States have a unique combination of regulatory levers, including relationships with health care systems and payers, and have knowledge of the health care needs of their residents; thus, they are well-positioned to lead the effort to align incentives across the health care delivery system to improve quality and value. States can spearhead care redesign efforts and collaborate and negotiate with Medicaid and private health care payers, but statewide health care transformation may be limited without participation from the nation’s largest public insurer: Medicare. Models tested by the Centers for Medicare & Medicaid Services (CMS) Innovation Center are one opportunity for Medicare participation in such efforts, and the Innovation Center has the authority to waive certain Medicare payment rules for the purposes of testing models, which can provide flexibility to states committed to transforming health and health care for their residents.
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Sapra KJ, Wunderlich K, Haft H. Maryland Total Cost of Care Model: Transforming Health and Health Care. JAMA. 2019;321(10):939–940. doi:10.1001/jama.2019.0895
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