New to Me: State Transformation Collaboratives

As the second installment in my “New to Me” series (see the first one here), I’d like to say a few words about an intriguing new idea put forward by the Health Care Payment Learning & Action Network (HCP-LAN, or “LAN” for short) called State Transformation Collaboratives, or STCs. According to the LAN website, STCs strive to formulate ways to overcome health disparities by increasing “healthcare quality, access, and outcomes” on a state-by-state basis by focusing more on person-centered, value-based care.

I attended a recent webinar hosted by the LAN during which STCs were discussed, and I get the sense that although there’s a lot of energy behind the initiative, the LAN is in the very early stages of rolling out this program. There also doesn’t seem to be much information about the effort online, but I’ve pulled together what I could find.

Four states are involved in the program, including Arkansas, California, Colorado, and North Carolina. For such a low number of states, there’s decently diverse representation here in a few key areas including geography, state size, region, politics, and willingness to expand Medicaid (according to the Kaiser Family Foundation, while California, Colorado, and Arkansas have all expanded Medicaid, North Carolina has not).

And as we’ll see in a moment, there’s a strong component of shoring up healthcare disparities baked into this initiative, so it bears mentioning that although some states on the list are more ethnically diverse than others, they’re all in the 55th percentile or better in terms of ethnic diversity. Since the effort to mitigate healthcare disparities must take into account ethnic diversity as one important factor, in my opinion it makes sense that the LAN chose to partner with these four states for the pilot study.    

Before we get to the disparities piece of this, though, it has to be said that despite the fact that this dedication “to transforming health care in a specific state or region within a state” isn’t a new concept overall (see my previous blog post on Place-Based Care in the UK), the fact that the LAN is emphasizing the importance of tailoring care in more bite-size pieces, focusing locally to meet “the needs of state populations through alternative health care payment” strikes me as different.

It’s not a knock against the LAN, but up until now, the organization’s literature and live events have tended to emphasize scalable solutions that apply nationally and across stakeholders (one look at their homepage will tell you this).

Now, on to the health disparities component of STCs. As stated on the initiative’s web page, one key component of the STC program is state initiatives that “focus on achieving health equity via payment reform and are grounded in HEAT APM Guidance for equity centered design and implementation.” But what does “HEAT APM guidance” mean, exactly?

The HEAT is the LAN’s Health Equity Advisory Team and, as its website states, it functions to guide alternative payment model (APM) design such that implementation addresses “factors that drive health inequities.” HEAT strives to influence APM development so that access to necessary care is opened up, healthcare disparities are narrowed, and patient outcomes improve. As the site says, “Patient experiences, priorities, and perceptions are crucial elements the HEAT will explore.”

The HEAT program has produced a document called “Advancing Health Equity Through APMs” which “provides stakeholders with actionable guidance on how they can leverage APMs to advance health equity in ways that are both aligned and tailored to meet their communities’ needs.” It’s a general framework for aligning stakeholders, who the group rightly lists as payers, purchasers, and providers, along with individuals, families, and their communities.

Since this post isn’t devoted exclusively to healthcare disparities I won’t go into much more detail about the HEAT’s work. In general, though, if done right, the group states that APM changes “will result in people accessing culturally appropriate and integrated care; providers delivering more equitable and accessible care; and payers, purchasers, and providers identifying opportunities for disparities reduction, setting specific and actionable health equity goals, and monitoring performance.” 

There’s a strong measurement component here which adds to accountability; indeed, in their APM design guidance, the group urges plan designers to “Meaningfully adjust prospectively paid primary care/population health APMs, earned shared savings rates, and other performance-based payments upward or downward based on equity performance credits or penalties reflected in the quality composite score.” If this guidance is followed across the board, this could have a big impact on opening up access to needed care to a larger segment of the U.S. population, which is a central goal of population health management.

As a bonus, the document doesn’t just speak in generalities, providing a few real-world examples of setting expectations in APM contract language and structuring payments around a measurement regimen. One example is Covered California’s health equity performance measure set, which consists of multiple “population health/primary care outcomes measures” which relate to hypertension and diabetes. The goal of this program is to reduce racial and ethnic health disparities of health plan members.

I will continue to monitor STCs and their associated programs, which I think on the whole have a lot of potential to move the dial on shoring up healthcare disparities and moving the healthcare system toward more equitable care.

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