Determining the Impact of State Demonstrations: Considerations for State and Federal Policymakers
States and the federal government are investing heavily in state demonstrations to reform the health care delivery system, and policymakers need data to assess the demonstrations’ effectiveness and justify these investments to state legislators, Congress, and other stakeholders. Gauging the impact of state demonstrations through monitoring and evaluation requires time and effort from both state and federal officials. Greater alignment between state and federal evaluation and monitoring activities and across programs could streamline reporting requirements, ease administrative burden, and improve the effectiveness and efficiency of monitoring and evaluation.
This brief reflects on a discussion of state demonstrations held at a meeting of state and federal leaders convened by the National Academy for State Health Policy with the support of The Commonwealth Fund. Included in the brief are highlights of Vermont’s efforts to streamline data reporting, a short case study of Texas and its multiple demonstrations, and actionable steps toward a shared federal-state agenda on improving the monitoring and evaluation of state demonstrations.

For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 























































































































































