Health Reform

Issue Spotlight

In 2013, six states (Arkansas, Massachusetts, Maine, Minnesota, Oregon, and Vermont) received $250 million in Round 1 State Innovation Models (SIM) awards to test how regulatory, policy, purchasing, and other levers available to state governments could transform their health care system by implementing value-based payment (VBP) models that shift away from fee-for-service toward payment based on quality and cost. A new study from the Milbank Memorial Fund gathered and analyzed qualitative data on states’ implementation of their SIM Initiatives between 2014 and 2018, including interviews with state officials and other stakeholders; consumer and provider focus groups; and review of relevant state-produced documents.The SIM Initiative’s test of the power of state governments to shape health care policy demonstrated that strong state regulatory and purchasing policy levers make a difference in multipayer alignment around VBP models. In contrast, targeted financial investments in health information technology, data analytics, technical assistance, and workforce development are more effective than policy alone in encouraging care delivery change beyond that which VBP model participation might manifest.

The Centers for Medicare and Medicaid Services (CMS) released additional information on federal pass-through funding under Section 1332 of the Affordable Care Act (ACA). CMS devoted a new section of its website on Section 1332 waivers to pass-through funding resources, an updated methodology, answers to frequently asked questions (FAQs), and state-specific premium data for the seven states with a current state-based reinsurance waiver. The new resources are designed to provide additional clarity as to how CMS and the Treasury Department calculate the amount of federal pass-through funding for each state.