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State Partnerships to Improve Quality: Models and Practices from Leading States Issue Brief
/in Policy Reports /by NASHP StaffThe National Academy for State Health Policy identified ten leading state quality improvement partnerships – interrelated broad-based partnerships, mostly with public and private sector representation, which have long-term, statewide, systemic quality improvement strategic intent, and transparent agendas. This State Health Policy Briefing summarizes results of NASHP’s full report examining these partnerships in Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington. The key factors, policies, and practices that influence the quality improvement partnerships in these 10 states offer insights for achieving systemic improvement in health care quality and performance. The full report is also available.
| QI Models and Practices | 136.6 KB |
State Partnerships to Improve Quality: Models and Practices from Leading States Report
/in Policy Reports /by NASHP StaffThis NASHP-led, Commonwealth Fund-supported report highlights ten leading state quality improvement partnerships, broad-based, public-private partnerships that strive for long-term, statewide, and systemic quality improvement. This report describes the state partnerships’ origins, internal processes, accomplishments, and lessons learned, as well as their five strategies for achieving quality improvement. The factors and policies that influence the 10 featured state partnerships offer key insights for achieving systemic improvement in health care quality and performance. The report features state partnerships in Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington.
| Quality Improvement Partnerships | 440.3 KB |
Massachusetts
/in Policy Massachusetts /by NASHP StaffORIGIN AND MISSION
The Massachusetts Health Care Quality and Cost Council is mandated under Massachusetts General Law Chapter 6A and was established by Chapter 58 of the Acts of 2006. The council’s mission is to develop and coordinate the implementation of health care quality improvement goals that are intended to both lower or contain the growth in health care costs and improve the quality of care, including reductions in racial and ethnic health disparities. The council’s vision is that by June 30, 2012, Massachusetts will consistently rank in national measures as the state achieving the highest levels of performance in care that is safe, effective, patient-centered, timely, efficient, equitable, integrated, and affordable.
The council is mandated:
• To establish statewide goals for improving health care quality, containing health care costs, and reducing racial and ethnic disparities in health care;
• To demonstrate progress toward achieving those goals; and
• To disseminate, through a consumer-friendly website and other media, comparative health care cost, quality, and related information for consumers, health care providers, health plans, employers, policy makers, and the general public.
The council is within, but not subject to control of, the Massachusetts Executive Office of Health and Human Services. It reports annually to the legislature on its progress in achieving the goals of improving quality and containing or reducing health care costs, and promulgates additional rules and regulations to promote its quality improvement and cost containment goals.
GOVERNANCE
The council is made up of 16 members that include a diverse group of individuals with a broad array of expertise in the public and private sectors. Subcommittees currently include Chronic Care, Communications and Transparency, Cost Containment, Governance, Patient Safety, and End of Life. The council receives input and advice from a 30-member advisory committee that includes representation from consumers, business, labor, health care providers, and health plans. Through its membership, outreach, and subcommittees, it interfaces across health care in the state. The council’s budget was reduced from $1.8 million to $1.1 million in 2009 as a result of state budget cuts.
ACTIVITIES AND ACCOMPLISHMENTS
The council is mobilizing stakeholders to address priority areas and is highly inclusive in all considerations. The council anchors its work in measurement, specifically reporting from the Commonwealth of Massachusetts, the Commonwealth Fund State Scorecard, Dartmouth Atlas, RAND, National Quality Forum, and other validated work. Specific accomplishments to date include:
• Release of its first annual report in April 2008, which identifies specific strategies designed to improve health care quality while containing costs;
• Establishment of an all-payer claims database via regulations in 2007 and 2008 (see 129 CMR 2.00: Uniform Reporting System for Health Care Claims Data Sets and 129 CMR 3:00: Disclosure of Health Care Claims Data);
• Launch of a consumer website (MyHealthCareOptions) based on extensive market research. Site includes hospital-level cost (for 20 inpatient and 20 outpatient procedures) and quality information built on an agreed upon set of principles for the selection of measures;
• Public reporting of serious reportable events by hospital; and
• Early selection as a state to participate in a four-year, multi-state initiative funded by the Commonwealth Fund and led by the Institute for Healthcare Improvement to reduce avoidable hospitalizations across the state.
NEXT STEPS
The council is working to:
• Develop a roadmap (by September 2009) to achieve cost containment goals that health care will increase only by inflation rates by July 1, 2012 and that Massachusetts will rank first on The Commonwealth Fund Commission on a High Performance Health System Scorecard;
• Drive the institution of specific activities, including a statewide campaign by spring of 2009 to improve care at the end of life so that it is respectful of patients’ wishes and includes effective resource utilization;
• Expand its focus on patient safety to non-hospital environments;
• Publicly report hospital-wide mortality (by January 2010);
• Update and expand the public reporting of quality and cost information; and
• Build consumer understanding of the quality and cost website and how to use it.
Financing State Coverage Expansions: Can New Medicaid Flexibility Help?
/in Policy Reports /by NASHPAs states like Massachusetts, Vermont, and Maine continue to implement their health reforms, other states are also considering ambitious coverage expansions. Financing is a key concern. In the past, states interested in drawing down federal Medicaid funds to expand coverage had two primary mechanisms available to them: filing a state plan amendment using available optional eligibility categories and income disregards, or applying for a Section 1115 waiver. Under the first approach, states are required to provide all the Medicaid mandatory benefits, and to cover all people who meet the eligibility standards, with full federal financial participation guaranteed. The waiver approach gives states flexibility in areas like benefit design and eligibility, but limits the amount of federal financial participation because of budget neutrality requirements.
Under the Deficit Reduction Act of 2005 (DRA), a new approach is available that gives states some of the flexibility of the §1115 waiver, but without a cap on federal financial participation. Although at first glance the DRA did not appear to be a vehicle for expanding coverage, a closer read reveals that the DRA’s language actually allows states to use their new flexibility with benefits design, coupled with income disregards in existing categories, to expand coverage. This new flexibility, combined with long-standing Medicaid authority to expand eligibility by disregarding income, allows states to file state plan amendments in order to expand coverage to higher income populations in plans that look more like commercial insurance and charge limited premiums. Since the DRA became law, the Centers for Medicare and Medicaid Services (CMS) has urged states to make these types of changes through state plan amendments using new DRA authority rather than through §1115 waivers.
This State Health Policy Briefing provides a roadmap of options made possible with new authority in the DRA that may make it easier for states to finance coverage expansions with federal matching funds. It describes:
• the key language in the DRA,
• the long-standing authority to expand eligibility to certain Medicaid eligibility groups through income disregards,
• the new benefits and cost-sharing flexibility provided in the DRA, and
• how this authority might support state coverage expansions.
| shpbriefing_financingexpansions.pdf | 360 KB |
Care Coordination for People with Chronic Conditions
/in Policy Reports Chronic and Complex Populations /by NASHPThis paper explores the components of care coordination and a sample of state initiatives that bridge the health and supportive systems.
| care_coordination.pdf | 341.3 KB |
Massachusetts
/in Policy Massachusetts /by NASHP StaffThe Massachusetts Department of Public Health administers a mandatory reporting system for the reporting of incidents that seriously affect the health and safety of patients in hospitals.
Note: Massachusetts administers two mandatory reporting systems. This toolbox features the system administered by the Massachusetts Department of Public Health. The alerts and advisories, however, are issued by the system administered by the Board of Registration in Medicine’s Patient Care Assessment Program.
Emerging Practices and Policy in Medicaid Managed Care for People with HIV/AIDS: Case Studies of Six Programs
/in Policy Reports Chronic and Complex Populations /by NASHPAs treatment strategies for HIV/AIDS undergo rapid change, states struggle with the dual challenges of providing quality health care and containing costs. By June 1996, in an effort to meet those challenges, 35 states (including the District of Columbia) reported enrolling at least some people living with HIV/AIDS (PLWHIV) in their risk-based Medicaid managed care programs.
The six Medicaid managed care programs studied for this report – Massachusettes, New Jersey, Tennessee, Texas, San Francisco (California) and Orange County (California) — cope with overseeing changes in HIV/AIDS treatment in different ways. These programs treat PLWHIV the same as other populations in certian areas, including: marketing/enrollment, consumer involvement, and capitated benefits.
| 1998.Aug_.emerging.practices.policy.medicaid.managed.care_.hiv_.aids_.case_.studies.pdf | 3.9 MB |
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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. 
