Delivery System and Payment Transformation
Delivery System and Payment Transformation

Medicaid Delivery System and Payment Transformation Services

With decades of experience supporting states and the federal government with design, implementation, and operation of government-sponsored health care programs, Myers and Stauffer is a market leader in advancing delivery system and payment transformation strategies. We leverage our extensive knowledge of Medicaid policy and program operations, integrated care, management of complex populations, and the impact of social determinants of health (SDOH) to support improved health outcomes and to ensure efficient health care spending through delivery system reform, value based purchasing, and enhancing patient experiences.

Jerry Dubberly, PharmD


Delivery System Transformation

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Myers and Stauffer is recognized as a national leader in partnering with states on emerging Centers for Medicare & Medicaid Services (CMS) sponsored health care initiatives such as state innovation models (SIM) and delivery system reform incentive payments (DSRIP), offering a range of technical, clinical, and operational support services to government agency clients. We have provided consulting services for some of the nation’s most effective health care delivery system and payment transformation initiatives. We understand that these initiatives require more than a simple restructuring of the current system. They require a true reengineering effort and a new way of thinking. Transformation must focus on the value of results in the health care system over the quantity of services provided. Our delivery system services include:

  • Section 1115(a) Waiver Consulting, Design, Implementation, and Evaluation
    Myers and Stauffer has an extensive understanding of 1115 demonstration waivers and has experience supporting states with development and negotiation, operation, monitoring, and assessment of such waiver applications and programs.
  • Delivery System Reform Incentive Payment (DSRIP) Program Models
    Through our transformation work, we have supported states in every phase of planning, implementation, operation, and evaluation of DSRIP programs. We support states in achieving their transformation goals through independent program assessments; developing and calculating performance measurement; creating industry training and education; and facilitating provider learning collaboratives.
  • Mental Health Parity
    It is critical that program administrators consider how state-specific requirements impact mental health parity compliance. Our team has experience performing analyses of the final Mental Health Parity and Addiction Equity Act (MHPAEA) rule’s impact on state Medicaid programs, providing recommendations for next steps, and staff education regarding corresponding technical requirements.
  • Integrated Care
    We offer strategic consulting services to address issues impacting the complexities of the care required by program beneficiaries, integrating physical medicine with behavioral health treatment pathways. Integrated care services include:

    • Patient-Centered Medical Home (PCMH)
      We have experience developing and implementing PCMH training and technical assistance programs to advance the way care is delivered in primary care offices, including comprehensive, patient-centered, coordinated, accessible care, and quality and safety capabilities.
    • Behavioral Health/Physical Health Care Coordination
      We have extensive knowledge of the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) integrated care model, and we provide technical assistance to states integrating behavioral health and primary care.
    • Institutions for Mental Disease (IMD) Strategies
      We can assist clients interested in pursuing CMS’ policy to support states in combatting the opioid crisis by increasing access to treatment options. Our team can support states in driving partnerships to improve behavioral health capacity. We support our clients with IMD transformation by providing outreach to stakeholders, supporting community-based needs assessments, developing prospective payment system methodology and rates of reimbursements, as well as developing cost report training tools.
    • Certified Community Behavioral Health Clinics (CCBHCs)
      We support states in the expansion and implementation of CCBHCs offering a full range of substance use disorder (SUD) treatment services, care coordination, and integration of behavioral and physical health services.

Payment Transformation

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State Medicaid programs are increasingly introducing alternative payment models (APMs) to promote smarter spending, better care, and healthier people. We have expertise in designing, evaluating, and recommending methods to advance APM models in use by states. We also have expertise in developing quality improvement projects designed to build capacity for APMs that are reflective of the provider environment. Our payment transformation services include:

  • Value-Based Purchasing (VBP) Programs
    We support our clients in the development of value-based contracting approaches to ensure performance of vendors and the states’ desired outcomes. We work closely with our clients and CMS to identify, select, customize, and calculate metrics that are used to inform provider incentive payments as part of the client’s VBP program. 
  • Alternative Payment Models (APMs)
    We help states fully explore their existing authority under Medicaid state plan amendments or other federal authorities to implement APMs. We work with each state client to tailor our support to meet specific needs.
  • Managed Care Organization (MCO) Supplemental Payment Phase Out
    We help states in planning and implementing a pass-through payment transition strategy consistent with CMS requirements. We assist states in developing models that minimize provider burden and focus on useful and actionable measurement. We assist states in developing rate strategies that protect upper payment limit (UPL) and disproportionate share hospital (DSH) dollars as they move from fee-for-service to a managed care delivery model.

Population Health

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A focus on population health at a payer, provider, state, and national level is a strong component of delivery system and payment transformation. Mapping population outcomes to treatment approaches can help identify best practices and opportunities for improvement. Our team has extensive experience developing quality improvement projects with associated measures that monitor the effectiveness and health care outcomes of those projects, including SDOH. The SDOH issues such as safety, food insecurity, homelessness, and transportation issues are increasingly being addressed through comprehensive patient treatment plans. We have helped states in coordination with our health IT team to identify resources that can be aligned and leveraged to address SDOH and improve population health.

Myers and Stauffer’s quality experts have experience identifying, adopting, modifying, measuring, and reporting quality and outcome measures. We are familiar with interpreting and using the National Quality Forum and National Quality Measures Clearinghouse to identify nationally-endorsed measures. We have applied specifications from respected measure stewards including National Committee for Quality Assurance (NCQA), American Medical Association, Agency for Healthcare Research and Quality (AHRQ) and the Joint Commission.