Keeping All The Plates Spinning: Coordinating Implementation

Given the large scope of state responsibilities in the ACA, coordination of efforts among executive branch agencies and the legislature is essential to successful implementation. With 29 new governors after the mid-term elections, coordinating bodies have also provided continuity in an environment of changing state leadership.  States have established health reform coordinating bodies to identify issues, make policy recommendations, and provide guidance on key decisions. For states that are still in the early phases of health reform planning efforts, establishing a coordinating body can be a good way to assess the current environment and develop an implementation approach. At State Refor(u)m, we have information about coordinating bodies in thirteen states, and we encourage other states to review them as they think about establishing their own.

Some states have established coordination bodies through executive orders issued by the Governor or through legislation, while other states have established informal coordinating bodies. Establishing documents give states the opportunity to lay out the body’s composition and mission. Some coordinating bodies include a cross-section of state leadership, encompassing the Governor’s office, legislature, department of health, insurance department, and other agencies. States have also recognized the value of bringing in outside stakeholders to provide perspective on implementation issues.

• Illinois established a Health Reform Implementation Council to make recommendations to assist the state in planning and implementation efforts. The Council held public meetings to inform the public of the state’s activities and to solicit public comments on implementation issues, like exchanges.
• Although Nevada did not use an executive order or pass legislation, the Nevada  Department of Health and Human Services has informally established health reform working groups and a policy planning group comprised of various state agencies involved with implementation.

Given the number of tasks and issues and short timeline for reaching 2014, many states have also established workgroups within their coordinating bodies to focus on specific implementation issues.

• North Carolina has established eight workgroups to examine a variety of implementation issues including workforce, Medicaid, prevention, and the Exchange. These workgroups are composed of representatives from state government, insurers, academia, provider groups, and consumer advocates. They meet monthly and are coordinated by the larger health reformadvisory group in the state.
• Virginia’s Reform Initiative Advisory Council formed six subgroups that focus on Medicaid, insurance reform, service delivery and payment reform, capacity, technology, and purchasers. The task force released a report in December, which provides a background on the state’s health care system and highlights the issues that each subgroup has addressed since being established.

The just released State of the States 2011 from State Coverage Initiatives also highlights the efforts of several state health reform coordinating bodies.

Is your state’s health reform coordinating body producing materials that would be helpful to share with other states? Please send them to us at State Refor(u)m.