Transforming health care through Medicaid waiver based incentive programs: Case studies from Massachusetts, California, and Texas

Section 1115 Medicaid waiver based incentive programs are encouraging hospitals and health systems to transform care delivery to better serve the nation’s most vulnerable patients. To date, as many as seven states have implemented delivery system transformation programs through waiver based incentive funds. However, this innovative work was first pioneered by California, Massachusetts, and Texas following the passing of the Affordable Care Act in 2010. Five years later, these initial providers are beginning to see tangible impacts of the incentive programs on care delivery and patient outcomes.

To better understand the journey and results of these three states, we conducted a webinar series which hosted clinical and non-clinical providers from Boston Medical Center in Massachusetts, Santa Clara Valley Medical Center in California, and UT Northeast in Texas. Each speaker was provided a list of questions to guide their presentation which covered various aspects of their experience with the waiver based incentive programs. The webinar presentations were recorded, transcribed, and qualitatively analyzed to inform a published research brief.

Providers expressed the waiver based incentive programs jumpstarted transformation projects they were not otherwise able to implement. Navigating cultural changes and extensive data reporting were common challenges amongst the sites. However, strong leadership buy-in and cross-department collaboration ultimately accelerated success. Most importantly, providers have seen vast spillover effects from the transformation projects which have driven quality improvement efforts upstream to impact larger population health efforts.