Stakeholder Engagement and Pilot Convening
States that are seeking to build multi-payer programs have critical roles to play in engaging payers and providing antitrust protection, engaging and contracting with providers, and partnering with other key stakeholders, such as consumers.
- Engaging Payers and Navigating Antitrust Issues
- Engaging Providers and Provider Contracting
- Engaging Consumers and Other Stakeholders
- Townley, Charles, and Rachel Yalowich. 2013. “Five Key Strategies to Engage Health Care Payers and Purchasers in a Multi-Payer Medical Home Initiative.” National Academy for State Health Policy.Identifies five overarching strategies that states convening multi-payer medical home initiatives can use to make a case for payer and purchaser participation: building trust among competitors; leveraging existing infrastructure; using the market to drive demand; striking the balance between flexibility and consistency; and illustrating the value of the model.
building trust among competitors; leveraging existing infrastructure; using the market to drive demand; striking the balance between flexibility and consistency; and illustrating the value of the model. – See more at: https://nashp.org/publication/five-key-strategies-engage-health-care-payers-and-purchasers-multi-payer-medical-home-in#sthash.VYrSTTrK.dpuf
- Wirth, Barbara, and Mary Takach. 2013. “State Strategies to Avoid Antitrust Concerns in Multipayer Medical Home Initiatives.” National Academy for State Health Policy.Describes legislative actions and other strategies states have used to address antitrust concerns in multipayer medical home initiatives.
- Harbrecht, Marjie G., and Lisa M Latts. 2012. “Colorado’s Patient-Centered Medical Home Pilot Met Numerous Obstacles, Yet Saw Results Such As Reduced Hospital Admissions.” Health Affairs 31 (9): 2010–2017.Describes Colorado’s HealthTeamWorks Multipayer Patient-Centered Medical Home Pilot, including a detailed description of pilot convening, particularly the challenges of coordination and alignment between multiple private plans. See Online Appendix for full list of stakeholders.
- Academy Health. 2010. “Navigating Antitrust Concerns in Multi-Payer Initiatives.”Discusses potential state solutions to antitrust regulations, focusing on the State Action Immunity Doctrine and approaches used in Pennsylvania, Maryland, Massachusetts, Rhode Island, and Washington.
- Burke, Taylor, and Sara Rosenbaum. 2010. “Accountable Care Organizations: Implications for Antitrust Policy.” BNA’s Health Law Reporter 19 (10).Reviews antitrust and other legal issues surrounding accountable care organizations and integrated delivery system models.
- Cavanaugh, Sean, and Gregory Burke. 2010. “A Multipayer Approach to Health Care Reform.” United Hospital Fund.Makes a case for the value of multi-payer initiatives and identifies potential roadblocks. Describes various models for multi-payer initiatives and highlights potential leadership roles for states.
- Chapters 5 and 6, Maryland Laws of 2010 – Maryland Patient Centered Medical Home Program. 2010.Maryland legislation authorizing the creation of the state’s all-payer Patient-Centered Medical Home program.
- Chapter 305, Washington Laws of 2009 – Primary Care Medical Home Reimbursement Pilot Projects. 2009.Washington legislation providing antitrust protection to multi-payer payment reform demonstrations in the state.
- Maine Patient Centered Medical Home Pilot. 2012. “Memorandum of Agreement for Participation: Maine PCMH Pilot Expansion & MAPCP Demonstration.”The participation agreement between Maine’s Patient-Centered Medical Home Pilot and participating practices reviews core expectations as well as the benefits of participation.
- Rhode Island Chronic Care Sustainability Initiative. 2011. “Chronic Care Sustainability Initiative Common Contract.”Common contract between all practices and payers participating in Rhode Island’s multi-payer medical home program, the Chronic Care Sustainability Initiative. Includes expectations around payment, quality metrics, and data sharing between practices, plans, and project management.
- Maryland Healthcare Commission. 2011. “Patient Centered Medical Home Program Participation Agreement.”Describes responsibilities of practices, payers, and the convening entity (Maryland Health Care Commission) in Maryland’s multi-payer patient-centered medical home program.
- Kaye, Neva, and Mary Takach. 2009. “Building Medical Homes in State Medicaid and CHIP Programs.” National Academy for State Health Policy.Includes discussion of strategically engaging providers and other stakeholders in medical home programs via advisory groups and other methods, beginning on pg. 15.
- Maine Patient-Centered Medical Home Pilot. 2013. “Maine Patient-Centered Medical Home Pilot Core Expectations: Minimum Requirements.”Practices participating in Maine’s PCMH pilot are required to include at least two patients or family members on the practice leadership team (see pg. 3).
- Roseman, Deborah, Jessica Osborne-Stafsnes, Christine Helwig Amy, Summer Boslaugh, and Kellie Slate-Miller. 2013. “Early Lessons From Four ‘Aligning Forces For Quality’ Communities Bolster The Case For Patient-Centered Care.” Health Affairs 32 (2): 232–241.Discusses efforts by four communities participating in the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative to better engage patients in health care quality improvement.
- Shafir, Adi, and Jill Rosenthal. 2012. “Shared Decision Making: Advancing Patient-Centered Care Through State and Federal Implementation.” National Academy for State Health Policy.Reviews the definition, process, and rationale for shared decision-making – a process that engages patients in a dialogue with their providers to help them select health care options that conform to their values and preferences – and potential roles of states in promoting shared decision-making.