States Tackling Health Care System Transformation with Federal Support

Rising health care costs are a pressing concern for governments, payers, employers, and patients. States have a vested interest in improving health care and controlling health care expenditures as payers (for Medicaid), purchasers (for state employees), regulators, and sponsors or funders of key infrastructure like health information exchanges or medical education. But is state government an effective agent for transforming health care systems within the United States?

That is the question addressed in three recently published Milbank Quarterly articles evaluating Round 1 of the Center for Medicare and Medicaid Innovation’s State Innovation Models (SIM) Initiative. These studies tackle the challenge of evaluation from different angles. Kissam and colleagues provide an overview of SIM activities in the six participating states, with a focus on where the initiative succeeded and where it failed in meeting initial goals for multi-payer engagement; Beil and colleagues assess efforts to integrate behavioral health and primary care; and Rutledge and colleagues measure the impact of accountable care organizations established with SIM support in the Medicaid programs of four of the states.

Three key themes emerged across these evaluation studies:

• States can transform Medicaid payment models, but they may have a greater impact when aligned with other payers.
• States were able to leverage federal funds to make targeted investments in health information technology to enhance communication across provider types, including behavioral health care providers.
• States face more work in overcoming challenges such as behavioral health provider shortages and patient dissatisfaction with some changes in care delivery.

This is the first in a new Milbank Memorial Fund series, Research Into Practice, that aims to make the research findings from Milbank Quarterly studies and their policy implications more accessible to policymakers and practitioners.