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IN THE STATES: Yearly Check-up for State Reform Efforts
It's been a tough year but many states have shown determination to make progress on health reform, even amid their economic challenges. State Coverage Initiatives, created by a partnership between the Robert Wood Johnson Foundation and AcademyHealth, recently released its "State of the States" 2009 report. Here's a brief overview of the findings:
Coverage Initiatives. Massachusetts is easily the most well-known. The only State to have implemented an individual mandate, it now reports that 97.4 percent of its residents are insured. Vermont has also made significant progress. Between 2005 and 2008, Vermont's uninsured rate dropped from 9.8 to 7.6 percent, and the goal is near-universal coverage by 2010. Even before yesterday's reauthorization and expansion of SCHIP, 10 States, particularly Iowa and New Jersey, were able to push forward on expanding children's enrollment in health care programs in 2008.
Cost Control. Rising unemployment and increasing Medicaid enrollment are big issues for States, as they add to the strain on their already overburdened budgets. States, such as Pennsylvania, Ohio, West Virginia, Maryland, and North Carolina, have taken steps toward aiding small businesses who are struggling to afford health care coverage to their employees, through subsidies, reinsurance programs, benefit plans, and tax cuts or credits. Minnesota enacted broad legislation that emphasized payment reform, price and quality transparency, chronic care management, administrative efficiency, and public health.
Quality Improvement. The report found that States are increasingly likely to consider both cost and quality along with access in their health reform initiatives. Many States, most notably Vermont and Massachusetts, have included quality as a significant part of their agenda in health care reform, believing that a focus on quality of care will also lead to efficiency and cost reduction. Iowa established the Iowa Electronic Health Information Commission to develop a statewide plan to expand the use of electronic health records, which can help control costs and enhance quality. The trend toward linking cost, coverage and quality is particularly heartening to us at New America's health policy program as it's a big theme of our work.
Arkansas, Connecticut, Ohio, Oregon, and Utah were among the States that worked during 2008 to build consensus for future action. State governments, however, are limited in the tools they have to address the many complexities and challenges of health care reform. But innovations at the State level should inspire leadership on a national level.
Don't forget PA!
Pennsylvania has been working on cost and quality with it's Chronic Care Commission and pilot programs:
http://www.timesleader.com/opinion/commentary/Chronic_care_focus_will_re...
"The commission is largely based on the chronic care model developed by Dr. Edward Wagner of the MacColl Institute for Healthcare Innovation in Seattle. A core belief is that when a group of physicians, specialists, case managers and health educators work together in getting to understand, educate and treat patients, health outcomes improve dramatically.
"This is important because chronic disease, while often avoidable, is the leading cause of death and disability in Pennsylvania, and about half of our residents suffer from at least one. Many of these individuals have not been educated about how to manage their chronic diseases, which often results in emergency room visits that could have been avoided."
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