration Waivers, Delivery System Reform Incentive Payment (DSRIP) programs incentivize infrastructure improvements, care delivery redesign, and improvements in the quality of care for low-income populations through value-based payments. DSRIPs can also be leveraged to promote alternative payment methodologies in managed care. DSRIP programs originated in 2010 as a mechanism for states to restructure hospital supplemental payments for safety net hospitals as they expanded Medicaid managed care. Many newer DSRIP programs permit states to re-invest Medicaid savings more broadly, often by promoting the development of regional integrated provider networks comprised of hospitals, primary care providers, behavioral health providers, community-based social services organizations, and others. DSRIP programs reward providers with incentive payments for achieving process and outcome metrics related to the implementation of DSRIP improvement projects. “DSRIP-like” programs, which do not require projects, reward providers for meeting performance improvement milestones.

To learn more about DSRIP and DSRIP-like programs, please visit MACPAC’s website and read NASHP’s Report.

Please check back for state updates as NASHP tracks DSRIP implementation.

Development and ongoing updates of DSRIP programs on the Delivery and Payment Transformation Map would not be possible without the generous support of the Robert Wood Johnson Foundation. 

 

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