Table 1.
Statewide Delivery System and Payment Reform Activities and Milestones of State Innovation Models Initiative (SIM) and Comparison States
| Delivery System Reforms | Payment Reforms | |
|---|---|---|
| SIM States, Round 1 | ||
| Arkansas | • Comprehensive Primary Care Initiative • Comprehensive Primary Care Initiative Plus • Multipayer patient-centered medical homes • Performance feedback reports via multipayer portal • Policies to encourage providers’ use of real-time alerts of patients’ hospital and emergency department (ED) use |
• Achieved multipayer alignment through SIM • Majority of SIM funding spent on supporting new payment models • 14 Episodes of Care tested • Included behavioral health (BH) performance measures in non-behavioral health home (BHH) value-based payment model • Medicaid Managed Care |
| Massachusetts | • Primary Care Payment Reform Initiative (PCPRI), a Medicaid PCMH with BH integration, shared savings • Required colocation of behavioral health and primary care providers for SIM payment • Performance feedback reports from Medicaid to providers participating in PCPRI • SIM funds for technical assistance to connect providers to health information exchange • Policies to encourage primary care physicians to access real-time alerts of hospital and ED use |
• Did not achieve multipayer alignment through SIM • Majority of SIM funding spent on supporting new payment models • Medicaid Accountable Care Organizations • Delivery System Reform Incentive Program • Included behavioral health performance measures in non-behavioral health value-based payment model • SIM payment models offered care management fee • Medicaid Managed Care |
| Vermont | • Multipayer Patient Centered Medical Homes • Medicaid Health Homes • Training for behavioral health in learning collaboratives for care management • System to offer real-time alerts of patients’ ED and inpatient use to nonhospital providers • Supported exchange of mental health and substance abuse data outside the health information exchange • Technical assistance to connect providers to health information exchange • Policies aimed at improving data quality in health information exchange |
• Achieved multipayer alignment through SIM • Multipayer Accountable Care Organizations • Delivery System Reform Incentive Program • Included BH performance measures in non-BHH value-based payment model • Had BHH model and supported BHHs or other implementation (not payment) with SIM funds |
| Comparison Group States | ||
| Georgia | • Medicaid Patient Centered Medical Homes | • No multipayer alignment • Medicaid Managed Care |
| Florida | • Medicaid Patient Centered Medical Homes | • No multipayer alignment • Medicaid Managed Care |
| New Mexico | • Medicaid Patient Centered Medical Homes • Medicaid Health Homes |
• No multipayer alignment • Medicaid Managed Care • Delivery System Reform Incentive Program |