To improve population health and health equity, states are working across Medicaid, public health, and other agencies to develop accountable health structures. State accountable health models — both currently operating and those in development — fall along a continuum. All of them promote healthy communities through community partnerships, but some contract with Medicaid agencies to provide health care services directly to individual Medicaid beneficiaries, while others focus only on community-based interventions.

In October 2017, the National Academy for State Health Policy (NASHP) convened state health officials representing 10 state accountable health models to discuss strategies for using accountable health structures to promote population health. Participants also discussed strategies to assess these structures’ impact on health, determine their return on investment, and develop sustainable funding approaches. The following are some of the key strategies that they identified:

  • Use states’ policy and contracting levers to address prevention and health-related social needs in payment and delivery reform. States can leverage Medicaid managed care contracting, build on the flexibility available through Section 1115 demonstration waivers, and maximize State Innovation Model (SIM) investment in population health to focus efforts to improve health.
  • Align population health goals, agendas, and, where possible, metrics across communities, payers, and stakeholders. Accountable health structures are most effective in reaching their goals and engaging stakeholders across sectors when they work toward shared goals.
  • Use data and measurement to raise the bar on performance, and consider financial incentives to address prevention and health-related social needs. Some policymakers suggest identifying a unified, small set of metrics that can be used across various systems and are tied to payment and accountability and based on community outcomes as well as provider outcomes.
  • Work across sectors and agencies to develop a range of financial strategies to support investment in prevention and community health. Identify any gaps and duplication in funding streams. States can bolster the resilience of their accountable health structures by braiding and blending funds across agencies and seeking private sector investment. Cross-sector financial mapping of health-related programs and services can ensure that federal funds support activities that align with state priorities.
  • Learn from other states’ value-based payment roadmaps and lessons learned. Instead of reinventing the wheel, state policymakers can adopt and adapt other states’ tools to fit their state’s needs.