- ACA Implementation & State Health Reform
- Coverage and Access
- Federal/State Issues
- Medicaid and CHIP
- Population and Public Health
- Providers and Services
- Acute Care
- Assisted Living
- Behavioral Health
- Case Management
- Child Development Services
- Chronic Care Management
- Community Health Centers
- Developmental Screening
- Early Childhood Services
- Emergency Care
- EPSDT
- Family Planning
- Federally Qualified Health Centers
- Home & Community Based Services
- Hospitals
- Long Term Services & Supports
- Medical Homes & Health Homes
- Mental Health
- Nursing Homes
- Oral Health
- Preventive Care
- Primary Care
- Safety Net Providers
- Quality, Cost, and Health System Performance
- ACOs
- Adverse Event Reporting
- Care Transitions
- Comparative Effectiveness
- Cost Sharing
- Delivery System Reform
- Fraud and Abuse
- Health Care Workforce
- Health Information Technology
- Managed Care
- Medical Homes & Health Homes
- Medical Malpractice
- Patient Safety
- Payment Reform
- Performance Measurement
- Provider Payment Policy
- Quality Oversight
- Specific Populations
- Adolescents
- Childless Adults
- Children
- Children with Special Health Care Needs
- Dual Eligibles
- Elders
- Families
- Low Income People
- Parents
- People with Chronic Conditions
- People with Developmental Disabilities
- Transitional Youth
- Vulnerable Populations
- Young Adults
- Youth
- Youth in Foster Care System
- Youth in Juvenile Justice System
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Shared Decision Making: Advancing Patient-Centered Care through State and Federal Implementation
Shared decision making (SDM)—a process that engages patients in a dialogue with their providers to help them select health care options that conform to their values and preferences—is receiving increased attention as a tool for improving quality and patient satisfaction, and addressing unwarranted variation in care. Building on NASHP's analyses of state health system improvement initiatives, this report reviews the definition, process, and rationale for SDM and potential roles of states in promoting SDM. The report and a companion document highlight state legislative, regulatory, and other approaches in Maine, Minnesota, Oregon, Vermont, and Washington. The report discusses the challenges of implementation, state strategies to overcome challenges, policy options states have pursued, and lessons from their experience.
March 2012» -
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» -
State Innovations to Transform and Link Small Practices
Federal and state governments play a significant role in strengthening the delivery of primary care, however current efforts have disproportionally been focused on large or multi-specialty practices. This report examines the roles states are playing to reorganize the delivery of primary and chronic care to produce more efficient and effective care, particularly in small practices. Through short case studies developed via interviews with state officials and physicians the authors highlight several state-based initiatives that seek to create high performing health systems by targeting local and regional strengths. Additionally, authors identified five themes critical to enacting strategic delivery system reforms.
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 -
Evaluating the Patient-Centered Medical Home: Potential and Limitations of Claims-Based Data
This State Health Policy Briefing summarizes the advantages and disadvantages of using claims-based data to evaluate patient-centered medical home initiatives. A Medicaid-based medical home initiative in Oklahoma and a multi-payer medical home pilot in Rhode Island are highlighted. Both states are using a mixture of claims-based data and supplementary resources like patient or provider surveys and data collected from electronic medical records to evaluate their medical home programs. Understanding the potential uses and limitations of both claims data and other data sources that can aid evaluators will help states to design appropriate evaluative criteria for their medical home programs.September 2010» -
Long Term Services and Supports and Chronic Care Coordination: Policy Advances Enacted by the Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act enacts a variety of initiatives aimed at enhancing long term services and supports (LTSS) and coordination of primary and chronic care for older persons and adults with disabilities. Many of these establish delivery systems demonstrations and Medicaid options that states could adopt to implement state reforms. This NASHP report, supported by THE SCAN Foundation, analyzes the Act’s provisions addressing: 1) National voluntary long term care insurance; 2) Medicaid options and incentives for financing LTSS expansions; 3) Other LTSS provisions; 4) Primary and chronic care coordination; and 5) Nursing home reforms.April 2010» -
State Multi-Payer Medical Home Initiatives and Medicare’s Advanced Primary Care Demonstration
In September 2009, the U.S. Secretary of Health and Human Services announced that Medicare will join selected state-based, multi-payer medical home initiatives in an Advanced Primary Care (APC) demonstration. States have welcomed this announcement viewing Medicare as a valuable potential strategic stakeholder, yet are concerned that the proposed APC criteria may be too narrow to fit many current initiatives. This paper builds from a December 2009 research scan and webcast that looks at a broad range of state multi-payer initiatives and compares some of these criteria against the proposed APC criteria.February 2010» -
Building Medical Homes in State Medicaid and CHIP Programs
With 47 million uninsured Americans, double digit inflation in medical spending and health outcomes that lag far behind other nations, comprehensive health care reform that addresses access, cost and quality issues is a national priority. A primary care oriented system may have benefits for population health, equity in health and cost containment and has been shown to reduce racial and ethnic disparities, and result in significantly lower health care costs and improved life expectancy diseases for those with chronic diseases.June 2009 -
Public Payer Medical Home Initiatives
The National Academy for State Health Policy (NASHP) and the Patient Centered Primary Care Collaborative (PCPCC) have partnered on a one-year project to advance medical homes in state Medicaid and CHIP (Children Health Insurance Program). Supported by The Commonwealth Fund, this project includes a series of three web seminars and accompanying State Health Policy Briefings that discuss strategies for states to consider when supporting practices in fulfilling their role as a medical home. This brief is the third and follows the web seminar State Roles in Multi-Payer Medical Home Pilots, held on November 12, 2008.April 2009 -
Strategies States Can Use to Support the Infrastructure of a Medical Home
The purpose of this State Health Policy Briefing is to examine strategies states can use to recognize and support medical practices that function as a medical home. This is the second in a series of briefs produced by the National Academy for State Health Policy (NASHP) in partnership with the Patient Centered Primary Care Collaborative (PCPCC). In order to support medical homes, payers – including state Medicaid and SCHIP programs – must define what they expect practices to do and how they will know when practices are meeting those expectations. This paper briefly reviews what states should measure. The paper looks at how three states are combining strategies to support medical homes.May 2008
