Archived: State Health Policy and Practices

This program is now closed.

Program Goals

The State Health Policy and Practices program, a component of The Commonwealth Fund's focus on health reform policy, is designed to help states implement policies and programs that ensure residents have access to affordable, accountable, high performance health systems. The program does this by:

  • working with state-initiated public–private partnerships to develop the policies and infrastructure necessary to improve quality of care and ensure greater accountability for patient outcomes;
  • fostering discussion among stakeholders and policymakers about ways to strengthen the health care safety net in vulnerable communities; and
  • nationally disseminating lessons from states as they implement health care reform.

The State Health Policy and Practices program is led by Vice President Edward L. Schor, M.D.

The Issues

The passage of federal health reform legislation creates a host of opportunities for states to expand access to care, improve quality, and achieve greater efficiency in their health care systems. At the same time, today's difficult economic environment makes it more challenging for state leaders to find the resources to pursue their efforts. The Fund's State Health Policy and Practices Program was established to assist states with developing the infrastructure needed to improve health system performance. as well as to help state leaders share information on the policy and practice innovations they are undertaking.

Recent Projects

Working with Public–Private Partnerships
Providing technical assistance for quality improvement. In 2008, The Commonwealth Fund and AcademyHealth launched the State Quality Improvement Institute (SQII) to help states address some of the shortcomings in performance highlighted by the Fund's State Scorecard on Health System Performance. Nine states—Colorado, Kansas, Massachusetts, Minnesota, New Mexico, Ohio, Oregon, Vermont, and Washington—were selected to participate in an intensive planning process and work with leading experts to improve care in three priority areas: delivery and financing system reform, chronic care and population health improvement, and data integration and transparency. SQII states have now begun the process of implementing action plans around specific evidence-based improvement strategies, among them: the implementation of medical homes and care coordination strategies, new community-based health initiatives for reducing chronic illness, chronic disease management programs to improve patient outcomes and avoid hospitalizations, and public reporting of health care quality data. A progress report covering the institute's first year is available on the AcademyHealth Web site.

Improving care coordination, case management, and linkages to community services. The Assuring Better Child Health and Development (ABCD) initiative, supported by The Commonwealth Fund and led by the National Academy for State Health Policy (NASHP), has helped 25 states launch projects to promote the use of structured developmental screening by physician practices. As practitioners have stepped up their identification of young children with developmental concerns, however, they have been presented with a new challenge: referring families to appropriate intervention services and coordinating their care with other developmental service providers. To address these issues, ABCD is currently engaging five states—Arkansas, Illinois, Minnesota, Oklahoma, and Oregon—in efforts to change their policies, develop programs, and work with physician practices to create the systemic changes needed for effective coordination and referral networks. NASHP is also continuing to support states' efforts to sustain their gains in developmental screening rates.

An April 2009 NASHP/Commonwealth Fund report, authors Kay Johnson and Jill Rosenthal show how states can foster greater integration of services delivered by physician practices and community agencies. One of the strategies they describe is offering medical home providers financial incentives and other support for care planning and case management, electronic medical record systems, and individualized, patient-centered care plans.

Helping to implement reforms in physician practices. To help physician practices make the changes needed to improve quality and efficiency, the Fund is supporting the development of statewide, multi-stakeholder collaborations called "improvement partnerships." The Vermont Child Health Improvement Program (VCHIP), the first of these initiatives, is assisting public–private partnerships in 19 states. An online guide available on the VCHIP Web site provides state leaders in child health with step-by-step instructions on developing sustainable collaborations of public and private partners. Along with the American Academy of Pediatrics and the National Initiative for Children's Healthcare Quality, the Fund sponsored a September 2009 webinar in which representatives from three improvement partnerships described how their initiatives have improved care and informed state policy.

Promoting state and federal dialogue. Successful implementation of health care reform will require committed, informed leadership within each state. With Fund support, the National Academy for State Health Policy is testing a model for fostering dialogue between state and federal leaders on issues related to health system performance. An October 2009 meeting of state and federal leaders in Washington, D.C., focused on patient safety and nonpayment for adverse medical events. (See this NASHP report for more information.)

Disseminating Lessons Learned
Circulated to some 15,000 policymakers, researchers, administrators, and providers, the Commonwealth Fund e-newsletter States in Action: A Bimonthly Look at Innovations in Health Policy tracks and reports on promising state initiatives to improve health system performance. The newsletter, co-produced by Sharon Silow-Carroll and her team at Health Management Associates and Fund staff, will be an even more valuable resource to states in light of new federal policies requiring them to create, test, and implement innovative ways to deliver high-quality health care.

In 2009, the National Governors Association launched a $1.5 million national initiative, Rx for Health Reform: Affordable, Accessible, Accountable, to assist governors and other state leaders with developing the kind of coordinated, efficient health care systems envisioned by the Affordable Care Act. The Fund is providing support for a series of papers that analyze the law and its implications for states, informing state activities as the law's provisions are implemented. Paper topics include health insurance reform, changes to Medicaid, establishing state-based health insurance exchanges, and delivery system redesign.

While states have been regulating private health insurance companies and products for a century, state regulatory activity has not addressed insurers' obligations regarding health care affordability and cost-containment. A project undertaken by Michael Bailit, M.B.A., of Bailit Health Purchasing, LLC, examined Rhode Island's innovative use of health insurance statutes and regulations to expand primary care capacity and change in the delivery of primary care services. A Fund issue brief provides details on the state's experience.

Future Directions

The State Health Policy and Practices program will continue to help states network practices and providers through shared resources and unified approaches to paying providers and improving quality of care. The program will also build on the Fund's experience with monitoring, evaluating, and reporting on health system innovation and performance. Grants will support projects that analyze states' capacity to adopt significant payment reform, integrate Medicaid into statewide reforms, and help state hospitals, physicians, and insurers work together. The program also will support technical assistance, such as case studies and meetings to inform state leaders about health care reform and help them share their experiences with federal policymakers.

For example, a grant led by Nikki Highsmith of the Center for Health Care Strategies is helping to advance primary care transformation in Medicaid. Already the nation's largest health coverage program, Medicaid will be greatly expanded by the new health reform law, and new ways are needed to improve the efficiency and effectiveness of the small primary care practices that provide much of the care for Medicaid patients, particularly in underserved areas. The project team has interviewed Medicaid leadership in several states to determine how they are supporting small practices and to identify funding strategies and potential partnerships.

The ABCD initiative, meanwhile, will continue to work with leaders from Arkansas, Illinois, Minnesota, Oklahoma, and Oregon to undertake policy reforms, develop programs, and collaborate with physician practices to create the systemic changes needed for effective coordination and referral networks for children with developmental problems.

To apply for a grant, visit the Commonwealth Fund Web site's Applicant and Grantee Resources page.

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