State Innovation Models (SIM) Studies
IMPROVING POPULATION HEALTH, QUALITY OF CARE, & COST GROWTH
Research led by the University of Washington around SIM took place over two separate evaluations — the Washington State SIM Evaluation and the SIM Follow-Up Evaluation.
Washington State SIM Evaluation
Washington state received a State Innovation Models (SIM) $65 million award from the U.S. Centers for Medicare & Medicaid Services Innovation Center to improve population health and quality of care, while reducing the growth of health care costs in the state, which has more than 7 million residents.
The overall SIM project was led by the Washington State Health Care Authority in collaboration with the Washington State Department of Health and Washington State Department of Social and Health Services. The project included one year of planning (during 2015) along with three years of implementation (February 2016 — January 2019).
While this SIM funding supported four years of health system transformation in Washington state, there was only funding to evaluate two of the three implementation years, known as the Washington State SIM Evaluation. Douglas Conrad and Tao Sheng Kwan-Gett with the UW Department of Health Systems and Population Health within the School of Public Health led this evaluation team.
Learn more about the University of Washington's SIM evaluations with these select publications and findings.
- Grembowski D, Ingraham B, Wood S, Coe NB, Fishman P, Conrad DA. Statewide Evaluation of Washington's State Innovation Model Initiative: A Mixed-Methods Approach. Popul Health Manag. 2021 May 19. doi: 10.1089/pop.2020.0374. Epub ahead of print. PMID: 34010039.
- Coe NB, Ingraham B, Albertson E, Zhou L, Wood S, Grembowski D, Conrad D. The one-year impact of accountable care networks among Washington State employees Health Serv Res. 2021 Apr 16. doi: 10.1111/1475-6773.13656. Epub ahead of print. PMID: 33861869.
- Grembowski D, Conrad D, Naranjo D, Wood S, Zhou L, Banks J, Coe NB, Kwan-Gett T, Baseman J. State-Level Evaluation of Washington's State Innovation Models (SIM) Initiative. J Health Care Poor Underserved. 2021;32(2):862-891. doi: 10.1353/hpu.2021.0069. PMID: 34120982.
- Kwan-Gett TS, Albertson EM, Banks J, Revere D, Rogers M, Baseman J, Andris L, Conrad D. Mixed-Methods Evaluation of the Washington State Practice Transformation Support Hub. J Public Health Manag Pract. 2020 Aug 6. doi: 10.1097/PHH.0000000000001221. Epub ahead of print. PMID: 32810069.
- Grembowski D, Conrad DA, Naranjo D, Wood S, Coe NB, Kwan-Gett T, Baseman J. Protocol for evaluating Washington's State Innovation Models (SIM) project using the RE-AIM Framework. Qual Manag Health Care. 2020 Apr/Jun;29(2):81-94. doi: 10.1097/QMH.0000000000000246. PMID: 32224792.
- Izguttinov A, Conrad D, Wood SJ, Andris L. From volume- to value-based payment system in Washington State federally qualified health centers: Innovation for vulnerable populations. J Ambul Care Manage. 2020 Jan/Mar;43(1):19-29. doi: 10.1097/JAC.0000000000000311. PMID: 31770183.
- Wood SJ, Albertson EM, Conrad DA. Accountable Care Program Implementation and Effects on Participating Health Care Systems in Washington State: A Conceptual Model. J Ambul Care Manage. 2019 Oct/Dec;42(4):321-336. doi: 10.1097/JAC.0000000000000302. PMID: 31449166.
- Conrad DA, Kwan-Gett T, Coe NB, Grembowski D, Wood SJ, Baseman JG, et al. (Department of Health Systems and Population Health, University of Washington, Seattle, WA). Washington State Innovation Models (SIM) Evaluation Final Report. 31 Jan 2019.
SIM Follow-Up Evaluation
The Robert Wood Johnson Foundation provided nearly $400,000 in funding that allowed a new research team to analyze all three implementation years of SIM (February 2016 — January 2019) by supporting data collection and analysis through August 2020. Thanks to this funding, the research team was able to finish collecting data from the final implementation year, combine that data with the two prior years, and analyze all three years.
David Grembowski led the research team at the University of Washington's Department of Health Systems and Population Health within the School of Public Health. The team evaluated the impact of SIM as a whole and analyzed several aspects of the Washington state model.
Our primary goal was to perform the following three quantitative analyses with data analyses for all three years.
- Statewide SIM Evaluation: Examine state-representative data from the 2013-2018 annual Behavioral Risk Factor Surveillance Surveys to estimate statewide SIM impacts on health status, health behaviors, and access and care coordination.
- Payment Model 2 Evaluation: Examine Medicaid records from July 2014 - December 2018 to estimate the impacts of Payment Model 2, a form of primary care per member per month payment with quality incentives and no downside financial risk, on the utilization, cost and quality of care for Medicaid beneficiaries in 16 federally qualified health centers (FQHCs).
- Payment Model 3 Evaluation. Examine claims-based administrative data from 2013-2018 for state employees to estimate the impacts of Payment Model 3, a form of "value-based contracting" where two accountable care networks face upside and downside financial risk for meeting quality of care targets on the utilization, cost and quality of care for state employees and their dependents in the networks.
Our secondary goal was to examine stakeholder perceptions of SIM performance and compare them to our quantitative findings.
- Regional accountable communities of health linking health and social services to address local needs;
- Practice transformation support hub;
- Four value-based payment reform pilot projects mainly in state employee and Medicaid populations; and
- Data and analytic infrastructure development to support system transformation with common measures.