State Innovation Model
In 2015, the Centers for Medicare and Medicaid Services (CMS) awarded Michigan $70 million over four years to test and implement an innovative model for delivering and paying for healthcare in the state. The award, made through the CMS State Innovation Model (SIM) initiative, was based on a plan submitted by the State in 2014 called “Reinventing Michigan’s Health Care System: Blueprint for Health Innovation.”
The Michigan Department of Health and Human Services (MDHHS) leads the state’s SIM initiative and has organized its work under three main umbrellas: Population Health, Care Delivery, and Technology. Community Health Innovation Regions, or CHIRs (pronounced “shires”), which are intended to build community capacity to drive improvements in population health, form the base of the Population Health component. The Care Delivery component includes the Patient-centered Medical Home (PCMH) Initiative and the promotion of alternative payment models. The Technology component is where the Michigan leverages its statewide infrastructure and related health information exchange (HIE) initiatives to enable and support advances in population health and payment and care delivery strategies.
The Patient Centered Medical Home (PCMH) Initiative is the core component of the State Innovation Model (SIM) strategy for coordinated care delivery, focused on developing and testing service delivery models to achieve better care coordination, lower costs, and improved health outcomes for Michiganders. The SIM PCMH Initiative is built upon the principles of a patient-centered medical home that generally define the model regardless of the designating organization. Value is placed on core functions of a medical home, such as enhanced access, whole-person care, and expanded care teams that focus on comprehensive coordinated care. To increase value and incentivize healthcare practices to provide high-quality and cost-efficient care, SIM is also working to promote the use of alternative payment models (APMs).
This initiative is aligned with the overall SIM Care Delivery goals of:
- Championing models of care that engage patients using comprehensive, whole-person-oriented, coordinated, accessible and high-quality services centered on an individual’s health and social well-being.
- Supporting and creating clear accountability for quantifiable improvements in care processes and quality, as well as health outcomes.
- Creating opportunities for Michigan primary care providers to participate in increasingly advanced APMs.
If you have questions about the PCMH Initiative, please contact the SIM team at MDHHS-SIMPCMH@michigan.gov.
Community Health Innovation Regions (CHIRs) form the foundation of the Population Health component of the SIM initiative. A CHIR is a broad partnership of community organizations, local government agencies, business entities, healthcare providers, payers, and community members that come together to identify and implement strategies that address community priorities. A primary goal of the CHIR initiative is to address nonmedical factors that affect health, such as housing and food insecurity, by supporting connections between primary care practices and community service providers, often referred to as clinical-community linkages.
The State has selected five Michigan regions in which to test the CHIR model. Each of the five SIM CHIRs is supported by a backbone organization that serves as a fiduciary and acts as a neutral convener for the CHIR’s governing body.
The State believes that health information exchange and data interoperability are essential to the successful reform of healthcare payment and delivery systems. To support its long-term vision of making the right data available to the right people at the right time, the State is partnering with the Michigan Health Information Network Shared Services (MiHIN). MiHIN represents a growing network of public and private organizations working to overcome data sharing barriers, reduce costs, and ultimately advance the health of Michigan’s population.
This network provides support for the Relationship and Attribution Management Platform (RAMP), which supports several aspects of care coordination, as well as use cases developed to facilitate data exchange within the SIM Patient Centered Medical Home Initiative and Community Health Innovation Regions (CHIRs).
Relationship and Attribution Management Platform (RAMP)
Michigan has established RAMP to ensure a foundation for supporting care coordination and identifying relationships between patients and providers. RAMP utilizes several critical aspects of care management and coordination, including a health provider directory, a system for tracking active care relationships between patients and healthcare providers, exchange of quality-related data and performance results, and sending admission-discharge-transfer notifications. Utilizing MiHIN as a foundation for the development of RAMP allowed the state to take advantage of a widespread network of networks to increase interoperability and support the goals of the SIM initiative.
SIM Use Cases
The SIM technology team worked with MiHIN to implement the Quality Measure Information (QMI) use case, which enables healthcare providers to transmit clinical quality measures electronically. The QMI use case allows Medicaid and other payers to access and view quality measures across all of their providers.
To support CHIR technology needs, the SIM technology team is working to develop a use case for the collection and reporting of social determinants of health data, identifying the data-sharing needs and requirements of CHIRs and community-based organizations, and establishing standards for the technology platform and data requirements of clinical-community linkages.