Center for Health Care Strategies (CHCS) commits to working with Medicaid agencies to use relevant policy levers within payment and delivery system reform efforts to more effectively promote partnerships and ultimately improve health outcomes and reduce resource inefficiencies. In order for provider-level cross-sector partnerships to be effective in addressing the SDOH, particularly for vulnerable populations, there must be the right financial, program, and state policies in place to encourage, facilitate, and incentivize such partnerships.
To this end, CHCS would work with its interested Medicaid agencies and health plans to: (1) elucidate the specific policy and program levers that can be used most efficiently, and in line with other health policy goals, to promote cross-sector provider partnerships; (2) experiment with and apply specific policy/program approaches; and (3) build state-level agency collaboration necessary to create more effective alignment at the state policy and financing level.
Participants would explore how they can utilize policy and programmatic levers, such as advanced payment models, governance requirements, enhanced benefits, and performance measurement to help lay the foundation and create the business case for cross-sector partnerships. States would also explore other approaches to support this work, such as greater cross agency collaboration, data sharing, and community investment mechanisms. To facilitate this work, CHCS would consider creating a learning collaborative to promote peer-to-peer exchange of ideas and approaches, and provide direct technical assistance to help participants tackle and address issues specific to their state or organization. CHCS anticipates working directly with up to eight Medicaid agencies and health plans under this commitment. Participants would be selected via a competitive application process, which would prioritize agencies and health plans that have a proven track record for implementing innovative delivery system and payment reform initiatives, on which this initiative would build.
2016
Begin to explore these issues with select states, such as those participating in the Medicaid ACO Learning Collaborative and State Innovation Model initiative; Gather information on emerging approaches and initial lessons; initiate exploratory conversations with interested funders.
2017
Disseminate policy brief that explores potential approaches to the three core issues; Develop project proposal; Secure new funding for the commitment from philanthropic funders.
2018
Launch Learning Collaborative and Technical Assistance (TA) team; Establish contracts with technical assistance provider; Issue Request For Application for participants; Select up to eight leading-edge Medicaid agencies and health plans to participate; Convene first in-person meeting with participants to launch the project and exchange information on current approaches and key challenges, and establish participant goals; Conduct bi-monthly peer-to-peer calls and engage in direct state TA.
2019
Conduct final in-person meeting to exchange information project achievements and lessons learned among participants; Conclude the first phase of the initiative; Disseminate lessons from direct work with states via a national webinar, issue brief, and other mechanisms; Evaluate the impact of the initiative.
Medicaid agencies are increasingly focused on social determinants of health (SDOH), which disproportionately impact the health of vulnerable and high cost populations. Important early innovations in this domain have been achieved via programs such as Medicaid Health Homes and so-called super-utilizer programs, which are targeted to improve health outcomes for specific, narrowly defined but high-need populations that stand to benefit most immediately from multi-sector interventions and partnerships. However, as Medicaid programs pursue more wide-ranging payment and delivery system reform programs that serve broader Medicaid populations, such as Accountable Care Organizations, global/population based payments, and Accountable Communities for Health, many have yet to fully utilize the available policy levers to incentivize and promote on-the-ground SDOH improvement strategies (e.g. supportive housing or linkages to work force development resources). This is due to several factors: (1) a prioritization on promoting other health-related partnerships; (2) a lack of understanding of the policy barriers and of what facilitators can truly drive such on-the-ground cross-sector partnerships; and (3) a lack of cross-agency partnership and alignment at the state policy level.
While CHCS would be able to initiate working on this commitment with existing program resources, additional funding from philanthropic organizations would be needed to work with states and others at scale. We look forward to partnering with other organizations such as NFF that have worked more directly with community-based organizations and social services agencies to help with this knowledge development and sharing.
CHCS is a knowledge and capacity-building organization. As such, the focus of the commitment will be sharing emerging best practices from the field of health provider and Community-Based Organization partnerships and helping states/health plans apply that knowledge to the development of more effective policies, payment, and program requirements. We will be providing subject matter expertise and technical assistance to participating Medicaid agencies and health plans.
