With the Center for Medicare and Medicaid Innovation (CMMI) recently announcing Round Two of the State Innovation Models (SIM) Initiative, the participating awardees will engage a wide set of partners to support their ambitious goals for statewide multi-payer delivery system and payment reform. Given their track record since 2006 for improving community health and health care quality in states across the country, the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) regional alliances are uniquely positioned to support SIM states’ efforts to transform their delivery systems and offer lessons for other regional efforts.

SIM Background

The State Innovation Models (SIM) Initiative is driving practice transformation through financial and technical support for state-led reforms that will enhance the quality of care, improve health system performance, and decrease costs. In SIM Round One, CMMI awarded nearly $300 million to 25 states; in Round Two, it awarded an additional $660 million to another 32 awardees, nine of which have active AF4Q alliances. Awardees are using SIM funding, which ranges from $750,000 to $100 million per state, to achieve targeted improvement milestones.

Spotlight on SIM Round 1 State-Alliance Partnerships

AF4Q alliances have been actively involved in SIM efforts to date including the following:

Stakeholder Engagement and Practice Transformation: The P² Collaborative of Western New York, which is supporting provider engagement, helped develop the practice transformation components of the state’s Advanced Primary Care model under SIM. More recently, the New York State Department of Health named the P² Collaborative as a Population Health Improvement Program entity. In this role, the P² Collaborative will continue to promote the Triple Aim by convening key stakeholders to measure health and well-being. The collaborative also provides a neutral forum for sharing best practices in the northwestern region of the state.

Similarly, the Greater Detroit Area Health Council and the Alliance for Health in West Michigan have participated in several steering committee meetings to provide feedback on Michigan’s SIM design of an Accountable Systems of Care model. These regional alliances also contributed information to Michigan’s State Health Care Innovation Plan under SIM. The Common Table Health Alliance in Tennessee has also been engaged in various steering committee discussions, given the state’s interest in leveraging the alliance’s patient-centered medical home readiness program.

Multi-Payer Quality Measurement Alignment: Washington Health Alliance, a purchaser-led, multi-stakeholder collaborative of more than 175 stakeholders, supported the state’s multi-payer landscape assessment process under SIM. The Alliance also convened stakeholders to identify evidence-based quality and utilization metrics and evaluation criteria to help establish a common measure set. The Maine Health Management Coalition has also supported Maine’s efforts to identify a set of common quality, cost, and utilization measures for use by Maine payers in evolving alternative payment models.

Quality Improvement Support:  Maine Quality Counts provides quality improvement support for three initiatives, working in close partnership with the state and MaineCare, Maine’s Medicaid program:

• MaineCare Health Homes: Supports changes in chronic illness care among 80 primary care practices. SIM funding also allows Maine Quality Counts to expand the state’s existing Patient-Centered Medical Home Learning Collaborative to include these practices.

• MaineCare Behavioral Health Homes Learning Collaborative: Supports 30 organizations that serve patients with serious mental illness/serious emotional disturbances in establishing health homes.

• Patient Provider Partnership Pilots: Promotes more effective communication between patients and their health care providers and more active engagement of patients in health care decision-making.

Data Exchange/Aggregation: Massachusetts Health Quality Partners conducted a stakeholder survey on behalf of the Massachusetts’ Center for Health Information Analysis for the state’s All Payer Claims Database provider portal to support SIM efforts.

The Maine Health Management Coalition also provides data and analytic support to the Maine SIM initiative by building and maintaining an all payer database, providing a secure portal for providers to log in and examine claims information, and providing detailed cost reports to all primary care practices in Maine.

Alliances in Cleveland and Cincinnati were instrumental in participating in the design phase of Ohio’s SIM proposal and have also leveraged their existing efforts in Ohio’s primary care communities to support the state’s SIM primary care payment reform efforts. The Cincinnati Alliance, through its participation in the Comprehensive Primary Care Initiative, will be the model used for the expansion of primary care transformation in Ohio. Both Alliances have also supported data aggregation activities that can be leveraged in spreading the state’s patient-centered medical home efforts.

Opportunities for State-Alliance Partnerships Moving Forward

As states begin planning for the next phase of their SIM work, there are major opportunities for the AF4Q alliances, and other regional efforts, to work together with states to achieve SIM’s ambitious goals:

• As regional conveners and engagement facilitators, regional alliances can help states bring together diverse partners, including multi-payer stakeholders, in a neutral way to develop collaborative solutions to improve health care delivery.

• As data service providers, regional alliances can support state efforts with data identification, research, aggregation, validation, and analysis to support health improvement efforts. State-alliance partnerships can provide comparable support to providers.

• In defining a sustainability model, alliances can serve as capacity builders to maximize the states’ resources and the potential to sustain results across regions beyond the SIM award period.

• In developing and operationalizing innovation and other deliverables, alliances can support risk mitigation strategies and efforts to support practice transformation support.

Since AF4Q was launched in 2006, it has served as a learning laboratory for how regional multi-payer efforts can be used to help support state goals. State-alliance partnerships, such as those achieved through AF4Q, offer models that other states can look to in engaging partners and accelerating SIM efforts nationally.