State and Regional Reform Efforts

Today, virtually every state is considering or actively developing new policy approaches that can help lower costs, improve quality, and improve the value of health care. Despite growing consensus about the need for delivery system reforms, fundamental questions remain about how to close the big gaps in quality, efficiency, and overall value of our health care system. On the one hand, the evidence of gaps is clear, while on the other hand, the evidence on how health care policy reforms can address these gaps in a feasible and sustainable manner is not. Yet against the backdrop of major gaps in quality and efficiency, rising spending on Medicaid and other public programs and the potential worsening of the economic recession, states are seeking promising solutions that can help achieve improvements in the overall performance of the health system.

Supporting State Efforts to Improve Health Care Delivery
The Engelberg Center’s state reform project is working to inform the health care reform process at the state level, with an emphasis on the need for improvements in efficiency and quality. Center activities are supporting the efforts of states in developing and refining actions to reform provider reimbursement, improve care coordination, and manage disease more effectively, and by generating or synthesizing evidence on the potential impacts of different policy options. The project has several specific goals:

• Identify and analyze a range of health reform efforts at the state or regional level that seek to improve overall health system performance, particularly efforts involving multiple stakeholders working together to improve the delivery of care
• Provide analytical and other assistance to support these efforts
• Disseminate findings to key stakeholders, including other states and national policy leaders

The project is comprised of three categories of activities. First, the Engelberg Center is working with states to influence the reform debate around the need to improve the delivery of care by convening policy conferences at the state level, and providing technical assistance to states or groups of states that are implementing or developing similar reforms. Also, the Center is building or supporting evidence that can inform key policy, technical, and organizational lessons from multi-payer, value-based purchasing initiatives. Finally, the Center seeks to mobilize leadership at the state and federal levels based on key results and best practices. Forums with policy makers in Washington and in the states communicate challenges and specific opportunities for delivery system reform, including the role of the federal government in supporting state-level reforms

The intended outcomes of this project include encouraging and equipping state policy leaders to take action on ways to improve quality and value as part of their broader health reform strategies. We also seek to develop better evidence on specific types of reforms for which there is now a great deal of interest but for which the evidence base is limited or mixed. In turn, better evidence can help support greater action by state and federal policy leaders. Thus, we also seek to inform state and national policy based on the results achieved and best practices identified through this project.

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