Work undertaken by Commonwealth Fund staff has also spurred action in the states. For example, one of the policy options offered in the Fund's "commencement day" report on health insurance coverage among young adults—mandating that insurance policies cover dependent young adults past the age of 19—has been enacted into law by five states since 2005.⁽³⁾ Other reform options outlined in the report formed the basis of bills introduced by Representative Vic Snyder (D–Ark.) and Senator Blanche Lincoln (D–Ark.) that propose to give states the option of raising the eligibility age for Medicaid and the State Children's Health Insurance Program (SCHIP) from 18 to 23.⁽⁴⁾

Fund grantees are also exploring how public and private purchasers of health care can collaborate to extract greater value from their health care dollars. With Fund support, Sharon Silow-Carroll of Health Management Associates is studying the experiences of states involved in joint public–private "value-based purchasing" initiatives. States have employed a variety of strategies: collecting quality-of-care data; contracting selectively with high-quality providers; partnering with health plans or providers to improve quality; and rewarding or penalizing plans or providers. The project investigators began field work in the fall of 2006, focusing on four initiatives—the Minnesota Smart Buy Alliance, Wisconsin Employee Trust Fund, Puget Sound Health Alliance, and Massachusetts Group Insurance Commission.

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 in public insurance. The Medicaid teams will take part in two intensive training sessions and receive follow-up assistance.

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. Launched as a quarterly, and now published bimonthly, the newsletter reaches an audience of more than 9,000 state policymakers, administrators, researchers, and others who are working on ways to stretch health care dollars to meet the needs of their state's residents.