Continuing Federal Support for State Health Innovation: Opportunities and Challenges

The Centers for Medicare and Medicaid Services (CMS) is looking for input to support state health innovation reform—either by building on the existing State Innovation Models (SIM) initiative or other innovation models. They recently issued a request for information (RFI) regarding state-based payment and delivery system reform initiatives. The Milbank Memorial Fund responded to the RFI.

“Continuing federal support for state health innovation on health care delivery system reform is consistent with many of the Fund’s priorities and programs,” said Christopher F. Koller, president of the Fund. The Fund’s response drew on much of its work with states, including facilitating the Multi-State Collaborative for multi-payer primary care transformation; measuring total costs of care and rates of health care cost growth; and identifying key health policy priorities for the new federal administration through the nonpartisan Reforming States Group.

The Fund’s response noted that there is continuing interest among states to build on current innovation models and to test new concepts that advance population health improvement through multi-payer, multi-sector collaboration.

One of the questions CMS is grappling with relates to the strategy for advancing robust alternative payment model (APM) activities working with states. Some states have embraced a comprehensive, state-specific model that directly engages Medicare (for example, Vermont and Maryland), while others have focused on reforms in Medicaid. Many have provided leadership and support for multi-payer alignment, often through new Medicare payment models like the Comprehensive Primary Care Plus program. CMS and the states, working in partnership, must find the appropriate balance between flexibility and standardization in these efforts. “States recognize that Medicare and Medicaid can’t let a thousand delivery system reform flowers bloom,” Koller said, “but the same flower may not grow in Vermont, Mississippi, and Arizona.”

Another topic raised in the RFI is whether and what type of federal investment is needed to sustain and expand state health innovation efforts. Successful programs for state innovation planning and implementation and for multi-payer payment reform, the RFI response notes, have already demonstrated that long-term investment is required, and Medicare and Medicaid should be meaningful partners to sustain that work.

CMS asked if there would be support for a new standardized care intervention model. The Fund has collected evidence in support of investments in social services that complement or even transcend a traditional health care model. CMS, the Fund noted, could work with states to align new payment models with new population health models.

Read the complete RFI response here.