State Directed Payments (SDPs) are a mechanism through which state Medicaid agencies direct managed care organizations (MCOs) to make specific provider payments to support state policy goals such as improving quality of care, enhancing access to services, or addressing priority healthcare needs.
SDPs offer states flexibility to align payments with value- based purchasing initiatives, provider incentives, and broader Medicaid program objectives.
Rely on IPRO to Ensure Your SDP Program Success
IPRO has the expertise to:
- Define the relationship between payment models and healthcare delivery outcomes.
- Draft the required SDP proposal to CMS, including the mandatory evaluation plan.
- Help ensure SDP project alignment with the state’s managed care quality strategy.
- Provide objective oversight, analysis, and recommendations to ensure programs are effective and compliant with federal regulations.
- Measure baseline performance for providers engaged in the SDP.
- Monitor performance to determine progress.
- Analyze data:
- Develop and execute evaluations and other accountability structures.
- Collect, analyze, and report on healthcare quality and utilization data to provide insights into how SDPs influence health outcomes.
- Identify trends in provider performance and patient care across different geographic and/or demographic groups.
- Provide recommendations for refining payment structures, adjusting performance metrics, or targeting high-need areas (e.g., rural healthcare or behavioral health).
- Assist states in redesigning SDPs to be more effective and responsive to healthcare needs, focusing on the use of quality improvement methodology.
- Assist with reporting to CMS.
Why IPRO?
IPRO has served as an External Quality Review Organization for more than 30 years, working with states of all sizes across the nation. Its Center for Program Evaluation is comprised of a team of health services researchers including biostatisticians, epidemiologists, and mixed methods researchers with experience in defining measures, identifying data sources, collecting and analyzing data, and reporting results. The team also has expertise in collecting qualitative information through interviews and observations to understand the context in which SDP initiatives function.
Learn More
Contact us to learn more about how we can help your state maximize SDPs.
