Alternative Payment Models and Financial Simulations Expression of Interest Form

Maternal and Infant Health Initiative (MIHI)

Value-Based Payment Technical Support

Expression of Interest Form

Please complete this Expression of Interest form to be considered for the MIHI Value-Based Payment Technical Support opportunity. The information provided on this form will enable the Medicaid Innovation Accelerator Program (IAP) to evaluateeach state’s: (a) ability to partner with a provider group(s), organization, and/or collaborative in their state;(b) state readiness; and (c) level of commitment to advancing maternal and infant health Value-Based Payment. Details of these three selection criteria are provided in the Program Overview.

Each participating state will receive individualized technical support to strategically select, design, and test Value-Based Payment approaches. Value-Based Payment refers topayment models that range from rewarding performance in Fee-For-Service (FFS) to capitation and includeAlternative Payment Models (APMs) and comprehensive population-based payments.

States interested in participating in the Medicaid IAP opportunity are requiredto partner with a provider group(s), organization, and/or collaborative in their state to select, design, and test Value-Based Payment approaches that sustain care delivery models that the partner already is implementing. The selected care delivery models are expected to have demonstrated success in improving maternal and infant health. When selecting care delivery models, states should, for example,look at evidence of the following:

Increased access to prenatal, postpartum and interconception care

•Improved perinatal health outcomes

•Improved appropriate prenatal, postpartum and interconception care utilization

•Improvedpatient experience/satisfaction

Evidence of improvement may be indicated by performance on measures in the Core Set of Maternity Measures for Medicaid and CHIPor other indicators of the quality of health care for women and infants. To assist states in the search process, IAP conducted an environmental scan to capture examples of care delivery models (see Table 1 in the Program Overview). The examples listed in the table are a starting point for states and should not be considered an exhaustive list of existing care delivery models.

In addition to tying Value-based Payment to care delivery models, states can alsochooseto partner with the same provider group(s), organization, and/or collaborative in their state to select, design, and test Value-Based Payment approaches related to improving maternal and infant health that are notassociated with a particular care delivery model. Examples of these types of activitiesare included in Section II of this form and include evidence-based reimbursement strategies that provide incentives for higher-value practice and outcomes (e.g. blended payment rates to incentivize vaginal over elective cesarean delivery,unbundling postpartum contraception from labor and delivery fees, or non-payment policies).

Components of MIHIValue-Based PaymentTechnical Support

This IAPopportunity will support fourto sevenstates for a period of up to two years. The content and method of technical support for selected states will be determined based on each state’s specific needs. The technical support is likely to involve the steps outlined below with financial simulation support available throughout the process. Additional details of these steps are provided in the Program Overview.

●Selection ofValue-Based Payment approaches. Determine which Value-Based Paymentoptions are appropriate for their Medicaid/CHIP environments,care delivery model(s), and goals. This includes, for example,assessing the appropriateness of approaches such as bundled payments or gain- or risk-sharing approaches.

Design ofValue-Based Paymentapproaches. Design or refine Value-Based Payment approaches, including specific features. This includes identifying infrastructure requirements, for example, health information technology or health information exchange, data collection, and quality measurement needed to test and implement the selected payment approach.
Testing of Value-Based Payment approaches. Support in testing the Value-Based Payment approaches in partnership with at least one provider group(s), organization, and/or collaborative, including decision-making tools, data and tracking reports, monitoring mechanisms, and other products. Testing may involve multiple iterations.
Development of financial simulations. During the design and testing phases, the technical support team will be available to provide assistance in developing financial simulations to assist the state to forecast the financial impact of the Value-Based Payment approach.

Support will be tailored to each state’s needs as identified through (1) this Expression of Interest form, (2) pre-selection office hour conference calls with IAP, and (3) a goal setting process that selected states will complete. States will also have access to group technical support and peer-to-peer learning throughout the two years.

The Center for Medicaid and CHIP Services (CMCS), IAP, and Centers for Medicare and Medicaid Innovation (CMMI)also willcollaborate to ensure that activities undertaken in this technical support opportunity align with and build on lessons learned from other related Value-Based Payment and quality improvement activities, such as the Health Care Payment Learning and Action Network’s Maternity Multi-Stakeholder Action Collaborative, State Innovation Models,and the MIHIAction Learning Series.

I.General Information

Name of your state and Medicaid/CHIP agency: Click here to enter text.

Please indicate the following:

Name of your state Medicaid/CHIP Director: Click here to enter text.
The state Medicaid/CHIP Director acknowledges that the state is seeking this IAP technical support:

Yes No

The state Medicaid/CHIP Director acknowledges that the team has or will have sufficient staff time and resources committed to this effort:

Yes No

Please provide contact information for the State Medicaid/CHIP Agency team’s Project Leadwho will lead this work day-to-day, not including the State Medicaid/CHIP Director:[1]

Project Lead / Information
Name / Click here to enter text. /
Title / Click here to enter text. /
Email Address / Click here to enter text. /
Phone Number / Click here to enter text. /

Provide names, organizational affiliations, titles, and e-mail addresses of stateteam members. These should include state agency staff and relevant staff from contracted entities, such as Medicaid managed care plans, as appropriate.(Enter additional lines if needed)

Name / Organization / Title / Email address
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Provide names, organizational affiliations, titles, and e-mail addresses of key team members from yourpartner provider group(s), organization, and/or collaborative including key clinical and/or administrative leads.(Enter additional lines if needed)

Confirm that you have attached the required Letter of Commitment from provider group(s), organization, and/or collaborative partners. I have attached the letter:

Yes No

Provide information about the care delivery model(s)that the state has chosen for this technical support opportunity:
Name of the specific care delivery model(s) in your state that your partner provider group(s), organization and/or collaborative is already successfully practicing/implementing: Click here to enter text.
Location(s) of the model site(s): Click here to enter text.
Provide a short description of the selected care delivery model(s) including its approach, setting, the population it serves, provider types, services (e.g. maternal engagement process, evidence-based delivery or promising practices, multidisciplinary care, and outreach and care coordination), and why you believe it is a viable model(s) to support with Value-Based Payment approaches: Click here to enter text.
Describe the current payment methodology and Medicaid/CHIP financing challenges of the care delivery model(s):Click here to enter text.
Indicate whether you have attached information from your provider group(s), organization, and/or collaborative partners about the selected care delivery model(s)demonstrating success in improving maternal and infant health outcomes.The following are examples of the type of information that a state could include: increased access to prenatal; postpartum and interconception care; improved perinatal health outcomes; improved appropriate prenatal, postpartum and interconception care utilization; and/or improved patient experience/satisfaction.Evidence of improvement may be indicated by sharing performance on measures in the Core Set of Maternity Measures for Medicaid and CHIPor other indicators of the quality of health care for women and infants.

Yes No

Attaching information that the selected model(s) has demonstrated success in improving maternal and infant health outcomes is a criterion for selection in this opportunity.

II.Types of Maternal and Infant HealthValue-Based PaymentApproaches

The next set of questions is geared toward gaining a better understanding of your state’s anticipated focus in selecting, designing, andtesting maternal and infant health Value-Based Payment approaches.

Please select up to two Value-BasedPaymentapproachesand related activities that are of the most interest to your stateMedicaid/CHIP agency:
Shared Savings and Shared Risk Models
Bundled Payments and Episodes of Care
Pay-for‐Performance Approaches
Population-Based Payment Approaches
Use of Contractual or other Vehicles to Advance Implementation of Value-Based

Payment Approaches

Financial Incentives to Support Perinatal Regionalization(e.g. system of perinatal care within a geographic region to ensure risk-appropriate care)
Other (please describe):Click here to enter text.
Not sure: Need support from IAP to identify aValue-Based Payment approach.

Please briefly describewhy the one or two approaches selected above are of most interest:
Payment strategy #1:Click here to enter text.
Payment strategy #2:Click here to enter text.
OPTIONAL: Our state and its selected partners also would like to select, design, and test a Value-Based Payment approach to improve maternal and infant health outcomes that is not associated with a specific care delivery model (e.g. blended payment rates to incentivize vaginal over elective cesarean delivery, non-payment policies, enhanced reimbursement for inpatient postpartum contraception, billable services for new providers, etc.).

Yes No

If yes, provide the setting and/or provider type that you are targeting for the Value-Based Payment approach: Click here to enter text.
Provide the perinatal goal addressed by the Value-Based Paymentapproach including the specific measures on which you would like to improve upon (e.g. decreasing elective deliveries or elective cesarean sections). Measures from the Core Set of Maternity Measures for Medicaid and CHIPshould be included as appropriate, in addition to other measures: Click here to enter text.
Provide a short description of the Value-Based Paymentproposed approach: Click here to enter text.

III.Description of State Maternal and Infant HealthValue-Based PaymentNeeds

In the space below, please provide a brief description of the state’s maternal and infant healthValue-Based Paymenttechnical support needs and interests. This information will help IAPto assess the anticipated technical support resources neededand whether the state would be ready to begin receiving IAP support shortly after states are selected in lateJune 2017. Please limit your reply to no more than threepages in double-spaced, 12-point,Times New Roman font and answer as specifically as possible. Include the following information, where relevant:

A brief description of how your state currently pays for perinatal care, and how your state would like to structure a Value-Based Payment approach. Include information about the following:
Maternity care payment structure, including payment for various provider types.
Financial incentives to managed care organizations or providers to encourage high value perinatal care and/or discourage ineffective perinatal care.
A brief description of the programmatic outcome you hope to achieve. For example, the development of a Medicaid/CHIP-focused payment model that aligns incentives and drives collaboration between providers delivering care for pregnant Medicaid/CHIP beneficiaries.
Describe any current or pending Medicaid authorities (e.g. 1115 waiver, State Plan Amendment) that you feel are relevant to the Value-Based Payment approach you are considering, and how you have thought about using those authorities for this effort. In addition, indicate whether your state foresees the need for new or additional authorities to implement Value-Based Payment.
The general stage of development of the Value-Based Payment concept you would like to further under this opportunity (formative, planning, partial implementation, etc.).
A description of the target population, including the expected size of the initial Value-Based Paymentpopulation and whether the target populations are currently served by Medicaid/CHIP managed care or enrolled as FFS members, or both.
Any current or planned activities you feel are relevant, including progress-to-date in the implementation of care delivery or payment models relevant to maternal and infant health Value-Based Payment (e.g., participation in Health Care Payment Learning and Action Network’s Maternity Multi-Stakeholder Action Collaborative, MIHI Action Learning Series, Strong Start, or other payment models supported by CMMI).
Note any state involvement in related stakeholder engagement, managed care health plan engagement, provider readiness activities, state perinatal quality collaboratives and other existing collaborations. These should not include any provider groups, organizations, and collaboratives for which you are partnering for this project.
Other information youbelieve is important for IAP to understand about your proposed Value-Based Paymentactivities.

Click here to enter text.

IV.Form Submission and Notification

Once you have completed this form, please submit it via email to ith thesubject line “Maternal and Infant HealthVBP”by April 27, 2017, at midnight, ET. All states that submit an Expression of Interest will be contacted by IAP for a one-on-one conference call to discuss the state’s goals and needs, as well as to answer questions about the technical support being offered. IAP will notify the selected states in June 2017.

Additional information about this opportunity can be found atthe Medicaid IAP webpage. For questions about this Medicaid IAP opportunity, contact ith the subject line “Maternal and Infant Health VBP.”

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[1] Note: The State Medicaid Director should play an important role in this work, but should not be responsible for its day-to-day management. Another senior leader in the State Medicaid agency should serve as the team lead.