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What Does the State Innovation Model Experiment Tell Us About States' Capacity to Implement Complex Health Reforms?
1Commonwealth Fund Australian Harkness Fellow, 2019-2020; University of Sydney, Australia.
The Milbank Quarterly
|March 29, 2022
Summary
State-led health reform requires genuine stakeholder engagement and political commitment. Federal support, particularly through initiatives like the State Innovation Model (SIM), can accelerate progress but needs refinement to better assist states in policy design and implementation.
Area of Science:
- Health Policy
- Health Services Research
- Government Reform
Background:
- The State Innovation Model (SIM) was a federal initiative (2013-2019) to accelerate state-led health care reform.
- This study evaluates state progress and federal support within the SIM initiative.
Purpose of the Study:
- Assess states' progress in implementing health reforms under the State Innovation Model (SIM).
- Examine the effectiveness of federal government support for state-led health reform initiatives.
Main Methods:
- Case studies in six diverse states (Arkansas, Connecticut, Oregon, New York, Tennessee, Washington).
- Data collection via SIM reports and semistructured interviews with 39 expert informants.
- Findings validated through an online forum with health policy experts.
Main Results:
- States with prior reform success and sustained support achieved greater progress under SIM.
- Federal support's value beyond funding is questioned; tailored advice for policy design and implementation is crucial.
- States recommended federal program reform (e.g., Medicare) and a long-term strategy.
Conclusions:
- State-led health reform can advance independently but requires sustained state-federal cooperation for significant progress.
- Federal initiatives like SIM should continue but be refined to offer more effective state support.