Developing West Virginia's State Innovation Model (SIM) Plan

The Challenge 

What can be done to improve public health and the quality of health care in a poor rural state plagued by the worst epidemic of opioid use disorder in the Nation?

The State of West Virginia received a Centers for Medicare & Medicaid Services (CMS) grant to develop a plan, the State Innovation Model (SIM) Plan, for restructuring the state’s health care delivery and payment system.  The goal of the plan was to better achieve the “triple aim”: improve population health and the care experience while controlling costs.

West Virginia tapped Westat to work with community members, health and behavioral health providers, and managed care organizations to develop strategies to integrate behavioral health and primary care that can succeed in poorly resourced rural settings, including innovative, state-of-the-art approaches to telehealth and expanded use of medication-assisted treatment for opioid use disorders.

Our Solutions 

  • Westat consulted with the planning team and with health and behavioral health providers throughout the state on the role of behavioral health integration in achieving plan goals.
  • To develop an understanding of the opportunities to integrate care, Westat interviewed leaders of many of the largest provider organizations and all of the Medicaid managed care organizations working in the state. A particular focus was on means to improve access for medication-assisted treatment for opioid use disorders in a state with extremely high rates of opioid overdose and death.
  • We developed a key segment of the plan that outlined strategies for increasing behavioral health and primary care integration, emphasizing three means of deploying telehealth to address health care access and workforce issues in this very rural state.
  • Westat edited the full plan and expanded sections on public health, clarifying the linkages between behavioral and public health.

The Results 

  • West Virginia’s SIM plan received high marks from CMS.
  • Efforts are underway to implement key components of the plan, including some of those recommended by Westat, around the state.

Our Client 

West Virginia University Research Corporation