Joel C. Cantor, Sc.D., is Director of the Center for State Health Policy at Rutgers. He spoke to Symptoms & Cures about the state’s role in the State Innovation Model (SIM) Design Grant by the Center for Medicare & Medicaid Innovation.
1. Can you give us a refresher on the goals of this project?
The goals are to support new designs of payment and service delivery that will reduce costs while preserving, or enhancing, quality of care. The grant will look at Medicare, Medicaid and CHIP program expenditures. We’ll be looking at birth outcomes through smoking cessation efforts, integrating behavioral and physical health, and addressing Medicaid value and costs, especially for high utilizing patients.
Our SIM grant is overseen by a Steering Committee comprised of representatives from the Governor’s office and the state department of health and the department of human services. The Rutgers Center for State Health Policy coordinates the New Jersey SIM project and is leading many of the project activities. Of course the Quality Institute is an important partner. Others are the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, Central Jersey Family Health Consortium, the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, and the Center for Health, Pharmaceutical Law & Policy at Seton Hall University School of Law.
2. How far along is New Jersey in the project’s implementation?
The SIM grant was for a 12-month period starting in February of last year and has been extended through May of 2016. Here are some of the focus activities in the grant:
- Advancing the implementation of Healthy New Jersey 2020, the State’s Population Health Improvement Plan developed by the NJ DOH
- Conducting an environmental scan of the NJ delivery system, including a survey of primary care physicians
- Optimizing the implementation of the Vital Information Platform (VIP) & coordination with health IT strategies. The purpose is to align the numerous pilots and incentive contracts to encourage collaboration and reduce measure fatigue.
- Aligning quality metrics across payers and delivery system to improve quality and reduce redundancy
- Facilitating and informing implementation of the Medicaid ACOs
- Supporting Behavioral Health Home pilot initiatives
- Designing a Delivery System Transformation Resource Center to accelerate innovation efforts, particularly with regard to advancing patient-centered primary care strategies
All activities are under way and initial work products are being reviewed by the Steering Committee. All work will be completed by May.
3. What are some activities that you and the project partners have done so far to achieve the project goals?
We’ve brought many stakeholders to the table. We’ve held two Innovation Summit meetings (one in June and one in November). We also convened six regional meetings on behalf of the state health department designed to engage stakeholders and gather input regarding priorities and strategies to advance the goals of Healthy NJ 2020. Finally, a SIM Quality Metric Alignment working group has been constituted and is working to identify ways to streamline and improve the way healthcare quality is measured and how those measures can lead to better care.
Other activities involve collecting new information and data that will inform New Jersey’s delivery system transformation efforts. For example, nearly 700 primary care physicians responded to the SIM Primary Care Physician survey in late 2015 and analysis of those data are under way to identify the extent of engagement of practices in value-based payment models, the degree of integration of behavioral health services with primary care, and the experiences of the physicians helping patients quit smoking.
We also recently completed a round of interviews with Medicaid ACO stakeholders to identify lessons from the early stages of implementation of the ACO Demonstration, and we are currently interviewing Medicare Shared Savings Program ACOs to shed light on opportunities to support medical practice transformation.
Still other SIM activities are directed at supporting the implementation of major ongoing innovations. For example, we are in the process of building and testing data dashboards for Medicaid ACOs to benchmark and target their care improvement strategies, and we completed background research to support state implementation of its Behavioral Health Home pilot program in two counties.
4. The project is now slated to end in May. What are your plans for the remainder of the project?
We still have a lot of work to ahead to complete all of the SIM activities. Soon we will begin posting findings from the investigations on the SIM page of our web site. At the conclusion of the project we will prepare a State Healthcare Innovation Plan that will summarize all of the SIM activities and identify opportunities to advance innovation in New Jersey healthcare and population health.
CMS had previously offered states completing SIM Design Awards to apply for “Test Awards,” with large scale funding to support the implementation of major initiatives. Unfortunately, CMS has informed us that there is no funding mechanism to support Test Awards. However, as we complete the work under the Design Award, the Steering Committee will be working to identify opportunities to sustain innovation related to SIM activities.
5. What has the role of the Quality Institute been in this project?
The QI Collaborative represents all of the Medicaid Accountable Care Organizations in the SIM project work being done by Rutgers. The QI collaborative facilitates information sharing between Rutgers and the ACOs on all SIM activities, use of quality measures, and how to best align the value-based payment initiatives within Medicaid. Through the work of the QI Collaborative, the ACOs have successfully executed data use agreements with the State to obtain the Medicaid data feeds they needed to begin their work under the demonstration project. The QI Collaborative is researching all the measures that must be reported through current state and federal policy initiatives. The QI’s will contribute to reviewing quality measures used in various Medicaid demonstration projects, such as the ACOs, along with the Managed Care Contracts and the Disproportionate Share Program and identify where and how measures and incentives can be made uniform and aligned to increase collaboration and decrease measure fatigue and reporting burdens.