Outsourcing this public program to insurers has become the preferred method for running Medicaid in 38 states. Stensland, Gaumer, and Miller provided another mechanism by which public payer—based hospital margins respond to private payer—based revenue. These gateways would handle the full range of electronic connectivity for payers and could, in addition to providing administrative and financial functions, also provide clinical connectivity and analytics, surveillance, and other services. Policy Implications VBID is a novel benefit design strategy that has attracted much attention in the payer community.