Archived: State Innovations

This program is now closed.

Program Goals:

As "laboratories of innovation," the states can point the nation to promising approaches for improving the performance of the U.S. health care system. The Commonwealth Fund's State Innovations Program aims to improve state and national health system performance by supporting, stimulating, and spreading integrated, state-level strategies for expanding access to care and promoting high-quality, efficient care, particularly for vulnerable populations. The program is one of several that supports the goals of the Fund's Commission on a High Performance Health System, and its analytic and grantmaking activities are informed by the Commission. Grants made by the State Innovations Program:

  • identify and assess promising public and private sector policies
  • disseminate state innovations
  • evaluate comprehensive and targeted state health reform proposals
  • respond to state needs for technical assistance and research.

The State Innovations program is led by Assistant Vice President Anne Gauthier, M.S. and Senior Policy Director Rachel Nuzum, M.P.H.

The Issues:

Faced with escalating costs, expanding uninsured populations, and uneven quality of care, a growing number of state policy leaders are taking matters into their own hands. The latest round of state reforms features a variety of approaches to improving health system performance. Some are incremental approaches—providing universal health insurance coverage for children, for example, or promoting public–private partnerships to insure low-income workers. Many others are comprehensive, attempting to achieve near-universal coverage while simultaneously creating incentives for improving quality and containing costs—through efforts such as better chronic care management. These comprehensive approaches to health reform enable states to address issues of quality and efficiency as well as increase access to care.

Recent Projects:

Evaluating Health Reform in Massachusetts. In partnership with the Blue Cross Blue Shield Foundation of Massachusetts and the Robert Wood Johnson Foundation, the Fund is supporting the Urban Institute in an evaluation of health reform in Massachusetts. A Health Affairs article with findings from a baseline survey in 2006 and follow-up survey in 2007 showed:

  • Increased access to care. In the first year after implementation reforms, the uninsurance rate among adults dropped by almost half, from 13 percent to 7.1 percent.
  • No crowd-out of employer coverage. The share of adults overall and of working adults who reported an offer of employer-sponsored health coverage remained stable between fall 2006 and fall 2007.
  • Fewer financial barriers to care. In fall 2007, only 16.9 percent of low-income adults said that they had not received needed care in the past 12 months because of cost, compared with 27.3 percent in fall 2006.

The third phase of this project will begin in late 2008 and will examine the early impact of the individual mandate, as well as new coverage programs and insurance-purchasing mechanisms created by the law.

ROI Purchasing Institute. The Center for Health Care Strategies (CHCS) developed a return-on-investment (ROI) forecasting calculator to assist Medicaid stakeholders interested in identifying interventions that have potential to improve quality, and at the same time, reduce costs. With support from the Fund and the Robert Wood Johnson Foundation, CHCS worked with eight states to test the value of the tool, improve its functionality, and incorporate its use into the planning and analysis of proposed initiatives to improve care for Medicaid beneficiaries. The ROI calculator is publicly available on the CHCS website.

States in Action. Since publication began in March 2005, the Fund e-newsletter States in Action has proven to be an effective vehicle for raising awareness of innovative state coverage expansions and quality improvement initiatives. Informed by an expert Editorial Advisory Board, this bimonthly newsletter reaches an audience of more than 11,000 state policymakers, administrators, researchers, and others who are working on ways to stretch health care dollars to meet the needs of residents.

Future Directions

In another partnership with the Robert Wood Johnson Foundation, the Fund is supporting CHCS to conduct a technical assistance project helping three communities design and implement large-scale, evidence-based quality improvement initiatives that target high-cost, high-risk patients and would be applicable to commercially insured populations. The results will aid policymakers in developing reforms that align financial incentives with high-quality care across multiple stakeholders.

The first State Scorecard, published by the Commonwealth Fund Commission on a High Performance Health System in June 2007, found wide variety across states and room for improvement even among top-performing states. In a follow-up effort, Joel C. Cantor, Sc.D., director of the Center for State Health Policy at Rutgers University, is gathering data on a comprehensive set of health system indicators to produce a second State Scorecard, patterned after the National Scorecards published by the Commonwealth Fund Commission on a High Performance Health System in September 2006 and July 2008.

With Fund support, AcademyHealth is using a Fund grant to lead the State Quality Improvement Institute, an intensive effort to help states develop and implement concrete action plans to improve performance across targeted quality indicators. based on the findings from the first State Scorecard. Nine states are participating in the first round.

In a complementary initiative, a Fund grant to the National Academy for State Health Policy supports efforts to understand critical factors in the success of interagency state partnerships to improve quality. With the help of an advisory committee, best practices and lessons learned will be shared among the states.

The National Academy of State Health Policy is also collaborating with the Brookings Institution's Engelberg Center for Health Care Reform on a Fund-supported State Public Employee Health Plan Forum to enhance state-to-state information exchange about the expanded role that public employee health plans could play in improvement efforts. The forum includes Web conferences on topics such as aligning incentives for quality with insurers and providers, engaging consumers in improving health care quality, and examining models of purchaser collaboration.

Another project in the quality arena, led by Stephen Somers, Ph.D., of the Center for Health Care Strategies is assisting six state Medicaid programs in the design of pay-for-performance programs that lead to better care, at lower costs, for enrollees. The Medicaid teams will take part in two intensive training sessions and receive follow-up assistance.

To apply for a grant from the Child Development and Preventive Care Program, visit the Applicant and Grantee Resources page.

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