Shaping High Performance
Health Systems: Innovative
State Policies and Practices
Catherine A. Hess
Senior Program Director
National Academy for State Health Policy
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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
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State Health Policies Aimed at Promoting
Excellent Systems (SHAPES):
Project Overview
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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
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Commonwealth Fund’s Commission on
a High Performance Health System
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Defining characteristics of a highperformance health system.
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Identifying policies needed to achieve such
a system, and setting realistic targets.
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Recommending concrete steps to achieve
five-, 10-, and 15-year goals.
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Issuing an annual 'scorecard' documenting
progress.
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Issuing an annual report outlining key
related policy issues.
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How To Study States’ Inputs to and Impacts
on Health System Performance?
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State Health Policies Aimed at Promoting
Excellent Systems (SHAPES):
Research Objectives
1.
Identify state policies/practices
contributing to high performing health
systems, consistent with the
Commonwealth Fund Commission.
2.
Assess extent to which states have
adopted important policies and practices
contributing to high performance systems.
3.
Describe innovative state policies and
practices contributing to high performance
health systems.
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Background Review of
State Policy Assessments
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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
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SHAPES Methodology-Overview
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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:
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coverage
quality, efficiency and value
infrastructure
Acknowledge and reflect that the nature and
amount of state action varies by domain.
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SHAPES MethodologyFramework Domains
A.
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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)
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Enrollment and retention
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Benefits
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SHAPES MethodologyFramework Domains
B. Quality, Efficiency and Value, goal that all people
get the right care at reasonable cost, and get
equitable care that is, safe, patient-centered, and
coordinated (Commission Values)
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Value purchasing, including performance
incentives and disincentives (via MA, SCHIP,
state only, and state employee health plans)
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Public reporting of quality indicators
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Quality collaboratives/forums
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SHAPES MethodologyFramework 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)
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Population based prevention and
promotion policies and practices
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Information systems and technology
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Provider availability and access (including
safety net)
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SHAPES Methodology-Definition of
State Policy and Practice
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Lead or substantial collaborative role of
state government in actions that include:
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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
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SHAPES MethodologyCriteria for Selecting State Policies and
Practices for Study
1.
Reflect state governmental action.
2.
Collectively address attributes of HPHS.
3.
Seen as important by stakeholders.
4.
Consistent with evidence, expert
consensus or preponderance of expert
opinion; best and promising practices.
5.
Actionable; states can adopt or change.
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SHAPES MethodologyCriteria for Selecting State Policies and
Practices for Study
6.
Range in diffusion, from large number of
states to smaller number of trendsetters.
7.
Range in scope, from discrete elements in
one domain, to broader/more systemic.
8.
Limited in number, although may include
“roll-up” of more discrete elements.
9.
Information collected (or could be) for all
states/DC, preferably over time.
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SHAPES Methodology-Information
Collection and Analysis
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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
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SHAPES- State Agency Surveys
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Medicaid
SCHIP
State Employee Health Plans
State Insurance Agencies
State Public Health Agencies
Governor’s Health Policy Advisors
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SHAPES Research Plan/Timetable
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Background Research, Framework and Criteria,
Advisory Group Review and Input- Sept. ’05Dec.’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 InformationAug.-Sept. ’06
Report writing-Sep.-0ct. ‘06
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Examples of State Contributions to a
High Performance Health System
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Coverage
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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
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Examples of State Contributions to a
High Performance Health System
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Quality, Efficiency, Value
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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
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Examples of State Contributions to a
High Performance Health Systems
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Infrastructure
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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
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SHAPES/NASHP
CONTACTS/RESOURCES
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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)
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