Today, there are a host of new opportunities to advance delivery system and payment reform.
- At the federal level, policies, programs, and funding have coalesced around a common national vision based on the Triple Aim of better care, better health, and lower costs. Medicare has advanced significant payment reforms for accountable care organizations, primary care, and bundled payments. Technical assistance and financial resources—State Innovation Model (SIM) awards and innovation grants—have been provided to states, providers, and others to test and implement broader reform models.
- States have advanced significant reforms through their Medicaid programs, with an increased focus on broader population-based initiatives and measures.
- Employers are adopting value-based purchasing strategies working with third-party administrators and carriers or directly with health systems and providers.
While there has been a major push for health care innovation within each of these sectors, the challenge seems to be how to foster productive partnerships across sectors. Effective changes that affect broad populations and delivery systems require coordination of policies and technical capacity. What should be the focus of improvement? What incentives will be created? How can progress be measured consistently using transparent methods of data collection and analysis? What investments are needed to strengthen care management and population health monitoring? In the absence of a single organization or authority, how are priorities established, resources allocated, and policies instituted to advance in a common direction?
State government health care leadership needs to support this coordinated approach, and states need strong partners to develop and advance specific strategies for health care transformation on the ground. The work of regional health improvement collaboratives (RHICs) is aligned with national and state policy goals and introduces opportunities to strengthen governance and technical capacity to support new models. RHICs have been established around the country as nonprofit, multi-stakeholder organizations made up of local health care, businesses, and community leaders.
They work directly with providers, provider organizations, commercial payers, employers, consumers, and other relevant stakeholders to build consensus on strategies and techniques to improve health outcomes and reduce health spending. In other words, states and RHICs have the potential to collaborate. To foster that opportunity, eight state governments and their local RHICs were brought together in March 2015 by the Milbank Memorial Fund and the Network for Regional Healthcare Improvement to explore how closer collaboration between state and regional efforts could help advance mutual health care improvement goals.
This paper was developed by the Milbank Memorial Fund and the Network for Regional Healthcare Improvement to document the experiences of selected states and RHICs that established formal partnerships designed to advance and accelerate shared aims—with a specific focus on cultivating more effective use of health care data. Why are these partnerships focusing on data? It is impossible to measure health care performance without robust data. Having comprehensive data depends on the contributions, collaboration, and cooperation of a broad array of stakeholders. In addition, the use of data requires agreement on the ground rules for its use, which necessitates building trusted governance and operating models. Finally, working with health care data is resource-intensive, and creating these partnerships can leverage infrastructure and resources to make data available in more effective and efficient ways. The case studies described in this issue brief highlight specific benefits and challenges associated with these activities.