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July 28, 2015

State Leadership in Health Care TransformationRed and Blue

Author Affiliations
  • 1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 3Milbank Memorial Fund, New York, New York
JAMA. 2015;314(4):349-350. doi:10.1001/jama.2015.8211

Despite substantial differences in the local politics of coverage expansion, states across the country are leading major changes in health care payment and delivery. For example, Arkansas and Tennessee are avidly pursuing bundled payments, Maryland has largely eliminated fee-for-service payment to hospitals, Massachusetts has established statewide cost growth targets, and Idaho is creating a statewide network of multipayer medical homes.

These efforts and many others, while largely under the radar of national attention, may have a profound effect on the health care system’s ability to provide better care at lower cost. Understanding why and how states of all political hues are engaged in such efforts and recognizing the limitations of state-led reform are critical to appreciating the opportunities and challenges of this unique moment in US health care.

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