CMS state innovation models show promise in second year

The first round of the Centers for Medicare & Medicaid Services’ State Innovation Model (SIM) Initiative returned promising results in its second year.

The results (.pdf) of the second year of the first round of SIM evaluations cover awards to programs in Maine, Minnesota, Oregon, Vermont, Arkansas and Massachusetts. CMS found several participating states have expanded SIM-supported models’ patient populations. For example, researchers found participants in Arkansas’ patient-centered medical home program account for more than seven in 10 eligible Medicaid primary care providers, serving about eight in 10 patients eligible for Medicaid. Similarly, Minnesota and Vermont’s alternative payment models supported by SIM funds reach about half of their state’s total population, while Oregon and Vermont’s alternative payment models reach more than 80 percent of Medicaid patients.


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Moreover, some of the most successful SIM programs involved collaboration between public and private health payers. For example, Arkansas Blue Cross Blue Shield and QualChoice collaborated with some large self-insured payer groups such as Walmart under the umbrella of SIM-supported PCMH and episode-of-care models, while Vermont’s SIM Initiative emphasized Medicaid and commercial accountable care organizations (ACOs), with most of the state’s providers participating in both types of ACO.

“CMS supports states through SIM and other innovation efforts to move towards this vision of multi-payer delivery system reform across an entire state,” CMS Chief Medical Officer Patrick Conway wrote in a statement. “Health system transformation and improvement happens at the state and local level and CMS will continue to support states in their transformation journey to improve care for people across the nation.”

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