Drawn from the report, States' Roles in Shaping High Performance Health Systems.

States shape the health system in many ways, influencing key components such as insurance coverage, quality of care, and information and provider infrastructures. This report presents findings from the State Health Policies Aimed at Promoting Excellent Systems project, undertaken by the National Academy for State Health Policy, with support from The Commonwealth Fund. After conducting surveys of multiple agencies in states across the country, as well as review of related literature, this study found that states are pursuing system improvements across the full spectrum of their authority, including health care purchasing, regulation of providers, reporting of performance data, integration of public health with health care approaches, and improving the availability and affordability of health insurance. Despite this activity, this study finds room for states to do much more. Ongoing efforts to track, study and diffuse information on state activities could accelerate adoption of promising polices and practices.

Minnesota's Quality Care and Rewarding Excellence (QCare) program seeks to realize savings to the public by insisting on stringent quality and safety standards in state health contracts. The program, currently under development, was established by executive order in July 2006. It requires that standards and payment incentives across state agencies, including Medicaid, Minnesota Care, and Minnesota Advantage (the state employee health plan) be aligned to meet benchmarks of improved patient safety and quality of care by 2010.

The initiative sets aggressive goals of improving the quality of care provided to patients for diabetes and cardiac conditions. It also seeks to improve preventive care for adults and children, including bringing rates of immunization, well-child visits, and breast and cervical cancer screening to 90 percent. Hospital safety is addressed through a set of best practices regarding care for all heart attack, heart failure, and pneumonia patients. Hospitals in the top 20 percent will receive payment incentives; after three years, hospitals that fall below minimal benchmarks will face penalties. Provider performance on all measures will be publicly reported on www.minnesotahealthinfo.org.

These contract standards are intended to improve the health of Minnesota patients and engage them in disease-management behaviors, such as the appropriate use of aspirin to manage heart disease, while at the same time helping to control the state's long-term medical costs. In regard to diabetes care, the state anticipates that meeting its goal of having 80 percent of patients receive optimal care, including bringing blood sugar under 8 percent, will save the state $66 million and reduce the risk of complications from diabetes by 31 percent. The Minnesota Department of Health estimates that if all QCare standards are met, more than $153 million in health care costs will be saved annually.

Source: Minnesota State Employee Health Plan SHAPES survey response, QCare website, http://www.health.state.mn.us/healthinfo/qcare.html, and the Governor's Health Cabinet website, http://www.thehealthcabinet.com/QCare.htm.