All Aboard: Engaging Self-Insured Employers in Multi-Payer Reform


Arkansas, Minnesota, Oregon, and Vermont are at the forefront of state efforts to coordinate value-based payment approaches across multiple public and private payers. Each is deploying some combination of payment and delivery system redesign that includes episode-based payment, patient-centered medical homes (PCMHs), and total cost of care arrangements among its Medicaid, Medicare, and commercially insured populations.

The Pacific Business Group on Health (PBGH) has partnered with the Milbank Memorial Fund to assess the development of these state-level, multi-payer delivery system and provider payment reform projects. The resulting report, after describing multi-payer activity generally, examines the extent to which self-insured employers are participating in the kind of delivery system transformation envisioned by the Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) program. The SIM program is an initiative of the CMS Innovation Center that provides states with up to $100 million to develop and test models for multi-payer payment and health care delivery system transformation over a three- to four-year period.

The report, which draws on a series of structured interviews conducted with state officials, insurance executives, and business leaders between June and October 2014, provides a summary of current recruitment efforts in each state and synthesizes lessons learned for public officials interested in further outreach to the employer community. More detailed case studies of individual states are included at the end.

While each state has had success in moving toward more coordinated action across payers, particularly for primary care services, recruitment of employers with self-insured plans remains an ongoing challenge. Despite this, a key conclusion is that recruiting self-insured employers is both a worthwhile and attainable goal. The findings and recommendations of this report can be used by stakeholders looking to address employer recruitment challenges in future multi-payer work. Further outreach and ongoing dialog with employers can help officials coordinate payment and delivery system changes across the vast majority of the publicly and privately insured populations. 

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