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
Only 20 percent of the factors that influence a person's health are related to access and quality of care. The other 80 percent are due to socioeconomic, environmental, and behavioral factors. Community Health Innovation Regions (CHIR) work to address these nonmedical factors that Michigan residents face.
CHIRs are a unique model for improving the wellbeing of a region and reducing unnecessary medical costs through collaboration and systems change. CHIRs engage a broad group of stakeholders to identify and address factors that affect residents’ health, such as housing, transportation, and food insecurity, as well as access to high-quality medical care. The CHIR model creates a neutral space for partners to unite around a common vision, aligning their objectives and services to meet the needs of the community. The result is a community that is purposeful in its response to residents’ needs, creating conditions that meaningfully support an individual’s ability to have a higher, more productive quality of life.
CHIR partners are organized by a neutral backbone organization that facilitates the development and implementation of key strategies, creating the necessary capacity to sustain progress on stated objectives. CHIR steering committees provide a clear leadership structure and promote shared accountability among partners for aligning their resources to address priority community health needs. It takes a comprehensive group of committed organizations to meet the needs of a community. No one entity can do this alone.
The State has selected five regions in which to test the CHIR model. Each of the five regions is supported by a backbone organization that serves as a fiduciary and acts as a neutral convener for the CHIR’s governing body. Contact information for each CHIR backbone organization is included below:
Greater Flint Health Coalition
Jackson Health Improvement Organization
Livingston / Washtenaw
Center for Health and Research Transformation
Muskegon Community Health Project
Northern Michigan Public Health Alliance
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.