Statewide Payment and Delivery Reform: Do States Have What It Takes?

Area of Science:

• Health Policy
• Healthcare Administration
• Public Health

Background:

• The Affordable Care Act (ACA) prompts ongoing debate regarding states' roles in healthcare payment and coverage.
• Rising healthcare costs and federal support under the ACA incentivize state leaders to act as healthcare stewards.
• State leaders are exploring strategies to enhance statewide healthcare systems, irrespective of payment sources.

Purpose of the Study:

• To explore state strategies for healthcare payment and delivery reform.
• To understand the factors influencing states' ability to achieve healthcare reform objectives.

Main Methods:

• On-site interviews with key stakeholders were conducted in five states in early 2015.
• Qualitative data analysis of stakeholder interviews to identify reform strategies and influencing factors.

Main Results:

• States share similar goals for healthcare reform but exhibit significant differences in statutory authority and purchasing power.
• Leaders' willingness to utilize their authority is a critical factor in achieving reform objectives.
• Effective state healthcare stewardship is influenced by a combination of legal power, financial leverage, and political will.

Conclusions:

• State leaders' desire to act as healthcare stewards may not guarantee successful reform implementation.
• Policy makers must consider states' varying capacities, including statutory authority and purchasing power, when designing healthcare policies.
• Achieving comprehensive state-level healthcare reform requires more than just political ambition; it necessitates leveraging specific state-level authorities and resources.