State Health Reform Initiatives

The U.S. health care system is currently undergoing significant change. Much of the change happening today is focused on finding ways to pay for and deliver care that will lead to improved quality, better outcomes and lower costs. Governors know that improving the health of citizens is not only essential to ensuring they live productive lives, but also to controlling health care costs and balancing budgets; as a result, states are leading on a wide array of health reform initiatives.

The National Governors Association Center for Best Practices (NGA Center) is working with states on a wide range of effective state health reform initiatives. The NGA Health Division hosts regular national health care summits to bring states together to learn and share experiences about transformative health reform initiatives from across the country. The following topics are examples of state-led health reform efforts that have been addressed:

  • Developing innovative approaches to coverage expansion. A number of states have considered alternatives to the expansion of Medicaid coverage for adults included as part of the Affordable Care Act. States pursuing innovative alternatives are looking at expansion options that offer a better overall fit with the particular goals and political culture of their state.
  • Fostering data exchange to support and drive change. The ability to share data across payers, providers, and state government is a key component of health system transformation. It allows for better care coordination, population management, integration of primary and behavioral health and patient engagement.
  • Transforming Medicaid payment and delivery systems. A number of states are engaged in a variety of large-scale efforts to significantly transform their Medicaid programs. One of the major vehicles states are using is the Delivery System Reform Incentive Payment, a federal waiver option that provides states with significant funding to support transformation of their Medicaid payment and delivery system.
  • Leveraging purchasing power to accelerate reform. States are purchasers of health care—through Medicaid programs, state employee health benefit programs, and health insurance marketplaces—and  have significant market influence. Therefore, they have an opportunity to leverage that purchasing power to accelerate health reforms.
  • Improving care for individuals with behavioral health needs. A number of states are leading initiatives to find better ways to care for Medicaid beneficiaries with behavioral health needs, particularly those with severe mental illness, substance use disorders, and related challenges such as homelessness and incarceration. One of the key focuses of state efforts is establishing better integration and coordination of services for those populations.