Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Other Publication


The Role of States in Achieving a High Performance Health System


See the PowerPoint charts at right to review my Oct. 16 keynote presentation given at the National Academy for State Health Policy annual conference.


Anyone who has traveled around the United States is keenly aware that regional differences, from cooking to music, still exist, despite the fact that you can purchase the same latte, jeans, or lawn mower in any state. While some of these differences should be preserved, other variations, such as those affecting the quality of health care residents of each state receive, must be eliminated. All Americans deserve the benefits of a high performing health system, no matter what state they call home.

The Commonwealth Fund's Commission on a High Performance Health System's first national scorecard found wide variation in health care among states. For example, on a health care indicator measuring preventive care visits for children, the best-performing states—those in the top 10 percent in terms of health care performance—scored 73 out of a possible 100 points, while the bottom 10 percent of states scored 48. Likewise, while the number of uninsured has ballooned throughout the country over the last five years—reaching 46.6 million Americans according to 2005 U.S. Census data—in 12 states, 23 percent or more of residents lack coverage, compared with five states where 14 percent or less are without coverage.

Ocean State Makes Waves
The scorecard shows that every state has room to improve its health care system. And states can learn from each other, by critically observing innovative strategies at work. That way, states can apply often scarce resources in pursuit of reforms that will really help improve the health of their residents.

The State of Rhode Island is already demonstrating its commitment to improving coverage and care. As part of its effort to promote affordable health insurance, Rhode Island's Office of the Health Insurance Commissioner (OHIC) gathered data on its uninsured population, learning that the majority are young, male, employed, and low income. This data was used to shape legislation passed in July that authorized OHIC to implement a new affordable health plan for small businesses and individuals and provided for the formation of an advisory committee to make recommendations on the health plan's requirements and insurer-proposed designs. The law also mandates the creation of a target average annual premium and affordability guidelines.

That's not all Rhode Island is doing to improve health care. The Rhode Island Department of Health is currently working with the nonprofit Rhode Island Quality Institute on an initiative to promote access to electronic health information data across the state. Called the Rhode Island Health Information Exchange, the initiative is funded by a $5 million contract from the federal Agency for Healthcare Research and Quality. Implementation will be gradual, beginning with laboratory data and eventually including medication histories, reports such as hospital discharge and pathology reports, and administrative data.

Once in place, consumers will be able to grant a variety of health providers permission to share their health information. Such a network is likely to reduce errors and improve efficiency by allowing each and every health provider a patient sees over time to get a good overall picture of that individual's needs and medical history.

Catching That Wave
Every state can learn from Rhode Island and other leading states' efforts to improve access, quality, and efficiency in their health care systems. In addition to Rhode Island, states can look to Maine, which is now refining its three-year old Dirigo Health initiative with a new product designed to encourage employer participation, and to Massachusetts, which passed a law earlier this year to expand coverage options for individuals and employers.

To help states and the nation move toward an improved health system, the Fund's Commission on a High Performance Health System has defined the following as core values and goals:

  1. Expanding health insurance coverage to all residents
  2. Implementing major quality and safety improvements
  3. Working toward a more organized delivery system that emphasizes patient-centered primary and preventive care
  4. Increasing transparency and reporting on quality and costs
  5. Expanding the use of interoperable information technology
  6. Rewarding performance for quality and efficiency
  7. Encouraging public-private collaboration to achieve simplification, more effective change

States such as Rhode Island, Maine, and Massachusetts have already adopted many of these goals. By watching these states' creative strategies in action, every state can develop initiatives tailored to its health care needs and unique circumstances. For more information on how your state rates on metrics tracking health care outcomes, quality, access, disparities, and efficiency, look for our forthcoming state scorecard on health system performance.

As always, I'm interested in your feedback—and in innovative state strategies you may want to share. Please e-mail me at [email protected].


IMPORTED: www_commonwealthfund_org__usr_img_davis_sig.gif


October 2006


Written with the assistance of Christine Haran, web editor.