On March 30th, NAMD released Perspectives on Innovation: A State Medicaid Approach to Evaluation. The paper describes the critical questions that state Medicaid programs ask themselves when evaluating the success of payment and delivery system reform – namely whether the reform is improving health outcomes relative to what preceded it, and whether there is a foundation for future improvement and success.
In Medicaid programs across the country, much of the internal infrastructure needed to stand up innovative programs are being created through the actual implementation of innovative reforms. States are using payment and delivery system reform as the impetus to create the data systems and analytics, hire the personnel, and develop the internal policies they need to be able to administer innovative programs. Many of the initiatives and programs that support state-led reform, from state dollars, to SIM grants, to DSRIP and other 1115 waivers, are the vehicles that provide Medicaid programs with the resources needed to create this infrastructure.
The paper discusses how sustained commitment to reform must also consider the appropriate timeframes for success as many states, payers, and providers have just begun their efforts. Progress has already been found in a number of evaluations that have already been released by states. While some reforms have matured, even the most advanced have only had a few of years of experience. However, the body of evaluative research has begun to demonstrate that real world progress has occurred in developing infrastructure, establishing the framework for reform, and demonstrating improved outcomes.