What’s Next? One State’s Thoughtful Look Toward the Future of Health Reform

Fans of the nineties television drama “The West Wing” might remember President Bartlett (Martin Sheen) often uttering the phrase, “What’s next?” to his staff, an indication that he was ready to move on to a new topic or activity. Simultaneously implementing national health reform and advancing their own health initiatives, states are immersed in efforts to transform their health care systems, so, like this fictional president, must constantly be asking “what’s next?”

Recently, Oregon officials asked themselves what’s next for health care transformation efforts in the state, and they chose six key health policy issues to address: 1) payment reform strategies, 2) integrated care organizations, 3) the post-2014 uninsured, 4) evidence of cost savings from reforms, 5) primary care medical homes, and 6) disparities. The state turned to NASHP’s State Health Access Program (SHAP) for resources on these topics, and SHAP staff delivered.

Highlights from SHAP’s research include:

Payment Reform Strategies

• In 2009, Maryland launched an initiative that links payments to hospital performance.
• Minnesota’s 2008 Health Reform Law called for the establishment of a statewide system of quality-based incentive payments for providers serving patients enrolled in the state employee health plan or in state public insurance programs.

Integrated Care Organizations

• Colorado has established an Accountable Care Collaborative (ACC) designed to transform the health care delivery system to a regional, outcomes-focused, client/family-centered, coordinated system of care for Medicaid clients.
• The Health Care Delivery Systems Demonstration (HCDS) in Minnesota creates a structure for provider organizations to contract with the Department of Health Services under a payment model that holds organizations accountable for the total cost of care and quality of services provided.
• North Carolina has established community care networks in which primary care, safety-net, and specialty providers were grouped with local health departments, departments of social services, and hospitals to serve public- coverage beneficiaries.
• Vermont has embarked on several distinct initiatives to improve the health care delivery system; among these are a patient-centered medical home initiative, and an accountable care organization (ACO) pilot.

The Post-2014 Uninsured

• Illinois’ All Kids program, launched in 2006, pools Medicaid, CHIP, and state funds to provide comprehensive insurance to all children residing in the state regardless of immigration status, income, or health status.
• Iowa has developed a plan to reimburse Federally Qualified Health Centers at a modified reimbursement rate to provide limited benefits to uninsured childless adults.
• The Health Safety Net in Massachusetts provides residents who cannot afford or are ineligible for health insurance, including undocumented individuals, medically necessary services at community health centers and hospitals.

Evidence of Cost Savings

• Data from a 2011 study of community health workers in New Mexico provided evidence of lowered costs for emergency department usage, inpatient care, and prescriptions.
• Oklahoma implemented a Medicaid-wide patient-centered medical home program that hasdemonstrated a decline of $29 per patient per year in per capita member costs under Medicaid from 2008 to 2010.
• Vermont has gathered evidence of lower or, in some cases slowed growth of, per member per month costs for patients participating in its Blueprint for Health pilots.

Finally, relating to state progress in the implementation of medical home and patient-centered care initiatives, NASHP has compiled a wealth of resources available through its Medical Home Map. Additionally, in 2011, NASHP wrote a series of reports for the Agency for Healthcare Research and Quality (AHRQ) assessing state experiences with measuring and addressing health disparities.
Like Oregon and the states featured in this compilation, other states are setting their own priorities for future health reform goals and activities. Post a comment below to tell us about what’s happening in your state.