H. Pelletier, How States Are Working with Physicians to Improve the Quality of Children's Health Care, National Academy for State Health Policy and The Commonwealth Fund, April 2006
States are increasingly interested in working with physicians, provider organizations, and other entities to support efforts aimed at improving the quality of children's health care, particularly for those children who are underserved and members of at-risk populations. States are primarily interested in supporting these efforts as a means to improve both the quality and coordination of care. However, they also view such quality improvement partnerships as an opportunity to shift their relationship with the provider community from that of regulator to that of collaborator. Providers engaged in these activities note that working collaboratively with states on these initiatives can indeed lead to improved quality and coordination of care and to more productive relationships with state officials.
A recent survey by the National Academy for State Health Policy found that half of all states provide some resources or materials to primary care providers to encourage them to focus on young children's early mental health development. An additional 13 states indicate that they are "planning for the future" to implement such activities. Medicaid agencies have often been the most involved state players, but other agencies—among them public health, early intervention, and maternal and child health—are also interested in working with and supporting physicians in their efforts to enhance the quality of care delivered to young children. In addition, state agencies are partnering with other organizations in their states to support primary care providers seeking to enhance the quality of care they deliver to children. These partners include state chapters of the American Academy of Pediatrics and the American Academy of Family Physicians, state infant or child mental health associations, university-associated academic medical centers, Head Start, and advocacy groups.
These partnerships are not always easy to establish and maintain. Physicians who have participated in them note that it can be difficult to overcome long-held assumptions about government bureaucracies, and state officials report that working with busy physicians can pose challenges. Meetings and calls cannot be quickly scheduled, and practices may not have sufficient time to focus on a specific quality improvement initiative. Also, partners often come to the table with different goals and priorities, and these differences can slow or stop progress.
The survey reveals that while many of the formats adopted or supported by states and their partners are fairly traditional, new models are emerging: some in response to past experience, some based on research on physician behavior change, and others based on quality improvement principles or new technologies that have made it possible to deliver information in new ways. A number of states have begun to adopt these newer models which include:
Each of the models profiled in this report is significantly different from the others and offers unique lessons for those interested in replicating them. However, a number of lessons were common to most, if not all, of the models. Among them: