State Innovation Model (SIM)

For information on Agendas, Meeting Minutes, and Other Documents.

Background

In February 2013, the federal Centers for Medicare and Medicaid Services (CMS) awarded Rhode Island $1,631,042 to participate in the first round (“Model Design”) of a multi-year grant intended to “improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries – and for all residents of participating states.” In Round One, 25 states were awarded almost $300 million to develop or test models for health care payment and service delivery reform. By early 2014, Rhode Island had completed the work of Round One through an extensive stakeholder engagement process and with the technical assistance of The Advisory Board of Nashville, Tennessee. The model design was set forth in the “Rhode Island State Healthcare Innovation Plan: Better Health, Better Care, Lower Cost.” In July 2014, Rhode Island applied for the second round of SIM awards in order to test its model design. As part of Round Two, 32 awardees received $660 million. Rhode Island has received a $20 million award to test its health care payment and service delivery reform model over the next four years.

Vision

The vision statement articulated in the SIM model design process reads as follows: 

"Healthy Rhode Island aims to achieve measurable improvement in health and productivity of all Rhode Islanders, and achieve better care while decreasing the overall cost of care.  We plan to transition from a disparate and health care provider and payer-centric environment to an organized delivery and payment system that is outcomes-oriented and person-centric."

This vision statement will be operationalized through a “value-based care” paradigm. This paradigm integrally includes patient care quality measurements and strategies for engaging patients in their own health care. As part of SIM Round Two, the value-based care paradigm includes the following six components:

1. Developing a population health plan (Rhode Island baseline measures);
2. Developing and refining clinical outcome measures;
3. Expanding the state’s health information technology infrastructure;
4. Establishing multi-disciplinary teams of health care providers to link provider practices with the communities that they treat (creating more effective relationships); 5. Identifying effective strategies for actively engaging patients in their own health care; 6. Achieving alternatives to fee-for-service arrangements, such that by the end of the grant period, 80% of insured Rhode Islanders will be in health insurance arrangements that link payment to value or quality of care.

Governance

The governance model for SIM Round Two includes the following:

Healthy Rhode Island Steering Committee:  This Steering Committee is the governing body of SIM Round Two. The Committee is composed of state officials, hospitals, long-term care providers, behavioral health practitioners, health insurers, primary care practice organizations, advocates, and consumers.  This Committee is setting the strategic direction and policy goals of SIM Round Two.

Contractural support:  EOHHS intends to enter into a competitive bid process for:  1)  project management, 2) evaluation and monitoring, and 3) data managment /analytics contractural support.

Internal working group of state staff:  SIM Round Two is a collaborative effort that includes staff representation from the following state agencies:  Office of the Governor, Office of the Lt. Governor, EOHHS, Department of Health (DOH), Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH), Office of the Health Insurance Commissioner (OHIC), Department of Administration (HealthSourceRI and the State Employee Health Plan).

Documents


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