State Innovation Models Initiative Wisconsin Round Two Model Design Award

Realizing Greater Value in Health Care—Aligning Wisconsin Initiatives and State Innovation Model Opportunities

Wisconsin is recognized as a national leader in health care quality, and yet health care costs continue to rise faster than quality is improving. The federal Center for Medicare and Medicaid Innovation (CMMI) was established for the purpose of testing “innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits. More information about CMMI is available at innovation.cms.gov.

CMMI is currently focused on the following priorities:

• Testing new health care payment and service delivery models
• Evaluating results and advancing best practices
• Engaging stakeholders to develop additional models for testing

One CMMI initiative provides funding to states for the development and testing of innovative state-based models for multi-payer payment and health care delivery system transformation. The State Innovation Model (SIM) aims to improve health system performance for individuals in participating states. To date, nearly $983 million has been awarded to 40 states and territories to design or test improvements to their public and private health payment and delivery systems. More information about SIM is available at innovation.cms.gov/initiatives/state-innovations.

The goals of SIM are to:

• Improve population health.
• Transform health care payment and delivery systems.
• Decrease total per capita health care spending.

Wisconsin SIM Award

In December 2014, Wisconsin received nearly $2.49 million from CMMI as a SIM Design Award. The award period was from February 1, 2015, through January 31, 2016.

The result of the Wisconsin SIM award is a realistic, comprehensive State Health Innovation Plan (SHIP) to transform the health care system in Wisconsin in a way that works for all stakeholders and to advance health care value for Wisconsin residents.

The Wisconsin SHIP:

• Identifies health care services with the greatest variation in quality and cost effectiveness.
• Identifies major cost drivers.
• Identifies clinical conditions with the most severe disparities in health outcomes.
• Establishes and analyzes a focused set of quality and cost measures.
• Improves dissemination and implementation of best practices.

The SHIP includes:

• A description of the state’s health care environment.
• A report on stakeholder engagement and design process deliberations.
• Health system design and performance objectives.
• A value-based payment and/or service delivery model.
• A plan for health care delivery system transformation.
• A plan for improving population health.
• A health information technology plan.
• A workforce development strategy.
• Financial analysis.
• A monitoring and evaluation plan.
• An operational plan.

SHIP Report and Appendices

In January 2016, Wisconsin submitted the final SHIP report and the following appendices to CMMI: