Medicaid Integrated Purchasing for Physical and Behavioral Health: Early Adopters’ Perceptions of Payment Reform Implementation in Washington State

Abstract

The Centers for Medicare and Medicaid Innovation (CMMI) gave rise to the State Innovation Models (SIMs). Medicaid Integrated Purchasing for Physical and Behavioral Health, referred to as Payment Model 1 (PM1), was a core payment redesign area of the Washington State SIM project under which our research team was contracted to provide an evaluation. In doing so, we leveraged an open systems conceptual model to assess qualitatively Early Adopter stakeholders’ perceived effects of implementation. Between 2017 and 2019, we conducted three rounds of interviews, examining themes of care coordination, common facilitators and barriers to integration, and potential concerns for sustaining the initiative into the future. Further, we noted the initiative’s complexity may require the establishment of enduring partnerships, secure funding sources, and committed regional leadership to ensure longer-term success.

Keywords:

• Medicaid integrated purchasing
• payment reform
• primary and behavioral health integration
• qualitative research
• value-based purchasing

Acknowledgements

The authors wish to thank Nicole Schwalbe, MPH, for her support and contributions to Round 1 qualitative coding and an initial draft of this manuscript. The study was approved by the Washington State Institutional Review Board, Project D-071416-A17.01, Years 1-4.

Disclaimers

The project described was supported by Grant Number 1G1CMS331406 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor.

This project was supported by Interagency Agreement No. K1445 from the Washington Health Care Authority (HCA), and Grant Number T32HS013853 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality, the HCA or an of the Washington state official agencies.