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Delivery System Reform

  • Building Medical Homes: Lessons from Eight States with Emerging Programs

    States are seeking to strengthen primary care through the medical home model to achieve better outcomes and lower costs. The eight states profiled in this report—Alabama, Iowa, Kansas, Maryland, Montana, Nebraska, Texas, and Virginia—are at different stages in the development and implementation of medical home programs. The states have drawn on both well-tested approaches and innovative tactics to help primary care providers adopt the model. As a whole, their experiences demonstrate that states can play critical roles in convening stakeholders, helping practices improve performance, and addressing antitrust concerns that arise when multiple payers collaborate.

    December 2011
  • Re-Forming Health Care Delivery Systems: A Summary of a Forum for States and Health Centers

    In June 2010, the National Academy for State Health Policy (NASHP) convened a forum to examine evolving model approaches as well as surface new strategies that could be promoted with federal and state policymakers, foundations and the health center community to help progression toward reformed health systems. This paper presents the vision laid out at the forum for a transformed delivery system. In addition, it offers specific examples of organizations, regions and states that are designing and implementing approaches aligned with this vision, and outlines the strategies identified by participants as important in moving towards a reformed delivery system.

    Laura Grossmann
    March 2011
  • State Strategies to Improve Quality and Efficiency: Making the Most of Opportunities in National Health Reform

    There is an acknowledged need for extensive reform to the health care delivery system in the United States. The Patient Protection and Affordable Care Act offers unprecedented opportunities to transform care delivery, with numerous provisions that support systemic improvements. States have an imperative to greatly improve system efficiency if they are to effectively and sustainably implement the law’s changes, particularly mandatory coverage expansion. This report examines specific Affordable Care Act provisions that support state system improvement goals and profiles efforts in 10 states: Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington. The report highlights the opportunities and challenges that federal health care reform will bring and offers suggestions for how state and national leaders can streamline implementation.

    December 2010
  • Making Connections: Medicaid, CHIP, and Title V Working Together on State Medical Home Initiatives

    The medical home model–an approach to offering excellent primary care–is gaining momentum. A wide range of stakeholders are now embracing medical homes, and the Affordable Care Act has dedicated resources to developing and spreading the model. In this context, states have been leaders in building medical homes – especially for vulnerable populations. Several of the most promising state medical home initiatives have entailed interagency collaboration. This report details best practices and policy considerations for collaborative medical home building in four areas: laying foundations for partnership, and then working together to engage patients and families, engage health care providers and practices, and build strong systems of care.

    September 2010
  • Service Delivery Policies: Findings from a Survey of Juvenile Justice and Medicaid Policies Affecting Children in the Juvenile Justice System

    NASHP, with the support of the John D. and Catherine T. MacArthur Foundation, is working with Models for Change grantee organizations and state policymakers to address the health needs of youth in the juvenile justice system. This issue brief from NASHP is the final in a series that highlights findings from surveys of juvenile justice and Medicaid agencies in order to determine policies around health care and Medicaid for youth involved in the juvenile justice system. The paper focuses on findings related to service delivery and continuity of care policies for juvenile justice-involved youth.
    August 2010
  • Reforming Health Care Delivery Through Payment Change And Transparency: Minnesota’s Innovations

    In 2008 Minnesota passed landmark legislation containing provisions to collect and report data to achieve price and quality transparency, as well as provisions to support care redesign and payment reform. This report illustrates several key achievements and the challenges Minnesota faces in implementing these reforms. It also derives lessons from the process of passing legislation, the content and potential impact of the package, and its replicability that are useful to other states working on similar reforms as well as in national discussions on controlling costs and improving value.
    Ann Cullen
    March 2010