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.

Community health centers and other safety net clinics provide vital access to health services, but states must know how these services are being used to plan for future needs. The Missouri Department of Health and Senior Services works collaboratively with the Missouri Primary Care Association to collect and report patient demographic data to better assess patient migration patterns. They primarily have used Medicaid payments to Federally Qualified Health Centers to track how patients utilize primary care, dental, and mental health services. Preliminary findings indicate that patients frequently cross county boundaries to access these services. This has highlighted a problem with the use of Medicaid data as a metric of a county's overall health. The county that a Medicaid claim is attached to is based on where the service was provided, and not the county where the patient resides. This could cause the state to overestimate the level of access to scarce services, like dental care, in one county and underestimate the access problems in adjoining counties. The state is working with the Primary Care Association to overcome these issues and refine its picture of health care safety net use in the state.

A related project, the Oral Health Preventive Services program, conducts surveys the patterns of use of oral health services among the state's children. It collects information on oral health screenings and provision of preventive services like fluoride varnish, an easy-to-apply cavity-fighting paste that is ideal for school-based interventions.

Sources: Missouri Public Health SHAPES survey response, and Oral Health Surveillance website, http://www.dhss.mo.gov/oralhealth/OralHealthSurv.html.