CMS State Innovation Model (SIM) Testing Award - Iowa

Program Location: 
Des Moines, IA
Payer Type: 

The State of Iowa developed a State Healthcare Innovation Plan (SHIP) to serve as the guiding structure to develop and implement a new health care payment and delivery system that will reduce health care costs, improve population health and improve patient care. The SHIP builds off other payment and delivery system reform efforts underway in Iowa, including Health Homes, Integrated Health Homes (IHH), the Balancing Incentives Payment Program (BIPP), the Iowa Health and Wellness Plan, and the Mental Health and Disability Services (MHDS) Redesign. All of these initiatives align with the State Innovation Model (SIM) which is providing the State with an opportunity to transform the health care system across the State. 

Iowa’s plan for health system transformation builds upon the ACO model that currently covers the state’s expanded Medicaid population, called the Iowa Health and Wellness Plan. This population-based model also will align with quality measures and payment methodology (shared savings and calculation of total cost of care) utilized by the Wellmark commercial ACOs. In addition, the state will work with the same data analytics contractor as Wellmark so that provider organizations have consistent and usable data to transform their practice from volume-based reimbursement to value-based reimbursement. By the end of the performance period, the Medicaid ACOs will be accountable for the long term care and behavioral health services of their attributed patients. Iowa will use SIM funding to integrate community-based resources into the ACOs by providing technical assistance through various partners. The state also will leverage and spread existing community transformation initiatives focused on the social determinants of health.

In December of 2014, CMS announced that the State of Iowa will receive approximately $43.1 million over 48 months to implement and test its State Health Care Innovation Plan.

For more information, see the Iowa project narrative (May 2015). 

Payment Model: 

By developing incentives for improvements in cost, quality of service, and patient satisfaction, Iowa will shift health care providers’ focus from 
maximizing the number of patient procedures performed to achieving positive patient outcomes. Iowa will also have key health care payers align their payment methods and quality strategies so that they are working toward the same patient outcomes. 

Last updated June 2015
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