Drawn from the report, States' Roles in Shaping High Performance Health Systems.

States shape the health system in many ways, influencing key components such as insurance coverage, quality of care, and information and provider infrastructures. This report presents findings from the State Health Policies Aimed at Promoting Excellent Systems project, undertaken by the National Academy for State Health Policy, with support from The Commonwealth Fund. After conducting surveys of multiple agencies in states across the country, as well as review of related literature, this study found that states are pursuing system improvements across the full spectrum of their authority, including health care purchasing, regulation of providers, reporting of performance data, integration of public health with health care approaches, and improving the availability and affordability of health insurance. Despite this activity, this study finds room for states to do much more. Ongoing efforts to track, study and diffuse information on state activities could accelerate adoption of promising polices and practices.

Arkansas provides health care benefits through plans offered to state and public school employees and their families, covering approximately 120,000 people. In this role, the state has a financial interest in improving the health status of this population. In 2004, it began a long-term strategy to avoid preventable diseases and encourage healthy behaviors. It introduced Health Risk Assessments (HRA) to gauge member behaviors in five areas: smoking, alcohol consumption, seat belt usage, body mass index, and weekly physical activity.

The state's strategy relies heavily on incentives for positive behaviors. Members who complete an HRA receive a $10 monthly discount to their health insurance premium; those who are found to be at low risk receive an additional $10 discount. In 2005, more than half of members completed the HRA. Arkansas has introduced enhanced tobacco cessation and obesity management (including nutrition counseling) benefits, and has proposed a further expansion of coverage for clinically directed weight-loss programs and surgical obesity interventions. State employees who assist in management of their health risks are also eligible for three days of vacation, known as "health days."

This is complementary to the state's effort, through the Healthy Arkansas initiative, to advance the idea of "worksite wellness." This effort promotes the notion that because adults spend most of their waking lives at work, work environments should promote healthy choices and healthy behaviors.

Sources: Arkansas Governor's Office SHAPES survey response, presentation by Rhonda Jaster, https://arbenefits.org/ebd_pages/forms/presentationEBDStateHRABackground.pdf, presentation by Joseph Thompson, http://www.nga.org/Files/pdf/0512HEALTHYThompsonJoe.PDF, and Healthy Arkansas website, http://www.arkansas.gov/ha/worksite_wellness/index.html.