SHADAC Expertise

Delivery and Payment System Reform

Payment and Delivery System Reform

SHADAC researchers have a broad range of experience related to delivery system and payment reform, particularly in the context of state Medicaid programs. SHADAC has conducted quantitative research aimed at understanding the impacts of Medicaid payment and delivery system reform initiatives, e.g., accountable care organizations, on cost and quality; conducted qualitative research focused on innovative state Medicaid approaches to payment and delivery system reform; and provided technical assistance and evaluation support to states and other stakeholders through foundation and federally funded projects.

Related SHADAC work:
Click on any title below to learn more about the project.

Data to Inform Research on Integrated Care for Dual Eligibles
This report by SHADAC researchers Lacey Hartman and Elizabeth Lukanen, conducted with support from the Arnold Ventures Foundation, summarizes the findings of a systematic review of data sources that could be used to study the broad topic of integrated care for dual eligibles. The paper concludes with a set of recommendations aimed at addressing key data gaps and advancing the availability of comprehensive, high-quality data for research in this area. Along with the report, a companion Excel chart was produced that contains all abstraction details for each data source.

Inventory of Evaluations of Integrated Care Programs for Dually Eligible Beneficiaries
Both federal and state policymakers are interested in integrating care for beneficiaries dually eligible for Medicare and Medicaid is a key priority for states and the federal government. A variety of models seek to do this, including the Program of All-Inclusive Care for the Elderly, the Financial Alignment Initiative (FAI), Medicare Advantage dual eligible special needs plans, and fully integrated dual eligible special needs plans, managed long-term services and supports programs, and demonstrations that pre-dated the FAI. This inventory, conducted by SHADAC researchers under contract to MACPAC, compiles available evidence on how these integrated care programs have affected spending, quality, health outcomes, and access.

Minnesota Accountable Health Model Evaluation
SHADAC conducted the state evaluation of Minnesota’s State Innovation Model (SIM)—the Minnesota Accountable Health Model—for the Minnesota Department of Human Services and in collaboration with the Minnesota Department of Health (MDH). SHADAC designed a formative evaluation assessing the state’s progress in achieving core goals related to the improvement of data analytics, expansion of e-health, practice transformation, accountable communities for health (ACH), and Accountable Care Organization (ACO) alignment related to performance measurement and payment. Using qualitative and quantitative methods, SHADAC collected and analyzed new and existing data to report on the implementation and outcomes. Ongoing document and literature review informed interview protocol and survey development as well as other data collection methods. A key component of the evaluation was to use the Minnesota All Payer Claims Database (MN APCD) to examine the impacts of the first two years of the Integrated Health Partnership (IHP) Medicaid ACO shared savings program.

Center for Medicare and Medicaid Innovation (CMMI) SIM Technical Assistance
SHADAC was part of a team led by NORC at the University of Chicago that provided tailored, content-driven technical assistance (TA) to State Innovation Model (SIM) states and territories, including Puerto Rico, Commonwealth of the Northern Mariana Islands, and American Samoa. SHADAC-provided TA was focused in the areas of quality measurement, data collection and analysis, multi-payer alignment, and evaluation. Most recently, SHADAC led an affinity group to share design elements and measure definitions across four SIM states implementing episodes of care in their Medicaid programs. SHADAC also provided TA on issues of measurement pertaining to opioids—including environmental scans of measures and data sources used by states for surveillance and monitoring of the opioid crisis—and evidence reviews of quality measures on appropriate opioid prescribing for use in value-based payment models. SHADAC also released a summary report of state efforts at aligning quality measures across multiple payers and a brief examining Ohio’s strategy to improve opioid prescribing through payment reform.

Value-Based Payment Reform in the Medicaid Program
The Medicaid and CHIP Payment and Access Commission (MACPAC) and SHADAC conducted site visits in 2013-2014 to a total of seven states—Arkansas, Connecticut, Maryland, Minnesota, Oklahoma, Oregon, and Pennsylvania—to learn about different payment and delivery system reforms aimed at improving value in Medicaid such as shared savings approaches, episode-based payment initiatives, and global budgeting. SHADAC produced an interim report reflecting the cross-state learnings from four of these site visits, entitled “Paying for Value in Medicaid: A Synthesis of Advanced Payment Models in Four States,” for MACPAC’s Commissioners and Congressional audiences. SHADAC also organized and convened Medicaid officials from all seven states to discuss Medicaid advanced payment models, particularly as they related to changes in provider behavior, health information technology (HIT), and the ability to target cost drivers.

Behavioral and Physical Health Integration Efforts in the Medicaid Program
SHADAC served as a contractor to the Medicaid and CHIP Payment and Access Commission (MACPAC) on a project in 2015 to document behavioral and physical health integration efforts in Medicaid, including target populations, level of integration, contracting, provider and payer relationships and alignment, data exchange, regulatory authority, and extent of evaluation. SHADAC conducted a comprehensive data scan for all states, followed by telephone interviews with officials from a subset of states. The focus was on integration programs that have been implemented or were underway that also have strong ties to Medicaid programs and funding.