With assistance from Sellers Dorsey, a western state’s Medicaid program had a two-fold agenda in mind. On one hand, they wished to provide incentives to hospitals for quality-based delivery system reforms, and on the other, they wished to preserve supplemental payments to hospitals already in place. Achieving these goals meant designing an 1115 waiver. To design the waiver, though, many factors had to be considered first, including collaboration with state officials, hospitals, payment program operators, and stakeholders. Other quality improvement programs needed evaluation, too, along with the results of Medicaid payment reform initiatives across the country.

The Collaboration

From the start, many aspects of the work required close research. Between the state’s upper-payment-limit (UPL) program design and funding levels, hospital-fee program design, DSH allocation, and prevailing budget neutrality models, every layer of the project was closely analyzed. Additionally, the team selected and researched certain hospital community-needs assessments and provided an overview, as well, of approved delivery-system reform projects across the country. In conjunction with research and analysis, the project called for close collaboration, too. Working with members of the UPL modernization workgroup and select state officials, the team learned the goals, past efforts, and financial issues of the state’s policy and fiscal agenda. They also worked with the state on internal and external stakeholder outreach and development strategies, including outreach to hospitals, state officials, and CMS. Once prepared and ready, the state issued a formal RFP to develop a Section 1115 Medicaid Waiver. The waiver in mind would outline the development of a delivery-system reform program, and to help gain approval, the state chose Sellers Dorsey as the winning respondent.

The Results

Currently, Sellers Dorsey is helping the state develop a comprehensive program that achieves its quality-minded goals. To ensure the success of the intended reforms, we are analyzing and coordinating with existing quality-focused programs. Additionally, we’re advising the state on how to work with hospitals to repurpose Medicaid supplemental payments for value-based payments.