Engaging Commercial Payers on Multipayer Alignment: Key Issues for SIM States
This brief provides some tips to states on how to productively engage with private payers on the goal of achieving multipayer alignment in payment reform and delivery system reform initiatives. In some states, Medicaid has been a very proactive purchaser and driver of delivery system reform, and is seeking ways to encourage commercial payers to follow this lead; in others, it is the commercial sector that has been more active in driving reform and Medicaid programs are trying to figure out how to implement reforms that align with existing private initiatives. In both cases, it will be necessary to foster an open and robust dialogue between states and commercial payers on where alignment is desired and how best to achieve it.
The key considerations for states include recognizing the other challenges that commercial payers are facing; focusing on shared big picture objectives rather than alignment at a very detailed level; recognizing that multipayer alignment and delivery system reform are long-term processes that require long-term commitments; having clear definitions of success; striving for consistency while retaining flexibility for experimentation and innovation; and understanding that commercial payers may be resistant to some of the types of changes states are seeking. Each of these factors is described in more detail below. The brief concludes with a list of key “do’s and don’ts” for engaging commercial payers.