In a complementary effort, Joel C. Cantor, Sc.D., who directs the Center for State Health Policy at Rutgers University, is gathering state data on a comprehensive set of health system indicators to produce a state-level "performance scorecard," patterned after the national scorecard released by the Commonwealth Fund Commission on a High Performance Health System in September 2006.⁽¹⁾ As shown in the figure, two of the scorecard's key indicators—mortality for conditions "amenable to health care" and infant mortality—vary widely across states, with poor-performing states well below national averages. Data such as these will inform policymakers about areas ripe for improvement, and will also serve as a platform for promoting comprehensive, systemwide approaches to care delivery.

One of the first and most promising state reform efforts is Maine's Dirigo Health Reform Act, which aims to extend coverage to all uninsured state residents by 2009. With Fund support, national and state health policy experts assisted the Maine Governor's Office of Health Policy and Finance as it designed a low-cost insurance product, created marketing and outreach strategies targeting the uninsured, and weighed various political and market considerations. Maine is now one of only four states where less than 14 percent of working-age adults are uninsured, and one of the few states to markedly improve adult health coverage over the last five years.⁽²⁾

A Fund-supported evaluation of DirigoChoice, the subsidized insurance plan that is the centerpiece of the Maine initiative, is currently under way. Led by James Verdier, J.D., of Mathematica Policy Research, Inc., the study is examining what impact DirigoChoice is having on health coverage and costs for low- to moderate-income individuals and small businesses—the groups for which the plan was designed—and on public and private payers. The evaluation team is also looking at sustainability and replicability of this model to inform other states considering similar coverage strategies. In partnership with the Blue Cross Blue Shield Foundation of Massachusetts, the Fund is also supporting an evaluation of the new Massachusetts Health Plan.

A 2006 keynote address given by Fund president Karen Davis at the annual meeting of the National Academy for State Health Policy sparked widespread interest in state innovations that are bringing about improved health care access, quality, and information technology capacity, as well as new payment systems that reward Medicaid providers for high quality and efficiency. Fund staff have responded to numerous requests to share this information at state forums.