States are exploring health care reform from a number of angles, ranging from universal coverage efforts to incentive programs that foster improvements in health care quality and efficiency. With Fund support, the Massachusetts Health Quality Partners is creating quality and efficiency profiles of the state's physicians to help insurers select plan doctors and develop pay-for-performance programs, and help group practices improve the care they provide.

Photo: Larry Mulvehill/Corbis

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he Commonwealth Fund's State Innovations program, now in its second year, 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 pursues the following activities:
Identifying and evaluating public and private sector policies that have the potential to improve health system performance, not just at the state level, but nationally as well.
Stimulating new efforts to improve the performance of state health systems and spread promising approaches.
Informing health care and policy leaders at the state and national levels about the ways in which states can take action to improve health system performance.
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 and modest—providing universal health insurance coverage for children, for example, or promoting public–private partnerships to insure low-income workers. Others are comprehensive and bold, attempting to achieve near-universal coverage while simultaneously creating incentives for improving quality and containing costs—for example through better chronic care management.
In its first year, the State Innovations program supported several efforts to identify innovative state initiatives and increase understanding of state performance in relation to benchmarks of high performance. For example, the National Academy for State Health Policy, under a Fund grant, is conducting a nationwide survey to identify states engaged in policies and practices that might lead to better health system performance. These include subsidy programs that enable the working poor to afford health insurance coverage; policies to promote the public reporting of information about the quality and safety of patient care; and policies encouraging physicians to implement electronic health record systems.
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Rachel Nuzum
Program Officer
Alan R. Weil, J.D.
Member, Commission on a High Performance Health System