VISIT STATE HEALTH COMPARE
Blog & News
Evaluations of Integrated Care Models for Dually Eligible Beneficiaries: Key Findings and Research Gaps from MACPAC
August 08, 2019:Under contract to the Medicaid and CHIP Payment and Access Commission (MACPAC), researchers at SHADAC recently compiled an inventory of evaluations of integrated care models for beneficiaries enrolled in both Medicare and Medicaid, for which both the inventory itself and a related issue brief have now been published.
About the Study
Currently, both the federal government and numerous states are testing a variety of models to integrate care for beneficiaries enrolled in both Medicare and Medicaid, including the Program of All-Inclusive Care for the Elderly, the Financial Alignment Initiative (FAI), Medicare Advantage dual eligible special needs plans and fully integrated dual eligible special needs plans, managed long-term services and supports programs, and demonstrations that pre-dated the FAI.
There is a limited but growing body of evidence examining the effects of these models on Medicare and Medicaid spending, health outcomes, and access to care. Broadly, studies to date have generally found a decrease in hospitalizations and readmissions for enrollees in the different models relative to those not enrolled in integrated models. Findings regarding the use of other services, such as use of the emergency department and long-term services and supports, were mixed—as are reports on beneficiary experience. It is often difficult to generalize from evaluations of specific models about the effects of integrated care more broadly.
This new inventory details a total of 51 studies, including those published between 2004 to November 2018 and formal evaluations on the FAI updated through July 2019, and gathers all available evidence on how programs have affected spending, quality, health outcomes, and access.
Access the Inventory of Evaluations of Integrated Care Programs for Dually Eligible Beneficiaries to read and download the full literature review and inventory compiled by SHADAC.
For a high-level summary on data methods and sources used for the review and inventory, see the companion brief, Evaluations of Integrated Care Models for Dually Eligible Beneficiaries: Key Findings and Research Gaps.
Blog & News
Register Now - Webinar on Supporting Payment and Delivery System Reform through Multipayer Quality Measure Alignment
January 23, 2020:Date: June 24, 2019
Time: 12:00 - 1:30 p.m. Central / 1:00 p.m. - 2:30 p.m. Eastern
View a recording of the "Supporting Payment and Delivery System Reform through Multipayer Quality Measure Alignment" webinar.
The State Health Access Data Assistance Center (SHADAC) will host a webinar on multipayer quality measure alignment as a strategy for supporting health care payment and delivery system reform. The webinar will draw on lessons learned from the experiences of states that received State Innovation Model (SIM) Round 1 and Round 2 awards from the Center for Medicare & Medicaid Innovation (CMMI) to test models for catalyzing health care system transformation.
The interactive webinar will feature presentations from SHADAC, which provides technical assistance to SIM states as part of a team led by NORC at the University of Chicago; from the state of Washington, which undertook a multipayer quality measure alignment effort to support a shift to value-based payment as part of its SIM initiative; and from CMMI’s SIM evaluation team.
Presenters will include:
SHADAC
Senior Research Fellow Colin Planalp, MPA, who authored a paper on SIM states’ quality measure alignment efforts with support from CMMI.
Washington State Health Care Authority
Value-based Purchasing Manager J.D. Fischer, who works with implementation of value-based payment in state health care contracting; Practice Transformation Manager Laura Pennington, who oversaw development of the Statewide Common Measure Set; and Healthier Washington Connector Bonnie Wennerstrom, who is the former SIM Project Director for the state.
CMMI
Jennifer Lloyd, PhD, and Gregory J. Boyer, PhD, the respective Evaluation Leads for SIM Round 1 and Round 2
The presenters will also participate in a Question and Answer session with webinar attendees at the conclusion of all presentations.
Related Resources
Publication
Supporting Payment and Delivery System Reform through Multipayer Quality Measure Alignment: Lessons from State Innovation Models (Webinar)
Date: June 24, 2019
Time: 12:00 - 1:30 p.m. Central / 1:00 p.m. - 2:30 p.m. Eastern
The State Health Access Data Assistance Center (SHADAC) hosted a webinar on June 24, 2019, on multipayer quality measure alignment as a strategy for supporting health care payment and delivery system reform. The webinar drew on lessons learned from the experiences of states that received State Innovation Model (SIM) Round 1 and Round 2 awards from the Center for Medicare & Medicaid Innovation (CMMI) to test models for catalyzing health care system transformation.
The interactive webinar featured presentations from SHADAC, which provides technical assistance to SIM states as part of a team led by NORC at the University of Chicago; from the State of Washington, which undertook a multipayer quality measure alignment effort to support a shift to value-based payment as part of its SIM initiative; and from CMMI’s evaluation team. Presenters included:
SHADAC
Senior Research Fellow Colin Planalp, MPA, who authored a paper on SIM states’ quality measure alignment efforts with support from CMMI.
Washington State Health Care Authority
Value-based Purchasing Manager J.D. Fischer, who works with implementation of value-based payment in state health care contracting processes; Practice Transformation Manager Laura Pennington, who oversaw the development of the Statewide Common Measure Set; and Healthier Washington Connector Bonnie Wennerstrom, who is the former SIM Project Director for the state.
CMMI
Jennifer Lloyd, PhD, and Gregory J. Boyer, PhD, the respective Evaluation Leads for SIM Round 1 and Round 2.
The presenters also participated in a Question and Answer session with webinar attendees at the conclusion of all presentations.
A recording of the webinar is available above, and webinar slides and transcript are both available for download.
Event Resources
Aligning Quality Measures across Payers: Lessons from State Innovation Models
Quality Measurement for HCBS and Behavioral Health in Medicaid: What’s Happening and What’s Missing
Blog & News
New Issue Brief Examines Ohio Strategy to Improve Opioid Prescribing Through Payment Reform
March 05, 2020:
In an effort to improve quality and contain the growing cost of health care, states are increasingly undertaking a shift away from fee-for-service reimbursement models that reward quantity of services and moving toward alternative payment models that reward value. Many of the states leading the way in payment and delivery system reform have received State Innovation Model (SIM) awards from the Center for Medicare & Medicaid Innovation (CMMI) that have aided in accelerating that work.
In a new issue brief, SHADAC senior research fellow Colin Planalp profiles the innovative work in Ohio to link the state’s payment and delivery system reforms with another important policy priority: interventions to curtail the opioid crisis.
This paper was produced collaboratively by SHADAC and the Center for Health Care Strategies (CHCS) with support from the Center for Medicare & Medicaid Innovation (CMMI). SHADAC and CHCS are part of a team led by NORC at the University of Chicago that serves as the SIM Resource Support Contractor. SHADAC and other technical assistance partners support states and the Innovation Center in designing and testing multi-payer health system transformation approaches.
Improving opioid prescribing practices through payment reform
In 2014, Ohio became one of seventeen states to receive a SIM test award from CMMI in order to implement payment and delivery system reforms aimed at controlling the cost and enhancing the quality of health care. Acting as laboratories of innovation, each state employed a unique strategy tailored to their specific situation.
One of the key components of Ohio’s SIM was developing “episodes of care” as an alternative to fee-for-service payments for some types of discrete health care conditions such as an appendectomy, colonoscopy, or treatment of an ankle sprain. Under the episodes of care payment model, participating Ohio providers are eligible for incentive payments if they meet targets for both cost containment and quality performance.
During the payment model development process, staff from the Ohio SIM team recognized that many of the state’s planned episodes focused on procedures such as spine and joint surgery, which they knew were associated with prescription opioid painkillers—a topic of particular concern in Ohio, which has some of the highest rates of opioid overdoses in the U.S.
Based on that realization, the state analyzed its Medicaid claims data and identified potential episodes that represented a large share of opioid prescribing. Afterward, they worked with a consultant and stakeholders to develop evidence-based quality measures for appropriate opioid prescribing. The state then built those quality measures of appropriate opioid prescribing into approximately a dozen episodes of care—such as dental tooth extractions and treatment of lower back pain—as part of a two-pronged strategy: 1) by giving health care providers information on their performance for opioid prescribing quality measures compared to benchmarks; and 2) by using their performance to influence their eligibility for incentive payments, the state aims to leverage its payment reform efforts to reduce inappropriate prescribing of opioids and ultimately mitigate the opioid overdose crisis.
For more information on Ohio’s SIM work to improve opioid prescribing and examples of SIM projects in other states, read the issue brief on CHCS's State Innovation Model Resources Page.
Suggested Further Reading
Quality Measurement for HCBS and Behavioral Health in Medicaid: What’s Happening and What’s Missing
Aligning Quality Measures across Payers
New SHADAC Issue Brief Highlights Lessons Learned from SIM States Working to Align Quality Measures
SHADAC Releases 50-State Analysis of the Evolving Opioid Crisis (Infographics)
Publication
SHADAC Issue Brief "Aligning Quality Measures across Payers: Lessons from State Innovation Models"
In an effort to improve quality and contain the growing cost of health care, states are increasingly undertaking a shift away from fee-for-service reimbursement models that reward quantity and moving toward alternative payment models that reward value.
Many of the states leading the way in payment and delivery system reform have received State Innovation Model (SIM) awards from the Center for Medicare & Medicaid Innovation (CMMI) that have aided in accelerating that work.
An issue brief authored by SHADAC researcher Colin Planalp examines the work of five SIM states to develop common measure sets that align quality measures across private and public payers—a strategy aimed at reducing administrative burdens on providers and giving focus to quality improvement efforts. Drawing from the experiences of Connecticut, Massachusetts, Minnesota, Rhode Island, and Washington, the brief outlines a framework for other states to undertake quality measure alignment projects in the future.
This paper was produced by SHADAC with support from the CMMI. SHADAC is part of a team led by NORC at the University of Chicago that serves as the SIM Resource Support Contractor. SHADAC and other technical assistance partners support states and the Innovation Center in designing and testing multi-payer health system transformation approaches.
Strategy: Voluntary or Mandatory Alignment
One of the first key decisions made by states undertaking multipayer quality measure alignment is the choice between adopting a mandatory approach—requiring private payers to use the measure set—or voluntary alignment approach—encouraging stakeholder buy-in via engagement and needs prioritization. The issue brief examines both methods and highlights important considerations of each using examples of voluntary alignment from Connecticut and Washington, and examples of mandatory alignment (e.g., statutory and regulatory authorities) in Massachusetts, Minnesota, and Rhode Island.
Alignment Adoption Techniques
Each state referenced in the brief emphasized stakeholder engagement (i.e., establishing workgroups with representatives from state agencies, commercial health plans, health care providers, consumer advocates and other stakeholders) to ensure that the common measure sets met important priorities and to develop buy-in for adopting measures. The brief examines states’ stakeholder engagement strategies, as well as other techniques employed by the states to bolster their new common measure sets such as Washington’s adoption of the measures in its Medicaid and state employee health plans.
Measure Set Development: Priorities and Goals, Measure Evaluation, and Selection
The issue brief also lays out a roadmap for other states to develop their own common quality measure sets, pulling lessons from the processes employed by the five study states. The state workgroups tasked with selecting metrics for their common measure sets reported that their responsibilities generally entailed identifying and incorporating shared priorities and goals in selecting common measures, cataloguing measures currently in use within the state, selecting criteria for systematically evaluating potential measures, and evaluating and selecting measures according to those agreed-upon criteria.
Measure Set Sustainability
As a final step, the states profiled in this brief also have created and implemented processes to ensure their common measure sets will remain effective and relevant by periodically updating the measure sets by either removing measures where provider performance has topped out and/or adding new measures to address evolving quality priorities.
Lessons Learned
Ultimately, what conversations with these states revealed was a common set of lessons that can be utilized by other states planning to undertake quality measure alignment moving forward. Articulated at various points within the issue brief are recommendations for states to focus on:
- Including workgroup members from all stakeholder groups: commercial, public, state agencies, providers, consumers, and any other key groups.
- Encouraging stakeholder engagement in all aspects of selecting and implementing common measure sets.
- Strongly defining a rationale to promote stakeholder involvement, buy-in, and engagement.
- Selecting measures that are meaningful and practically applicable for providers and payers alike.
- Adopting a common measure set in public programs in order to promote mirrored alignment in commercial programs.
- Continuing to review measures after they have been set, and updating or modifying if necessary.
Read the full issue brief for more details on aligning quality measures in states.
Suggested Further Reading
Quality Measurement for HCBS and Behavioral Health in Medicaid: What’s Happening and What’s Missing
