Public-private multi-payer pilots are unique opportunities to support high-performing delivery systems by creating alignment around payment, reporting, and infrastructure investments. Multi-payer projects benefit both payers and providers: Multi-payer projects spread transformation costs among all payers seeking to improve both quality and costs, creating a shared incentive to build essential infrastructure for delivery system improvement. In addition, multi-payer models can make it possible for practices to afford investments in staff and infrastructure that would otherwise be beyond their reach, aligning incentives and reporting requirements for large portions of providers’ panels – not just a small subset. States are a critical partner in multi-payer efforts, uniquely equipped to lead, plan, convene, and implement pilots. They have extensive purchasing power for Medicaid, CHIP, and state employees, and can play a role that no other payer can play—state participation, especially as a convener, enables competing payers to work collaboratively to establish a common initiative without risking antitrust violations.
The National Academy for State Health Policy has assisted states in advancing medical homes for Medicaid and CHIP since 2007 through a series of consortia and learning collaboratives, and began writing about and tracking state accountable care activity in 2011. Support for these initiatives, as well as funding for this resource center, has comes through grants from The Commonwealth Fund, most recently to support four states in building multi-payer medical home programs. NASHP is also a member of the evaluation team for the Center for Medicare & Medicaid Services (CMS) Multi-payer Advanced Primary Care Practice Demonstration and ACA Section 2703 Health Homes program.
Now is a time of opportunity for states to pursue multi-payer medical home initiatives. Recent initiative of the federal Centers for Medicare & Medicaid Services (CMS) – including the State Innovation Models program, the Comprehensive Primary Care Initiative, and the Multi-payer Advanced Primary Care Practice demonstration – promote multi-payer collaboration on payment and delivery system reform. This resource center aims to support states as they confront five key decision points along the road to multi-payer programs:
- Stakeholder Engagement and Pilot Convening: This page features resources on engaging payers, providers, and other key stakeholders (PCAs, consumers, hospitals, etc.), including navigating antitrust concerns.
- Developing Infrastructure and Community Linkages: This page features resources on building community infrastructure to support multi-payer pilots, including information technology, shared practice supports, and behavioral health integration.
- Payment: This page features resources on payment methodologies to support practices participating in multi-payer payment and delivery system reform programs.
- Attribution and Enrollment: This page features resources on identifying and attributing patients to practices for participation in multi-payer models.
- Evaluation: This page features resources on evaluating state multi-payer initiatives.
Please also see the Forming Partnerships section of NASHP’s Medical Home Map and the Authority and Governance sections of NASHP’s State Accountable Care Activity Map.
Related NASHP resources include the Medical Home Map and State Accountable Care Activity Map, both funded by The Commonwealth Fund, and the Integrated Delivery System Toolkit, funded by the Kaiser Permanente Community Benefit and hosted on State Refor(u)m.
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