Shaping High Performance Health Systems: Innovative State Policies and Practices

1. Shaping High Performance Health Systems: Innovative State Policies and Practices Catherine A. Hess Senior Program Director National Academy for State Health Policy

2. Non-profit, non-partisan organization dedicated to helping states achieve excellence in health policy and practice.   • Conduct policy analysis and research, interactive forums and assistance driven by and for state policymakers/administrators in executive and legislative branches. • Annual conference Oct. 15-17, Pittsburgh • Offices in Portland, ME & Washington, DC NASHP@June 2006

3. State Health Policies Aimed at Promoting Excellent Systems (SHAPES): Project Overview • Funded by the Commonwealth Fund to complement work of Commission on a High Performance Health System • Goals to focus attention on & further promote state policies and practices shaping high performance health systems • One year funding for initial study/report NASHP@June 2006

4. Commonwealth Fund’s Commission on a High Performance Health System • Defining characteristics of a high-performance health system. • Identifying policies needed to achieve such a system, and setting realistic targets. • Recommending concrete steps to achieve five-, 10-, and 15-year goals. • Issuing an annual 'scorecard' documenting progress. • Issuing an annual report outlining key related policy issues. NASHP@June 2006

5. How To Study States’ Inputs to and Impacts on Health System Performance? NASHP@June 2006

6. State Health Policies Aimed at Promoting Excellent Systems (SHAPES):Research Objectives • Identify state policies/practices contributing to high performing health systems, consistent with the Commonwealth Fund Commission. • Assess extent to which states have adopted important policies and practices contributing to high performance systems. • Describe innovative state policies and practices contributing to high performance health systems. NASHP@June 2006

7. Background Review of State Policy Assessments • Map and Track: State Initiatives for Young Children and Families (2000), National Center for Children in Poverty • State Profiles 2003: Reforming the Health Care System, AARP Public Policy Institute • Making the Grade on Women’s Health: A National and State by State Report Card (2004), National Women’s Law Center/Oregon Health and Science University • Ready or Not? Protecting the Public’s Health in the Age of Bioterrorism (2004), Trust for America’s Health • Grading the States 2005, Government Performance Project • 2005 Assets and Opportunity Scorecard, Corporation for Enterprise Development • Policy Matters:Twenty State Policies to Enhance States’ Prosperity andCreate Bright Futures for America’s Children, Families and Communities (2005), Center for the Study of Social Policy NASHP@June 2006

8. SHAPES Methodology-Overview • Study/report on a limited set of selected state policies and practices that are: • of relatively well established importance or • innovative and appear promising in contributing to a high performance health system. • Study/ report on state policies and practices in three major domains consistent with Commission core values: • coverage • quality, efficiency and value • infrastructure Acknowledge and reflect that the nature and amount of state action varies by domain. NASHP@June 2006

9. SHAPES Methodology-Framework Domains A. Coverage of Essential Benefits -goal that all people have equitable and affordable coverage of essential health care services (Commission Values) • Eligibility for and affordability of coverage (e.g. public coverage beyond federal minimums; private market regulation; major coverage expansions) • Enrollment and retention • Benefits NASHP@June 2006

10. SHAPES Methodology-Framework Domains B. Quality, Efficiency and Value, goal thatallpeople get the right care at reasonable cost, and get equitable care that is, safe, patient-centered, and coordinated (Commission Values) • Value purchasing, including performance incentives and disincentives (via MA, SCHIP, state only, and state employee health plans) • Public reporting of quality indicators • Quality collaboratives/forums NASHP@June 2006

11. SHAPES Methodology-Framework Domains C. Health Systems Infrastructure, with all people having access to systems of personal health care and population-based public health services that promote long and healthy lives and that have capacity to improve(Commission Values) • Population based prevention and promotion policies and practices • Information systems and technology • Provider availability and access (including safety net) NASHP@June 2006

12. SHAPES Methodology-Definition of State Policy and Practice • Lead or substantial collaborative role of state government in actions that include: • legislating • regulating • requiring via contract • financing • purchasing • encouraging or discouraging via financial and non-financial rewards or penalties • providing guidance • providing technical assistance • publicly reporting • convening NASHP@June 2006

13. SHAPES Methodology-Criteria for Selecting State Policies and Practices for Study • Reflect state governmental action. • Collectively address attributes of HPHS. • Seen as important by stakeholders. • Consistent with evidence, expert consensus or preponderance of expert opinion; best and promising practices. • Actionable; states can adopt or change. NASHP@June 2006

14. SHAPES Methodology-Criteria for Selecting State Policies and Practices for Study • Range in diffusion, from large number of states to smaller number of trendsetters. • Range in scope, from discrete elements in one domain, to broader/more systemic. • Limited in number, although may include “roll-up” of more discrete elements. • Information collected (or could be) for all states/DC, preferably over time. NASHP@June 2006

15. SHAPES Methodology-Information Collection and Analysis • Report on important state policies or practices for all 51 jurisdictions, drawing on existing data sources whenever possible or collecting information via (51) state surveys. • Identify innovative, trendsetting state policies and practices via the same methods, with follow-up to provide additional detail. • Group state performance in broad categories, as determined with the Advisory Group • Likely to be deferred NASHP@June 2006

16. SHAPES- State Agency Surveys • Medicaid • SCHIP • State Employee Health Plans • State Insurance Agencies • State Public Health Agencies • Governor’s Health Policy Advisors NASHP@June 2006

17. SHAPES Research Plan/Timetable • Background Research, Framework and Criteria, Advisory Group Review and Input- Sept. ’05-Dec.’05 • Selection of Policy Elements for Study, Targeted Research to Identify Existing Information Sources, Information Collection Plan- Jan.-Apr.’06 • Drafting Survey Questions -May-June ’06 • Fielding Surveys- July ’06 • Analysis and Follow-up for Additional Information- Aug.-Sept. ’06 • Report writing-Sep.-0ct. ‘06 NASHP@June 2006

18. Examples of State Contributions to a High Performance Health System • Coverage • Covering childless adults • Covering all children and youth • Public-private coverage strategies • Administrative (“passive”) renewals • Monitoring trends and taking action to assure adequate benefit packages NASHP@June 2006

19. Examples of State Contributions to a High Performance Health System • Quality, Efficiency, Value • Cross agency purchasing leverage- eg well child services, cultural competency • Multi-agency/multi-state purchasing and/or research for quality/efficiency • Performance incentives/disincentives • Disease/Care management NASHP@June 2006

20. Examples of State Contributions to a High Performance Health Systems • Infrastructure • Integrated health information systems • Facilitating HIE/HIT (convening, investing in demonstrations, reviewing and changing policy barriers) • Monitoring the status of the safety net • Reimbursing for telemedicine NASHP@June 2006

21. SHAPES/NASHP CONTACTS/RESOURCES • Catherine Hess Senior Program Director Chess@nashp.org • Alan Weil Executive Director (and Commission member) Aweil@nashp.org • National Academy for State Health Policy www.nashp.org • Commonwealth Fund Commission on a High Performance Health System http://www.cmwf.org/topics (Health System Performance) NASHP@June 2006