States' Role in Systems Improvement
In order for states to address health reform they have to look more broadly than just solving the problem of the uninsured. Over the past few years, state reform efforts reflect a greater understanding among policymakers that the issues facing the states cannot be remedied by focusing just on coverage and access issues. Yet, there is also increasing recognition that coverage expansions are still necessary to have an effective and efficient health care system. Consequently, more than ever, states are aiming to improve health care from a systemic perspective - tackling the challenges of cost, quality, and access in tandem to improve the value in the health care system.
There is a large body of evidence showing that the American health care system does not consistently deliver high quality care. Care is often poorly coordinated[1]and fails to consistently meet best practice standards.[2] While the national data are compelling, states recognize that ‘all health care is local’ and consequently, they are trying to encourage and insist on systems improvements within their own borders. In their quest for a more effective and efficient health care system, many states are leading the way with pilot projects and innovative programs that will inform future federal and state reforms.
States are exploring various strategies to tackle systems improvement, including: prevention and wellness programs; improved care coordination for chronic conditions; public health initiatives that target specific diseases and conditions such as obesity, tobacco use, diabetes, and asthma; value-based purchasing and other payment reforms; medical error reduction; health-care acquired infection reduction and other patient safety initiatives; data collection and reporting of price and quality information; and administrative and regulatory efficiencies. Many states are also speeding the adoption of electronic systems and other health information technologies to improve the efficiency, effectiveness, and coordination of medical care.
[1]The Commonwealth Fund Commission on a High Performance Health System, Framework for a High Performance Health System for the United States,” (New York, NY. The Commonwealth Fund, August 2006).
[2]E.A. McGlynn et. Al. The Quality of Health Care Delivered to Adults in the United States, New England Journal of Medicine 348, 26 (June 2003): 2635-2645.
[2]E.A. McGlynn et. Al. The Quality of Health Care Delivered to Adults in the United States, New England Journal of Medicine 348, 26 (June 2003): 2635-2645.
