A New Opportunity for Consumers to Help Transform Care Delivery
Since its inception, the Center for Medicare and Medicaid Innovation (the Innovation Center) has announced a number of funding opportunities that will transform the health care delivery system as we know it. The Innovation Center was established by the Affordable Care Act (ACA) to test innovative care, payment and delivery models that have the potential to reduce costs while preserving or enhancing the quality of care. The latest funding opportunity is the State Innovation Models Initiative, which calls for states to propose a multi-payer, community led integrated system that improves care, improves population health, and reduces Medicare, Medicaid and CHIP costs.
Through fostering innovative care models, this grant opportunity encourages states to address social, economic, and behavioral determinants of health, including mental health and substance use disorders, and to reduce health disparities. This is a big deal for states and an even bigger deal for consumers who currently have to navigate through a fragmented health care system.
There are two types of awardsbeing offered:
- Model Design Awards
- Model Testing Awards
Where do Consumer Advocates fit in?
A broad group of stakeholders must be engaged from the outset of the design process, and throughout the projects. The Funding Opportunity Announcement (FOA) explicitly states that Governors’ offices must engage key stakeholders, including: providers, consumers, health care advocates, community leaders, and faith-based groups in planning and implementation. The FOA also states that Governors’ offices can include consumer and provider engagement and focus groups as part of the grant budget.
Advocates should find out if their state is applying for the grant by contacting their Governor’s office. If your state is applying, below are some ways that you can be involved:
1. Ongoing consumer engagement is critical to success. This can only happen if states work with advocates to ensure that there is adequate consumer education and support to understand the key issues at hand and craft approaches that are responsive to consumer needs. Talk to your Governor’s office about using the grant funds to:
— provide support and training for consumer representatives who are part of the planning and implementation process — support public education meetings conducted by consumer groups to talk about the initiative, what the state is proposing, and how it will affect individuals and their communities — conduct focus groups that will inform the planning and ongoing implementation process
2. Align with other key stakeholders. Form a broad-based coalition to have a greater impact on the outcome (better care, lower costs) of the initiative. Potential stakeholders to engage would be:
— providers and payors — community leaders/groups/organizations — faith-based groups — community health centers — mental health and substance use groups — long-term services and support providers — academic experts
3. Engage key state policymakers and officials so they are educated about this initiative, what it means for their state and the impact it will have for the individuals they represent. Talk to:
— legislators and their staff — state and local health agencies — local government officials
Successful innovation models could lead to high quality health care and an improved quality of life for consumers. As a part the grant, the state is required to engage stakeholders. However it will be up to advocates to take the initiative to make this engagement meaningful.
— Leena Sharma, State Advocacy Manager