Commonwealth of Massachusetts
Executive Office of Health and Human Services

State Innovation Model Overview

October 16, 2013

Agenda

•	Health Care Reform and SIM 
•	SIM Project Overview
•	Next Steps

Massachusetts’ Overarching Vision of Reform

Reduce overall health care costs while ensuring accessible, quality, affordable health care for the Commonwealth’s residents by:

System Redesign
•	Redesigning the health care system to an integrated model in order to deliver higher quality, coordinated, person-centered care

Payment Reform
•	Aligning payment methods with desired outcomes through payment reform

Consumer Engagement
•	Promoting consumer engagement in health care decision-making, and through wellness initiatives

State Innovation Models Opportunity

•	Competitive funding opportunity for states to design and test multi-payer payment and delivery models that deliver high-quality health care and improve health system performance
•	Two types of awards:
•	“Model design”: For states to create a State Health Care Innovation Plan (a state proposal to transform its health care delivery system)
•	“Model testing”: For states that are “ready to implement a multipayer model in the context of a State Health Care Innovation Plan” 
•	Because of Massachusetts’ progress on cost containment, quality improvement, and system redesign in the public and private sector and the passage of Ch. 224, the Commonwealth submitted a “Model Testing” proposal

Proposal Requirements

•	Proposal must have potential to benefit Medicare, Medicaid, and CHIP populations, and must include multi-payer participation, provider engagement, and stakeholder support
•	CMS defined allowable costs, such as costs related to technical resources, evaluation, data collection, collaborative learning

Application Timeframe

•	Application submitted September 2012
•	Awards announced in February 2013 
•	Massachusetts awarded $44 million over 3.5 years 
•	Implementation phase April 1, 2013 through December 31, 2013

SIM and Chapter 224

•	Chapter 224 defines a clear vision for health reform in the state and provides tools to achieve that vision
•	SIM supports and accelerates progress, by, for example:
•	Supporting transition to alternative payments
•	Strengthening IT infrastructure
•	Building on initiatives to align on quality measurement

Agenda

•	Health Care Reform and SIM 
•	SIM Project Overview
•	Next Steps

Participants and Organization

Coordinating Agency: EOHHS/MassHealth

Implementing and Strategic Partners: Department of Public Health, Department of Mental Health, Center for Health Information and Analysis, Group Insurance Commission, Elder Affairs, Health Policy Commission

Cross-cutting Supports: Legal, IT, Outreach/Stakeholder Engagement, Finance

SIM Grant Projects

•	What is our goal?
o	The Triple Aim: Better population health, better experience of care, lower costs
•	How do we do it?
o	Payment Reform
o	Delivery system transformation
o	Cost and quality accountability
•	How does SIM help us get there?
o	Medicaid’s Primary Care Payment Reform Initiative
o	The Group Insurance Commission’s value based purchasing initiative  
o	Provider portal on the APCD
o	Adoption of the Health Information Exchange
o	Data infrastructure for LTSS Providers
o	Electronic referrals to community resources
o	Access to pediatric behavioral health consultation
o	Linkages between primary care and LTSS
o	Technical assistance to primary care providers
o	HIE functionality for quality reporting
o	Statewide quality measurement and reporting 
o	Payer and provider focused learning collaboratives 
o	Rigorous evaluation 

SIM Timeline Overview

•	Stakeholder engagement (throughout grant period)
•	Participation in models (starting in Year 1)
•	Implementation and provision of foundational supports for model (throughout grant period)
•	Design evaluation (in implementation phase)
•	Conduct evaluations (in Years 1 through 3)
•	Stakeholder engagement (throughout grant period)

SIM Goals and Objectives

Massachusetts’ SIM Aim
To transform Massachusetts’ care delivery and payment systems by strengthening primary care, rewarding quality, encouraging providers to take accountability for total cost of care, coordinating with community and public health resources, integrating behavioral health, and promoting primary care payment reform. 

Driver 1: Supporting public payers in transitioning to a system that strengthens primary care and rewards quality over volume

Driver 2: Supporting a state-wide cross-payer approach to building data infrastructure for care coordination and accountability

Driver 3: Supporting a state-wide quality strategy aligning payers around a standard set of quality metrics

Driver 4: Integrating primary care with a robust set of public health and community-based services

Driver 5: Promoting a multi-payer statewide approach to learning, evaluation and disseminating best practices

Agenda

•	Health Care Reform and SIM 
•	SIM Project Overview
•	Next Steps

Next Steps

Next steps:
•	Update operational plan based on CMS feedback
•	Submit continuation application
•	Complete implementation phase milestones to enter testing phase as of January 1, 2014 (subject to CMS approval)
For more information:
•	http://innovation.cms.gov/initiatives/state-innovations/
•	http://www.mass.gov/eohhs/gov/commissions-and-initiatives/state-innovation-model-grant.html
•	SIMgrant@state.ma.us