CMMI model helped several states make big strides in population health integration

Since the Center for Medicare and Medicaid Innovation implemented its State Innovation Model's Round 2 Test, states that received SIM funding have made payment reform progress in the form of a population health infrastructure and advanced behavioral health integration, finds a new report from RTI International and the Centers for Medicare and Medicaid Services.

CMMI gave more than $622 million to 11 states as part of the Round 2 Model Test, and resulted in New York implementing the most drastic changes, creating a patient-centered medical home model that meets the standards of both Medicaid and private payers.

The other 10 states to receive funding are Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, Ohio, Rhode Island, Tennessee and Washington.

IMPACT

Payment reforms and new delivery models, such as the one created in New York, are part of a broader move to value-based care, which aims to raise quality while lowering costs.

Yet challenges remain for states wanting to switch fully to value-based payments. Shortages of healthcare workers, such as nurses and physicians, represent one such roadblock. Difficulty recruiting small, independent practices are yet another challenge, as is a dearth of delivery and payment models for large, rural Medicare populations.

The report pointed to a plan in Washington, currently in the design phase, that will include all rural payers and could serve as a future model for how to improve care delivery and payment in rural parts of the country.

More than half of the states receiving funds had set up population health programs, typically involving clinical and community health integration, the report found. Colorado, Delaware, Iowa, Michigan, Rhode Island, Washington and Idaho all fell into this group.

THE TREND

The findings could be good news in particular for rural areas. With healthcare services being concentrated more and more among major health systems and larger providers, rural hospitals are struggling.

A 2018 study from Chartis Group and iVantage Health Analytics shed light on the scope of the problem: About 41 percent of rural hospitals faced negative operating margins in 2016.

If those hospitals were located in a state that elected not to expand Medicaid under the Affordable Care Act, those margins were generally worse than those of their peers, suggesting that such expansion had a mitigating effect on financial pressures.
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com