Why Not the Best? A High Performance
Health System in Hawaii
Hawaii Uninsured Project Fall Forum
October 23, 2006
Anne Gauthier
Senior Policy Director
The Commonwealth Fund
www.cmwf.org
Presentation Overview
• The Commission on a High
Performance Health System
• The National Landscape: How are
States Performing Compared to
Achievable Benchmarks
• State Efforts to Improve
Performance
• Legislative Proposals
• Moving Forward
The Commonwealth Fund
Commission on a High Performance Health
System
Objective:
• Move the U.S. toward a higherperforming health care system
that achieves better access,
improved quality, and greater
efficiency, with particular focus
on the most vulnerable due to
income, gaps in insurance
coverage, race/ethnicity, health,
or age
The Commission is made up of 19 Commission members who come with
divers practical and policy expertise in health care delivery, financing,
and access and quality improvement.
Major Commission Products
• Framework Statement (August 2006)
–
–
–
–
Provides sense of urgency to transform U.S. health care
Defines “systemness” and stresses need to achieve it
Depicts major sources of current system failures
Delineates roles for public and private sectors
• Scorecard Report (September 2006)
– Compares U.S. national average with the best achieved
benchmarks across arenas of quality, access, efficiency,
and equity
– Provides a mechanism for monitoring change over time
– Provides a yardstick against which to assess the effects of
existing or proposed policies to improve performance
• The framework and scorecard reports are aligned in
using the same dimensions of high performance
Commission Conception of High
Performing Health System
ACCESS
QUALITY
•
Getting the right care
•
Coordinated care
•
Safe care
•
Patient-centered care
•
Universal participation
•
Affordable
•
Equitable
LONG,
HEALTHY, AND
PRODUCTIVE
LIVES
EFFICIENCY
SYSTEM CAPACITY TO
IMPROVE
Achieving a High Performance Health System
Requires:
• Committing to a clear national strategy and
establishing a process to implement and
refine that strategy
• Delivering care through models that
emphasize coordination and integration
• Establishing and tracking metrics for health
outcomes, quality of care, access,
disparities, and efficiency
The National Landscape:
How are States Performing
Compared to Achievable
Benchmarks?
C
F
A
D
Scorecard on US Health System
• The U.S. falls far short on each of the core goals for health system
performance relative to benchmarks
– The US average ratio score is 66 across health outcomes, quality,
access, equity, and efficiency
– There are wide gaps across key indicators on benchmarks largely
drawn from achieved rates
• The consequence is needlessly lost lives, wasted health care
expenditures, and lower economic productivity
– $50 to $100 Billion annual savings and 100,000 to 150,000 lives
– $130 billion in potential productivity gains from insuring the
uninsured (IOM estimate)
• Given that the US spends more than any other country, we should
expect to lead on access, quality and efficiency
– Benchmarks provide targets for improvement
• With cost and coverage vital signs moving in the wrong direction,
moving to a high performance system is of great urgency to secure a
healthy nation
LONG, HEALTHY & PRODUCTIVE LIVES
Mortality Amenable to Health Care
Mortality from causes considered amenable to health care is deaths before age 75 that
are potentially preventable with timely and appropriate medical care.
Deaths per 100,000 population*
International Variation, 1998
State Variation, 2002
134
150
129 130 132
106 107 109 109
119
110
115 115
103
93
97 97 99
100
75
81 84
90
84
92
88 88 88
50
Fr
an
ce
Ja
pa
n
Sp
a
Sw in
ed
en
I
Au taly
st
ra
Ca lia
na
d
No a
Ne
r
th w a
er y
la
nd
s
G
re
G e ce
er
m
an
Ne Au y
s
w
Ze tria
al
a
De nd
Un n
ite ma
rk
d
St
at
es
Fi
nl
an
Un
ite Ire d
d
l
Ki and
ng
do
Po m
rtu
ga
l
0
U
.
.S
i
ge ai 0 th 5 th ia n 5 th 0 th
a
r
2 ed
7
9
aw 1
ve H
M
A
Percentiles
* Countries’ age-standardized death rates, ages 0–74; includes ischemic heart disease
DATA: International: WHO mortality database from Nolte and McKee 2003; U.S. 2002 state estimates: K. Hempstead,
Rutgers University using Nolte/ McKee methodology. Methods in technical appendix to Scorecard Chartpack.
SOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
LONG, HEALTHY & PRODUCTIVE LIVES
Infant Mortality Rate, 2002
Infant deaths per 1,000 live births
International variation
State variation
10
9.1
8.1
7.0
7.0
7.1
6.0
5.4 5.6
5.0 5.0 5.0 5.0 5.1 5.2
5
7.4
5.3
4.4 4.4 4.5 4.5
4.1 4.1 4.1 4.2 4.2
3.0 3.0
3.3 3.5
2.2
U.
S.
av
ge
ra
g
Ha e
10 wa
t h ii
25 %il
th e
%
M ile
e
75 dia
th n
90 %il
th e
%
ile
Ic
el
a
nd
Ja
pa
Fi n
nl
an
Sw d
ed
e
No n
rw
ay
Sp
ai
n
Fr
an
ce
Cz
ec Aus
h
t
Re ria
pu
b
Ge lic
rm
a
Be ny
lg
i
De um
nm
ar
k
Sw
Ita
ly
itz
Ne erla
nd
th
er
la
n
Au ds
st
ra
Po lia
rtu
ga
Ire l
la
nd
Un
ite Gre
ec
d
Ki
ng e
do
Ca m
Ne
na
w
Ze da
Un
a
ite land
d
St *
at
es
0
* 2001.
Data: International estimates—OECD Health Data 2005;
State estimates—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
States Vary In Quality of Care
2000–2001
WA
VT
MT
ND
WI
SD
NY
RI
PA
IA
OH
NE
IL
UT
CA
CO
MA
MI
WY
NV
ME
MN
OR
ID
NH
KS
MO
CT
NJ
DE
IN
MD
WV
VA
DC
KY
NC
TN
OK
AZ
NM
AR
SC
MS
TX
AL
GA
LA
FL
AK
Quartile Rank
First
Second
Third
Fourth
Note: State ranking based on 22 Medicare performance measures.
Source: S.F. Jencks, E.D. Huff, and T. Cuerdon, “Change in the Quality of Care Delivered to
Medicare Beneficiaries, 1998–1999 to 2000–2001,” Journal of the American Medical
Association 289, no. 3 (Jan. 15, 2003): 305–312.
QUALITY: THE RIGHT CARE
Preventive Care Visits for Children, by Top and Bottom States,
Race/Ethnicity, Family Income, and Insurance, 2003
Percent of children (ages <18) received BOTH a medical
and dental preventive care visit in past year
59
U.S. average
64
Hawaii
73
Top 10% states
48
Bottom 10% states
62
White
58
Black
49
Hispanic
70
400%+ of poverty
48
<100% of poverty
63
Private insurance
Uninsured
35
0
50
Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource
Center for Child and Adolescent Health database at http://www.nschdata.org).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
100
QUALITY: COORDINATED CARE
Nursing Homes: Hospital Admission and Readmission Rates
Among Nursing Home Residents, by State, 2000
Hospitalization
rates
Percent
Re-hospitalization rate
(within 3 months of
nursing home admission)
Percent
30
30
21
19
20
20
16
16
13
12
10
8
12
9
10
8
10
7
0
0
Median
Best
state
10th
%ile
25th
%ile
75th
%ile
90th
%ile
Median
Best
state
10th
%ile
25th
%ile
75th
%ile
90th
%ile
Data: V. Mor, Brown University analysis of Medicare enrollment data and Part A claims data for all Medicare
beneficiaries who entered a nursing home and had a Minimum Data Set assessment during 2000.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
13
QUALITY: SAFE CARE
Pressure Sores Among High-Risk and Short-Stay Residents in
Nursing Facilities
Percent of nursing home residents with pressure sores
State distribution, 2004
30
By race/ethnicity, 2003
22
18
15
14
13
9
8
23
19
16
14
15
9
0
l
s
a ii
ta
5% 10%
5%
te
To Haw Sta op 2 m 2
m
T
%
tto otto
o
10
B
B
p
To
High-risk residents
High-risk
residents
Shortstay
residents
White
13%
21%
Black
17
26
Hispanic
15
25
Asian
12
22
AI/AN
17
23
l
s
a ii
ta
5% 10%
5%
te
To Haw Sta op 2 m 2
m
T
%
tto otto
o
10
B
B
p
To
Short-stay residents
Data: Nursing Home Minimum Data Set (AHRQ 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
ACCESS: UNIVERSAL PARTICIPATION
Percent of Adults Ages 18–64 Uninsured by State
1999–2000
2004–2005
NH
NH ME
VT
WA
NH
WA
ND
MT
VT
MT
MN
OR
ID
NY
WI
SD
MI
WY
PA
IA
NE
CA
OH
IN
NV
UT
IL
CO
MA
KS
MO
WV
VA
KY
NJ
RI
CT
MN
OR
ID
PA
IA
CA
IL
CO
KS
MO
AZ
NM
MS
TX
AL
NC
AZ
GA
NM
OK
LA
TX
AL
GA
LA
FL
FL
AK
HI
SC
AR
MS
AK
VA
TN
SC
AR
WV
KY
TN
OK
OH
IN
NV
UT
RI
MI
NE
23% or more
19%–22.9%
HI
14%–18.9%
Less than 14%
Data: Two-year averages 1999–2000 and 2004–2005 from the Census Bureau’s March 2000, 2001 and
2005, 2006 Current Population Surveys. Estimates by the Employee Benefit Research Institute.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
MA
NY
WI
SD
WY
DE
MD
DC
NC
ME
ND
NJ CT
DE
MD
DC
States with Highest and Lowest
Adjusted Health Plan Premiums, 2002
Employee-only adjusted premiums
Dollars
5,000
4,000
4,001
3,621
3,582
3,544
3,203
3,000
2,981
2,954
2,833
Alabama
Oregon
California
2,717
2,000
1,000
0
Wyoming
Maine
Wisconsin
West
U.S.
Virginia
average
Hawaii
Adapted from J. Gabel, R. McDevitt, L. Gandolfo et al., “Generosity and Adjusted Premiums in Job-Based
Insurance: Hawaii Is Up, Wyoming Is Down,” Health Affairs, May/June 2006 25(3):832–43.
EFFICIENCY
Medicare Hospital 30-Day Readmission Rates, by Regions, 2003
Rate of hospital readmission within 30 days
30
25
22
20
20
18
15
15
16
14
10
5
0
National Mean
Hawaii
10th
25th
75th
Percentiles
Data: G. Anderson and R. Herbert, Johns Hopkins University analysis of 2003 Medicare Standard Analytical Files 5%
Inpatient Data
SOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
90th
QUALITY: COORDINATED CARE
Children with a Medical Home, by Top and Bottom States, Race/Ethnicity,
Family Income, and Insurance
Percent of children who have a personal doctor or nurse and receive care that is accessible,
comprehensive, culturally sensitive, and coordinated*
46
U.S. average
45
Hawaii
60
Top 10% states
36
Bottom 10% states
53
White
Black
39
30
Hispanic
58
400%+ of poverty
31
<100% of poverty
53
Private insurance
23
Uninsured
0
50
100
* Child had 1+ preventive visit in past year; access to specialty care; personal doctor/nurse who usually/always spent enough
time and communicated clearly, provided telephone advice or urgent care and followed up after the child’s specialty care visits.
Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource Center for Child and Adolescent
Health database at http://www.nschdata.org).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
EQUITY: THE RIGHT CARE
Receipt of All Three Recommended Services for Diabetics,
by Race/Ethnicity, Family Income, Insurance, and Residence, 2002
Percent of diabetics (ages 18+) who received HbA1c test, retinal exam, and foot exam in past year
Total
53
55
White
54
Black
38
Hispanic
61
400% + of poverty
200% –399% of poverty
50
100% –199% of poverty
47
46
<100% of poverty
Private*
54
24
Uninsured
Urban**
55
45
Rural
0
40
* Insurance for people ages 18–64.
** Urban refers to metropolitan area >1 million inhabitants; Rural refers to noncore area <10,000 inhabitants.
Data: Medical Expenditure Panel Survey (AHRQ 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
80
What are States Doing to
Transform Health System
Performance?
C
F
A
D
?
Keys to Transforming the U.S. Health Care
System
1.
2.
3.
4.
5.
6.
7.
Guarantee affordable health care coverage
Implement major quality and safety improvements
Work toward a more organized delivery system that emphasizes
patient-centered primary and preventive care
Increase transparency and reporting on quality and costs
Expand the use of interoperable information technology
Reward performance for quality and efficiency
Encourage public-private collaboration
State Efforts to Guarantee Affordable Health
Insurance Coverage
1. Guarantee Affordable Health
Insurance Coverage
Hawaii Employer Mandate
• Prepaid Health Care Act of 1974
requires all private-sector employers to
provide health insurance to full-time
employees
• Only state to implement an employer
mandate
Massachusetts Health Plan
• MassHealth expansion for
children up to 300% FPL;
adults up to 100% poverty
• Individual mandate, with
affordability provision;
subsidies between 100% and 300% of poverty
• Employers must offer Section 125 Flex Accounts
• Employer mandatory offer, employee mandatory
take-up
• Employer assessment ($295 if employer doesn’t
provide health insurance)
• Connector to organize affordable insurance
offerings through a group pool
Source: John Holahan, “The Basics of Massachusetts Health Reform,” Presentation to United Hospital
Fund, April 2006.
Massachusetts Strategies for Coverage:
Everyone “does their part”
Health Care
System
Government
• Subsidized insurance
• The Connector
• Uncompensated Care
pool reform
• Meet quality and performance
standards
• New levels of “transparency”
• Adjust to payment changes
Expanded
Coverage
Employers
• Fair Share Assessment
• “Free Rider” provisions
• Mandatory “cafeteria
plans”
Individuals
• Individual Mandate
Source: Lischko, Amy. October 16, 2006. “Massachusetts Health Reform.” NASHP 19 th Annual State
Health Policy Conference, Pittsburgh, PA.
Retaining and Expanding Employer
Participation: Maine’s Dirigo Health
Annual expenditures on deductible and premium
$3,000
Deductible amount
$2,738
Employee share of annual premium
$2,500
$2,188
1250
$2,000
$1,638
$1,500
1000
• Employers pay fee
covering 60% of
worker premium
$1,100 750
$1,000
$500
$0
$550
$0
0
MaineCare
250
300
<150%
500
600
<200%
888
<250%
• New insurance
product; $1250
deductible; sliding
scale deductibles and
premiums below 300%
poverty
1188
<300%
1488
>300%
* After discount and employer payment (for illustrative purposes only).
• Began Jan 2005;
Enrollment 14,700 as of
4/30/06
Vermont Health Care Affordability Act
Enacted May 2006
• Coverage expansion
– Catamount Health Plans
• Targets individuals w/o access to work-based coverage
• Premium subsidies based on sliding scale up to 300% FPL
• Comprehensive benefit package including primary care,
chronic care, acute care & other services
• No patient cost-sharing for preventive or chronic care
services
• Builds upon Wagner’s Chronic Care Model
• Financing
– Employer assessment
– Increase in tobacco taxes
– Federal matching funds from Medicaid waiver
Illinois All-Kids
•
•
•
•
•
Effective July 1, 2006
Available to any child uninsured for 6 months or more
Cost to family determined on a sliding scale
Linked to other public programs - FamilyCare & KidCare
Funded by federal and state funds
– Children <200% of the federal poverty level funded by federal
funds
– Children 200%+ of the federal poverty level funded by state
savings from the Medicaid Primary Care Case Management
Program
• All-Kids Training Tour
– Public outreach program to highlight new and expanded
healthcare programs
New Jersey Raises Age of Dependent
Status for Health Insurance
• As of 5/2006, NJ requires
all state insurers to raise
dependent age limit to 30
Millions uninsured, adults ages 19–29
15
– Highest age limit in country
– Covers uninsured, unmarried
adults with no dependents
10
who are either NJ residents
or full-time students
– Premium capped at 102% of
amount paid for dependent’s 5
coverage prior to aging out
• 200,000 young adults
expected to receive
coverage under the law
11.2 11.8
13.7
13.4
12.7
0
2000 2001 2002 2003 2004
Source: S.R. Collins, C. Schoen, J.L. Kriss, M.M. Doty, B. Mahato, “Rite of Passage? Why Young
Adults Become Uninsured and How New Policies Can Help,” Commonwealth Fund issue brief, May
2006. (Analysis of the March 2001–2005 Current Population Surveys)
Implement Major Quality and Safety
Improvements
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
Puget Sound Health Alliance
• Regional partnership involving employers,
physicians, hospitals, patients, health plans
• Working to promote evidence-based
medicine throughout King County,
Washington
• Participants agree to use evidence to
identify and measure quality health care,
then produce publicly-available comparison
reports designed to help improve health
care decision-making
Work Toward a More Organized Delivery System
that Emphasizes Patient-Centered Primary and
Preventive Care
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
3. Emphasize PatientCentered Primary,
and Preventive
Care
Utah’s Primary Care Network
Section 1115 Medicaid Waiver
• Targets uninsured adults (19–54) with family income
less than 150% FPL
• Provides primary care and preventive care services
– Physician office visits
– Immunizations
– Emergency care
– Lab, X-ray, medical equipment & supplies
– Basic dental care
– Hearing & vision screening
– Prescription drugs
• Hospitals provide $10 million in charity care for PCN
participants
Increase Transparency and Reporting on Quality
and Costs
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
4. Increase
Transparency and
Reporting on
Quality and Costs
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
Wisconsin
• Wisconsin Collaborative for Healthcare Quality
– Voluntary consortium formed in 2003 -- physician groups, hospitals,
health plans, employers & labor
– Develops & publicly reports comparative performance information on
physician practices, hospitals & health plans
– Includes measures assessing ambulatory care, IT capacity, patient
satisfaction & access
• Wisconsin Health Information Organization
– Coalition formed in 2005 to create a centralized health data repository
based on voluntary sharing of private health insurance claims,
including pharmacy & laboratory data
– Wisconsin Dept of Health & Family Services and Dept of Employee
Trust Funds will add data on costs of publicly paid health care through
Medicaid
Expand the Use of Interoperable
Information Technology
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
5. Expand the Use of
Interoperable Information
Technology
4. Increase
Transparency and
Reporting on
Quality and Costs
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
Information Exchange:
States Leading the Way
• New York State Health Information Technology
(HIT) initiative
– Under the Health Care Efficiency and Affordability Law for
New Yorkers, $52.9 million awarded to 26 regional health
networks to expand technology in NY health care system
and support clinical data exchange; Commonwealth
Fund-supported evaluation underway
Source: Evolution of State Health Information Exchange, AHRQ, Publication No. 06-0057, January 2006.
Reward Performance for Quality and
Efficiency
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
5. Expand the Use of
Interoperable Information
Technology
4. Increase
Transparency and
Reporting on
Quality and Costs
6. Reward Performance for
Quality and Efficiency
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
Building Quality Into RIte Care
Higher Quality and Improved Cost Trends
Percent
160
Cumulative Health
Insurance Cost Trend
Comparison
140
120
100
• Improved access, medical
home
– One third reduction in
hospital and ER
RI Commercial Trend
80
– Tripled primary care
doctors
60
40
RIte Care Trend
20
20
03
20
01
19
99
19
97
0
19
95
• Quality targets and $
incentives
– Doubled clinic visits
• Significant improvements
in prenatal care, birth
spacing, lead paint, infant
mortality, preventive care
Source: Silow-Carroll, Building Quality into RIte Care, Commonwealth Fund, 2003. Tricia Leddy,
Outcome Update, Presentation at Princeton Conference, May 20, 2005.
Encourage Public-Private Collaboration
to Achieve Simplification,
More Effective Change
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
5. Expand the Use of
Interoperable Information
Technology
4. Increase
Transparency and
Reporting on
Quality and Costs
6. Reward Performance for
Quality and Efficiency
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
7. Encourage
Public-Private
Collaboration
to
Achieve
Simplification,
More
Effective
Change
Minnesota Smart-Buy Alliance
• Initiated in 2004 – alliance between state, private businesses
& labor groups
• Purchase health insurance for 70% of state residents ~3.5
million people
• Pool purchasing power to drive value in health care delivery
system
• Set uniform performance standards, cost/quality reporting
requirements & technology demands
• Four key strategies:
1. Reward or require “best in class” certification
2. Adopt and utilize uniform measures of quality and results
3. Empower consumers with easy access to information
4. Require use of information technology
Expanding Coverage is Only One Piece of the Puzzle
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
5. Expand the Use of
Interoperable Information
Technology
4. Increase
Transparency and
Reporting on
Quality and Costs
6. Reward Performance for
Quality and Efficiency
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
7. Encourage
Public-Private
Collaboration
to
Achieve
Simplification,
More
Effective
Change
Several States Attempting
Comprehensive Health Reform
• Maine, Maine and Vermont have quality
initiatives built into coverage expansions
• Maine
– Created Maine Quality Forum to advocate for high quality health
care and help each Maine citizen make informed health care
choices.
• Massachusetts
– Cost and Quality Council formed
• Vermont
– Quality improvement initiatives
• Public-private collaboration
• Collection of health care data from all payers
• Provides rules to publicly report price & quality information
Rhode Island:
Five-Point Strategy
• 5 point strategy
–
–
–
–
–
Creating affordable health plans for small businesses & individuals
Increasing wellness programs
Investing in health care technology
Developing centers of excellence
Leveraging the state’s purchasing power
RI Quality Institute
– Non-profit coalition including hospitals, providers, insurers,
consumers, business, academia & government
– Partnered with “SureScripts” to implement state-wide electronic
connectivity between all retail pharmacies and prescribers in the state
• Health Information Exchange Initiative
– Statewide public/private effort
– AHRQ contract 5 yr/ $5M
– Connecting information from physicians, hospitals, labs, imaging &
other community providers
National Legislative Proposals to
Facilitate State Innovations
H.R. 5684: Health
Partnership Through
Creative Federalism Act
Rep. Tammy Baldwin (D-WI)
•
•
•
•
Rep. Tom Price (R-GA)
Real cooperation from across the aisle – proposed by Baldwin and Price
with the support of both the Heritage Foundation and the Brookings
Institute; National Governor’s Association also had role in drafting the bill
Requests that states submit proposals for state health care coverage
expansion and improvements in quality, efficiency, cost-effectiveness, and
the appropriate use of health information technology
State proposals defined as statewide, multi-state or limited to certain
regions
Establishes a Commission to:
– Request and review proposals and submit a list it recommends for approval to
Congress
– Report to the public concerning progress made by states
– Make recommendations for minimizing negative effects of state programs
on national employer, provider organizations, insurer
S. 2772: Health
Partnership Act
Senator George Voinovich (D-WI)
Senator Jeff Bingaman (D-NM)
• Provides states with grants to carry out innovative state
health programs, with priority given to programs most
likely to expand coverage and improve access
• Establishes a Commission to:
– provide states with reform options for state health care
expansion and improvement programs
– establish minimum performance measures and goals with
respect to coverage, quality, and cost of state programs
– review state applications and determine whether to submit a
state proposal to Congress
Moving Forward
States Can Lead the Way
What States Can Do to Promote a High Performance
Health System:
Strategies to Expand Coverage
• Design shared responsibility strategy to include state,
employers and individuals
• Expand public programs
• Provide financial assistance to low income workers and
employers to afford coverage
• Require employers to offer Section 125 benefit plans
• Mandate individuals to purchase coverage
• Require employers to offer and employees to take up insurance
• Require insurers to raise age limit for dependents
• Pool purchasing power and promote new benefit designs
to make coverage more affordable
• Develop reinsurance programs to make coverage more
affordable in the small group and individual markets
What States Can Do to Promote a High Performance
Health System:
Strategies to Improve Quality and Efficiency
•
•
•
•
•
•
•
•
Promote evidence-based medicine
Promote effective chronic care management
Promote transitional care post-hospital discharge
Encourage data transparency and reporting on performance
Promote/practice value-based purchasing
Promote the use of health information technology
Promote wellness and healthy living
Encourage selection of medical home and improved access to
primary care and preventive services
• Simplify and streamline public program eligibility and redetermination
Challenge for Hawaii:
Continue the commitment to
universal coverage
AND choose another dimension on
which to lead!
Selected Commonwealth Fund Publications
• The Commonwealth Fund Commission on a High
Performance Health System, Framework for a High
Performance Health System for the United States, The
Commonwealth Fund, August 2006
• The Commonwealth Fund Commission on a High
Performance Health System, Why Not the Best? Results
from a National Scorecard on U.S. Health System
Performance, The Commonwealth Fund, September 2006
• S. Silow-Carroll and F. Pervez, States in Action: A
Quarterly Look at Innovations in Health Policy, The
Commonwealth Fund, Summer 2006, Vol. 5.
• Forthcoming: State Scorecard on Health System
Performance
All publications are available at
http://www.cmwf.org
Acknowledgements
Karen Davis
President
Stephen C. Schoenbaum Executive
Vice President for Programs
Cathy Schoen
Senior Vice President
for Research and
Evaluation
Alyssa Holmgren
Research Associate
Sabrina How
Research Associate
Ilana Weinbaum
Program Associate
Visit the Fund at:
http://www.cmwf.org