In this August 14, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Design award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
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Webinar: State Innovation Models Initiative for State Officials - Model Design
1. State Innovation Models Initiative:
Model Design
Centers for Medicare and
Medicaid Services
August 14, 2012
Webinar
2. Agenda
Background & Goals for Preparing for the Proposal
The State Health Care Innovation Plan
The Application Package and Scoring
Funding & Evaluation
Timeline and Contacts
2
3. State Innovation Models: Theory of Action
Hypothesis to be tested: New service delivery and payment
models will be more effective and produce better outcomes
when they are implemented as part of a broad-based, Governor-
led, statewide initiative that brings together multiple payers and
stakeholders -- and uses the levers of state government to effect
change
States can be strong partners in transforming health care because they:
• Pay for a large percentage of health care services
• Have broad regulatory powers over health care providers and payers
• Regulate public health, social service, and educational services
• Can convene multiple parties
• Are closer to the actual delivery of care
• Can integrate state health information exchange infrastructure and
capabilities to support accountable care
3
4. A reformed delivery system will support and reward
those who improve the health of populations
Coordinated Community
Acute Health Care
Seamless Health Integrated Health
System
Care System Care System
High quality acute care • High quality acute care • High quality acute care
• Accountable care systems Accountable care systems • Accountable care systems
• Shared financial risk Shared financial risk • Shared financial risk
• Case management and Case management and • Case management and
preventive care systems preventive care systems preventive care systems
• Population-based quality Population-based quality • Population-based quality
and cost performance and cost performance and cost performance
• Population-based health • Population-based health Population-based health
outcomes outcomes outcomes
• Care system integration • Care system integration Care system integration
with community health with community health with community health
resources resources resources
4
5. Definitions for Models
Two Key Concepts
Comprehensive approach to transforming the health system of
a state. The State Health Care Innovation Plan includes the
State Health Care state’s vision and strategies to transform its payment and
Innovation Plan service delivery system that will improve the quality of care
and lower costs through continuous improvement.
Refers to specific delivery system designs, such as accountable
Payment and care organizations, integrated care systems, or medical homes that
Service delivery are supported by aligned payment methods that reward value.
Model These models will be described in a State Health Care Innovation
Plan.
5
6. How to Present a Compelling Proposal
1. Provide the case for State Health Care System Transformation
– Establish a rationale for redesigning the delivery system and moving to a value-
based payment system which incentivizes improved health outcomes
– Include multiple payers in the model design planning effort
2. Provide evidence that the collaborative planning process will supported with state
level performance data and information.
– Describe how the planning effort will be supported by cost, quality, population
data collection and health system performance information
– Describe the specific data resources that are going available to support the
model design work
3. Present the state’s strategy for engaging the key stakeholders
– Describe the strategies or approach that will be used to engage various
stakeholders
– Present how the state will achieve provider, payer, and other stakeholder buy-in
for the State Health Innovation Plan
6
7. Agenda
Background & Goals for Preparing for the Proposal
The State Health Care Innovation Plan
The Application Package and Scoring
Funding & Evaluation
Timeline and Contacts
7
8. The purpose of the
State Health Care Innovation Plan is to…
• Align all of the stakeholders around a common approach
and set of model designs
• Provide the framework for bringing all of the state’s
resources -health care and public health programs,
health insurance coverage, social, educational, and
community based services -- into the delivery system re-
design process
• Include specific multi-payer models that the state
proposes to test
• Engage communities and citizens in improving the state’s
health system
8
9. Agenda
Background & Goals for Preparing for the Proposal
The State Health Care Innovation Plan
The Application Package and Scoring
Funding & Evaluation
Timeline and Contacts
9
10. Required components of Model Design application
• State Health Care Innovation Plan
– Provide a Vision Statement for health system transformation
– Describe population demographic including Medicaid and CHIP populations
– Describe population health status and issues or barriers
• Health System Design and Performance Goals
– Describe cost, quality and population health performance targets
– Set goals for improving care, population health and reducing health care cost
– Describe proposed payment and service delivery models
• Roadmap for Health System Transformation
– Provide a timeline for transformation
– Review milestones and opportunities
– Describe policy, regulatory and legislative changes necessary to achieve the
state’s vision transformation
– Describe any waiver or state plan amendment requirements and their timing
10
11. Model Design Proposal Requirements
States must consider levers and strategies in developing
their State Health Care Innovation Plans and new models,
such as:
• Creating multi-payer strategies to move away from
payment based on volume and toward payment based
on outcomes
• Developing innovative approaches to improve the
effectiveness, efficiency and appropriate mix of the
health care work force
• Aligning state regulatory authorities to reinforce accountable
care and delivery system transformation or developing
alternative approaches to certificate of need programs
11
12. Model Design Proposal Requirements
Examples of additional levers and strategies States must
consider in developing their State Health Care Innovation Plans
and new models:
• Creating opportunities to align regulations and requirements
for health insurers with the broader goals of multi-payer
delivery system and payment reform;
• Coordinating State-based Affordable Insurance Exchange
activities with broader health system transformation efforts;
• Integrating the financing and delivery of public health services
and community prevention strategies with health system
redesign models;
• Leveraging community stabilization development initiatives in
low income communities and encouraging community
investment to improve community health.
12
13. Model Design Application Requirements
All state applicants for Model Design awards must submit the
following:
• Standard forms • Provider Engagement
• Letter of Endorsement from the • Project plan and timeline
Governor
• Budget narrative and itemized
• Project abstract expenditure plan
• Model design strategy • Financial Analysis demonstrating
net savings
• Description of stakeholder
engagement • Letters of support and
participation from major
• Evidence of public and private
stakeholders
payer participation
• Project organization information
13
14. Model Pre-Test Award
is not the same as Model Design
Criteria for Pre-Test Award:
• States applying for Model Testing awards may receive
pre-testing assistance ranging from $1-3 million if they
do not qualify for a full Model Testing award in the round
one
• The eligibility standards, deliverables and other
requirements for pre-testing assistance awards are based
on the review of the state’s Model Testing application
• States awarded a cooperative agreement for a pre-test
award must resubmit their improved proposal as part of
round two model testing
14
15. Model Design Scoring
Model Design Strategy 30 points
Plan for provider Engagement 15 points
Evidence of Engagement 15 points
Organizational Capacity 10 points
Budget & Financial Analysis 30 points
Total 100 points
15
16. Agenda
Background & Goals for Preparing for the Proposal
The State Health Care Innovation Plan
The Application Package and Scoring
Funding & Evaluation
Timeline and Contacts
16
17. Examples of Allowable Model Design Costs
Allowable costs associated with state Model Design work:
• State staff costs to engage in model design
• Staff participation and travel to relevant learning
collaboratives and workshops and other relevant learning
and diffusion opportunities
• Investments in State data collection and analysis capacity
and cost and utilization pattern analysis
• Consumer and provider engagement and focus group costs
• Actuarial modeling
• Performance measure development and evidence-based
improvement research
• Business process analysis and requirement system analysis
17
18. Examples of Allowable Model Design Costs
Additional allowable costs associated with state Model Design work:
• Policy, legal, and regulatory research to address legislative and legal
frameworks for models
• Planning and convening for creating a statewide all–payer data-base
• Planning work relating to public health programs including the state’s
Healthy People 2020 plan, and meeting goals for the National Quality
Strategy and/or National Prevention Strategy
• Model Design costs, including:
– Model scope development
– Theory of action development
– Target population research
– Setting performance targets
– Financial analysis and analysis of health care trend impacts
– Budget planning
– Travel to SIM workshop and conferences
18
19. Prohibited Uses of Cooperative Agreement Funds
States may not use funds:
• To match any other federal funds
• To provide services, equipment, or support that are the
legal responsibility of another party under federal or
state law
• To supplant existing federal state, local, or private
funding of infrastructure or services
• To satisfy state matching requirements
• To pay for the use of specific components, devices,
equipment, or personnel that are not integrated into the
entire service delivery and payment model proposal
• To lobby or advocate for changes in federal or state law
19
20. Model Design Evaluation
• The Innovation Center will assess the ability of the Model
Design states to engage stakeholders and develop a State
health Care Innovation Plan
• Each Model Design state will be evaluated through a series of
case studies using qualitative methods (interviews with
grantees and CMS staff and site visits)
• CMS has the ultimate responsibility for the evaluation process
and reports
• The Innovation Center’s contractor will be able to assist states
with evaluation-related technical assistance in developing a
State health Care Innovation Plan
20
21. Agenda
Background & Goals for Preparing for the Proposal
The State Health Care Innovation Plan
The Application Package and Scoring
Funding & Evaluation
Timeline and Contacts
21
22. Model Design Award Timeline
Applications Period of
due: Anticipated performance:
Announcement :
September 17, award date: From award date
July 19, 2012
2012, November 2012 through
5 p.m. EDT May 14, 2013
22
23. Additional Information
• Additional webinars will be scheduled for state policy makers to cover the
following topics:
– 8/15 Model Testing
– TBD Application submission guidance
– TBD Financial Templates and Medicare data resources
• Submit questions to stateinnovations@cms.hhs.gov
(Note: States may wish to create a similar in-box for your stakeholders)
• FAQ will be updated and posted to the Innovation Center website at
innovation.cms.gov
• Additional information is available on our website:
innovation.cms.gov/initiatives/state-innovations
23