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Monday, September 21, 2015

Advocate Participation in State Innovation Model (SIM) Grants

Melissa Burroughs

Oral Health Government Affairs Advocacy Manager

States are leading the way in improving how health care is paid for and delivered. Consumer advocates are integral to these reform efforts. Their participation can help ensure that reforms protect and improve consumers' access to high-quality care. While advocates often find it difficult to get involved in these discussions, the State Innovation Model (SIM) grant program gives consumer advocates an opportunity to weigh in on reforms in their states. In our recent brief, we share lessons learned from the initial phase of this grant program about how advocates can effectively engage in payment and delivery reform discussions. 

Consumer advocate participation in payment and delivery reform efforts is critical

It can sometimes be difficult for consumer advocates to find entry points into discussions about health system transformation that can be dominated by insurers and health care providers and cover diverse, complex topics. However, consumer advocates have a vital role to play in shaping health system transformation activities at the state level. Advocates can work to protect consumers from any harmful changes that might come as providers and insurers work to reduce costs, as well as take advantage of opportunities to change health care delivery to better serve people. 

The SIM grant program provides consumer advocates with an entry point into health system transformation discussions

The SIM program, run by the Center for Medicare and Medicaid Innovation (CMMI), provides consumer advocates with an avenue to get involved with health system transformation work. Because SIM-related activities are more structured than some other payment and delivery reform discussions, they offer advocates an opportunity to engage in these conversations.

Reform efforts supported by the SIM program are taking place around the country: 34 grantee states, territories, and the District of Columbia have begun developing and implementing payment and delivery reforms using SIM grants. This competitive grant program provides awardee states and territories financial and technical assistance to develop, pilot, and implement reforms to improve their health care systems. 

CMMI oversees the SIM grant program and requires states to follow some core processes when designing and carrying out reforms.  As part of these requirements, states must bring a variety of stakeholders to the table, specifically including consumer advocates. 

Lessons from early SIM grantees can help states improve consumer advocate engagement in their own SIM grants and other health system transformation programs

In our brief, we evaluated the six states that received Round 1 SIM Testing grants to identify best practices for—and common challenges to—engagement of consumer advocates. By looking at 39 measureable components of consumer advocate engagement and interviewing consumer advocates, we found that states vary widely in how effectively they engage consumer advocates in their SIM-related activities. 

To make their engagement in SIM more meaningful, we identified a number of best practices that advocates can work toward in their states. For example, advocates can:  

  • Push their state to establish a body responsible for addressing consumer representation in SIM grant activities 
  • Encourage their state to require that a certain number of seats at SIM tables are set aside for consumer advocates 
  • Request that their state establish strong conflict-of-interest standards as part of the application process for seats at SIM-related tables
  • Establish coalitions related to SIM or health system transformation work to bring advocates together and help them connect

Consumer advocates in states that have implemented some of these practices report being able to make a more meaningful impact on their state’s SIM-related discussions. As states continue to move forward with their SIM grant activities, they have the ability to design or improve processes that ensure that consumer advocates are well represented and receive the support they need. Consumer advocates should push their state to make these changes so that they will be able to take even better advantage of the opportunity SIM presents to get involved in health system transformation. 

Advocates can use these same strategies to take advantage of other opportunities to weigh in on reform

Luckily, the lessons we can learn from improving the engagement of consumer advocates in the SIM program are translatable to many other health system transformation-related efforts. Consumer advocates can push their states to adopt similar best practices when they are designing stakeholder engagement processes in other programs. For example, consumer advocates and state governments could use the same strategies to improve stakeholder engagement in state’s delivery system reform efforts made through DSRIP waivers, Medicaid 1115 waivers, or other state-led efforts. 

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