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State Health Care System Transformation


The Patient Protection and Affordable Care Act (ACA) ushered in the largest sea change to the US health care system in decades. Yet, states remain the laboratories of health system reform and transformation, experimenting with new delivery and payment models, often involving Medicaid programs as drivers of state health care system change.

Learn more about what is happening in states across the country with the following resources, which include state plan documents, analyses, summaries, and tools. Also included is information on the Centers for Medicare and Medicaid Innovation (CMMI, or Innovation Center), which was created by the ACA and provides funding to states in their health system transformation work. CMMI funding comes in several forms, including Model Pre-Design Awards, Model Design Awards, and Model Testing Awards. You will also find information on the Centers for Medicare and Medicaid Services (CMS) Medicaid Innovation Accelerator Program.

For consultation or technical assistance with state health care system transformation efforts, please contact the AAP Division of State Government Affairs at stgov@aap.org or 800.433.9016, x 7799. ​Also please visit the Academy's practice ​transformation page​ for more information and resources on AAP practice transformation efforts.


General Information on State Health System Transformation Efforts:

Medicaid Reforms/Center for Medicare and Medicaid Innovation (CMMI)

National Academy for State Health Policy (NASHP): Measuring Physical and Behavioral Health Integration: A Look at State Approaches in the Context of Value-Based Purchasing (NEW)

Driving Health Care Innovation through DSRIP:
State of the States and Delivery System Reform Incentive Payment: Mapping State Programs (NEW)

Center for Health Care Strategies: Medicaid Accountable Care Organizations: State Update and State Activity Map (NEW)

National Academy for State Health Policy: A Federal-State Discourse on Maintaining Momentum for Payment and Delivery System Reform (NEW)

Centers for Medicare and Medicaid Services (CMS): State Innovation Models (SIM) Initiative Evaluation – Model Test Year Two Annual Report (NEW)

National Governors Association (NGA): The Future of Medicaid Transformation: A Practical Guide for States (NEW)

Medicaid and CHIP Payment and Access Commission (MACPAC): Comparing Section 1332 and Section 1115 Waiver Authorities (NEW)


Bailit Health: Value-Based Payment Models for Medicaid Child Health Services (NEW)

National Association of Medicaid Directors: The Role of State Medicaid Programs in Improving the Health Care System  

National Academy for State Health Policy: Understanding Medicaid Claims and Encounter Data and Their Use in Payment Reform  

Medicaid Innovation Accelerator Program

Families USA Report: New Medicaid Program Will Support State Efforts to Improve Quality and Delivery of Health Care

Milbank Memorial Fund Report: Population Health in Medicaid Delivery System Reforms

National Academy for State Health Policy: Money Talks: How SIM Round 1 States Are Reducing Costs

Centers for Medicare and Medicaid Innovation (CMMI, or Innovation Center)

CMMI Map of Model Pre-Design, Design, and Testing Awards

Commonwealth Fund Issue Brief: State Innovation Models: Early Experience and Challenges of an Initiative to Advance Broad Health System Reform

Families USA Report: Shining Light on SIM: Understanding the State Innovation Models (SIM) Initiative

State Refor(u)m: A Closer Look at State Innovation Model Testing Winning States: Payment and Delivery System Reform Analysis

State Refor(u)m: Population Health Components of State Innovation Model (SIM) Plans: Round 1 Model Testing States | Round 2 Model Testing States


Medicaid Accountable Care Organizations (ACO)


Leavitt Partners: Medicaid ACO Pediatric Quality Measures and Innovative Payment Models

Families USA Issue Brief: Accountable Care Organizations (ACOs) in Medicaid: Challenges and Opportunities for Advocates 

Kaiser Family Foundation Report: Emerging Medicaid Accountable Care Organizations: The Role of Managed Care

Center for Health Care Strategies Report: Core Considerations for Implementing Medicaid Accountable Care Organizations

Commonwealth Fund Post: A Unicorn Realized: Promising Medicaid ACO Practices Really Exist

Center for Health Care Strategies: Medicaid Accountable Care Organizations: State Update

Center for Health Care Strategies: Supporting Social Service Delivery through Medicaid Accountable Care Organizations: Early State Efforts

Center for Health Care Strategies: Medicaid Accountable Care Organizations: Program Characteristics in Leading-Edge States

Center for Health Care Strategies: Comparing State Medicaid Accountable Organization Governance Models

Center for Health Care Strategies: Medicaid Accountable Care Organizations – State Update

Center for Health Care Strategies: Approaching the Tipping Point? Medicaid ACO Momentum Continues to Build


Patient Centered Medical Home

National Center for Medical Home Implementation Medical Home Resources by State

Patient Centered Primary Care Collaborative (PCPCC) State Patient Centered Medical Home (PCMH) Map

National Academy for State Health Policy: State Delivery and Payment Reform Map


Other System Reforms

National Academy for State Health Policy: Addressing and Reducing Health Care Costs in States: Global Budgeting Initiatives in Maryland, Massachusetts, and Vermont  

The Commonwealth Fund: Innovation Waivers: An Opportunity for States to Pursue Their Own Brand of Health Reform

Manatt Health: The Megatrends Reshaping Healthcare: Managing Change and Maximizing Opportunity

 
State Specific Health System Transformation Information:

This page will be continually updated with more information on state system transformation. If you have information on activities in your state, let us know at
    
Tennessee | Utah | Vermont | Washington      ​