All Aboard: Engaging Self-Insured Employers in Multi-Payer Reform

Multipayer Primary Care Network
Focus Area:
Sustainable Health Care Costs
Delivery System Reform

Arkansas, Minnesota, Oregon, and Vermont are at the forefront of state efforts to coordinate value-based payment approaches across multiple public and private payers. Each is deploying some combination of payment and delivery system redesign that includes episode-based payment, patient-centered medical homes (PCMHs), and total cost of care arrangements among its Medicaid, Medicare, and commercially insured populations.

The Pacific Business Group on Health (PBGH) has partnered with the Milbank Memorial Fund to assess the development of these state-level, multi-payer delivery system and provider payment reform projects. The resulting report, after describing multi-payer activity generally, examines the extent to which self-insured employers are participating in the kind of delivery system transformation envisioned by the Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) program.

While each state has had success in moving toward more coordinated action across payers, particularly for primary care services, recruitment of employers with self-insured plans remains on ongoing challenge. Despite this, a key conclusion is that recruiting the self-insured employers is both a worthwhile and attainable goal. The findings and recommendations of this report can be used by stakeholders looking to address employer recruitment challenges in future multi-payer work.