Multi-payer health care initiatives — payment and delivery system strategies coordinated across private and public payers — promise to drive health system change by leveraging collective purchasing power across payers to achieve shared goals. Such goals may include investing in primary care, reducing the growth of high and rising health care costs, maintaining and increasing access to quality care, and more.

To better understand how to leverage a multi-payer reform strategy to drive health system change, the National Academy for State Health Policy (NASHP), in partnership with the West Health Policy Center, engaged an advisory group of state leaders with experience implementing multi-payer efforts to discuss key lessons and opportunities for future reforms. Participants included senior state leaders representing Medicaid, Departments of Insurance, state employee health plans (SEHPs), and Departments of Health and Human Services, from Arkansas, Colorado, Massachusetts, Minnesota, Nebraska, North Carolina, Oregon, Rhode Island, Vermont, and Washington.

Through this engagement, NASHP has developed resources to share states’ vision for effective and strategic state and federal efforts to advance multi-payer initiatives. First, a letter shared with the Center for Medicare and Medicaid Service’s Innovation Center (the CMS Innovation Center) that includes state-suggested considerations to inform future federal multi-payer efforts. Second, a slide deck resource that organizes perspectives from the advisory group on catalyzing multi-payer initiatives in states.

Discussions with these state leaders highlight that the time is ripe to engage in efforts aimed at driving transformational health system change. The pandemic and its residual effects on patient care needs, as well as economic instability, have tested our health care system, exposing vulnerabilities of traditional payment models, workforce, health system inequities, and insufficient investments in care, especially in primary care and behavioral health. Multi-payer initiatives may be an effective strategy to address these issues and ultimately improve efficiency, access, and quality. However, several challenges must be addressed for reforms to be most successful including:

• Engagement in a clear, unified vision for reform shared across public and private payers including state, federal, and employer purchaser groups
• Improved provider and payer capacity to test and implement reforms, including dedicated workforce investments
• Dedicated resources to implement programs including financial support for technical assistance toward program administration and improved data and capital infrastructure
• Consideration of unique geographic and community concerns, including needs specific to rural, underserved, and cross-state communities.

More details sharing state perspectives on the opportunities and recommendations for state-federal partnerships moving ahead are available in the resources below.