"laboratories of innovation," the states can point the nation to
promising approaches for improving the performance of the U.S. health
care system. The Commonwealth Fund's State Innovations Program 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 is one of several
that supports the goals of the Fund's Commission on a High Performance
Health System, and its analytic and grantmaking activities are informed
by the Commission. Grants made by the State Innovations Program:
- identify and assess promising public and private sector policies
- disseminate state innovations
- evaluate comprehensive and targeted state health reform proposals
- respond to state needs for technical assistance and research.
The State Innovations program is led by Assistant Vice President Anne Gauthier, M.S. and Senior Policy Director Rachel Nuzum, M.P.H.
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 approaches—providing universal health
insurance coverage for children, for example, or promoting
public–private partnerships to insure low-income workers. Many others
are comprehensive, attempting to achieve near-universal coverage while
simultaneously creating incentives for improving quality and containing
costs—through efforts such as better chronic care management. These
comprehensive approaches to health reform enable states to address
issues of quality and efficiency as well as increase access to care.
Evaluating Health Reform in Massachusetts.
In partnership with the Blue Cross Blue Shield Foundation of
Massachusetts and the Robert Wood Johnson Foundation, the Fund is
supporting the Urban Institute in an evaluation of health reform in
Massachusetts. A Health Affairs article with findings from a baseline survey in 2006 and follow-up survey in 2007 showed:
- Increased access to care.
In the first year after implementation reforms, the uninsurance rate
among adults dropped by almost half, from 13 percent to 7.1 percent.
- No crowd-out of employer coverage.
The share of adults overall and of working adults who reported an offer
of employer-sponsored health coverage remained stable between fall 2006
and fall 2007.
- Fewer financial barriers to care.
In fall 2007, only 16.9 percent of low-income adults said that they had
not received needed care in the past 12 months because of cost,
compared with 27.3 percent in fall 2006.
The third phase of
this project will begin in late 2008 and will examine the early impact
of the individual mandate, as well as new coverage programs and
insurance-purchasing mechanisms created by the law.
ROI Purchasing Institute.
The Center for Health Care Strategies (CHCS) developed a
return-on-investment (ROI) forecasting calculator to assist Medicaid
stakeholders interested in identifying interventions that have
potential to improve quality, and at the same time, reduce costs. With
support from the Fund and the Robert Wood Johnson Foundation, CHCS
worked with eight states to test the value of the tool, improve its
functionality, and incorporate its use into the planning and analysis
of proposed initiatives to improve care for Medicaid beneficiaries. The
ROI calculator is publicly available on the CHCS website.
States in Action. 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. Informed by an expert Editorial Advisory Board, this
bimonthly newsletter reaches an audience of more than 11,000 state
policymakers, administrators, researchers, and others who are working
on ways to stretch health care dollars to meet the needs of residents.
another partnership with the Robert Wood Johnson Foundation, the Fund
is supporting CHCS to conduct a technical assistance project helping
three communities design and implement large-scale, evidence-based
quality improvement initiatives that target high-cost, high-risk
patients and would be applicable to commercially insured populations.
The results will aid policymakers in developing reforms that align
financial incentives with high-quality care across multiple
The first State Scorecard, published by the
Commonwealth Fund Commission on a High Performance Health System in
June 2007, found wide variety across states and room for improvement
even among top-performing states. In a follow-up effort, Joel C.
Cantor, Sc.D., director of the Center for State Health Policy at
Rutgers University, is gathering data on a comprehensive set of health
system indicators to produce a second State Scorecard, patterned after
the National Scorecards published by the Commonwealth Fund Commission
on a High Performance Health System in September 2006 and July 2008.
With Fund support, AcademyHealth is using a Fund grant to lead the State Quality Improvement Institute,
an intensive effort to help states develop and implement concrete
action plans to improve performance across targeted quality indicators.
based on the findings from the first State Scorecard. Nine states are
participating in the first round.
In a complementary initiative,
a Fund grant to the National Academy for State Health Policy supports
efforts to understand critical factors in the success of interagency
state partnerships to improve quality. With the help of an advisory
committee, best practices and lessons learned will be shared among the
The National Academy of State Health Policy is also
collaborating with the Brookings Institution's Engelberg Center for
Health Care Reform on a Fund-supported State Public Employee Health
Plan Forum to enhance state-to-state information exchange about the
expanded role that public employee health plans could play in
improvement efforts. The forum includes Web conferences on topics such
as aligning incentives for quality with insurers and providers,
engaging consumers in improving health care quality, and examining
models of purchaser collaboration.
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. The Medicaid teams will take part in two intensive
training sessions and receive follow-up assistance.
To apply for a grant from the Child Development and Preventive Care Program, visit the Applicant and Grantee Resources page.