SHADAC Expertise

Payment and Delivery System Reform

Payment and Delivery System Reform

SHADAC researchers have extensive experience in state government, including leadership in the design and implementation of multi-payer health system delivery reform initiatives. SHADAC leverages this experience in our project work and has several ongoing and recent projects addressing payment and delivery system reforms in the states:

State Innovation Model (SIM) Technical Assistance
Since 2012, SHADAC has been part of a team led by NORC at the University of Chicago that is serving as the State Innovation Model (SIM) Resource Support Contractor for the Center for Medicare and Medicaid Innovation (the “Innovation Center”). SHADAC is currently supporting 38 states and territories and the Innovation Center in designing and testing innovative multi-payer health system transformation approaches.  SHADAC works with NORC and other technical assistance partners, including the Center for Health Care Strategies (CHCS), National Governors Association, Manatt Health Solutions, and Mercer Consulting to provide consultation and technical assistance to states as they develop and implement health care transformation models.

Value-Based Payment Reform in the Medicaid Program
The Medicaid and CHIP Payment and Access Commission (MACPAC) and SHADAC conducted site visits in 2013-2014 to a total of seven states—Arkansas, Connecticut, Maryland, Minnesota, Oklahoma, Oregon, and Pennsylvania—to learn about different payment and delivery system reforms aimed at improving value in Medicaid such as shared savings approaches, episode-based payment initiatives, and global budgeting. SHADAC produced an interim report reflecting the cross-state learnings from four of these site visits, entitled “Paying for Value in Medicaid: A Synthesis of Advanced Payment Models in Four States,” for MACPAC’s Commissioners and Congressional audiences. The final report for this project can be found here.

Behavioral and Physical Health Integration Efforts in the Medicaid Program
SHADAC is currently serving as a contractor to The Medicaid and CHIP Payment and Access Commission (MACPAC) on a project to document behavioral and physical health integration efforts in Medicaid. Study questions include:

  • What populations are targeted by physical and behavioral health integration efforts?
  • At what level—state, community, provider organization, clinic, clinician—is physical and behavioral health integration occurring and not occurring?
  • How does integration of programs and financing at a state level facilitate clinical integration at the point of care for individuals?
  • To what extent do existing evaluations of state-integrated care programs address outcomes?
  • Within unique state purchasing models, markets, and contexts, what strategies are used to: design and oversee vendor contracts and subcontracts, promote collaborative relationships with providers and between payers and providers; facilitate the exchange of data to monitor access to needed care; and align other payers around common goals like integrated care?
  • How are integration initiatives that operate under different regulatory authorities (e.g., different waivers, State Plan Amendments (SPA) alike, and how are they different?

To assess these questions, SHADAC is conducting a comprehensive data scan for all states, followed by telephone interviews with officials from a subset of states. The focus is on integration programs that have been implemented or are currently underway that also have strong ties to Medicaid programs and funding.