JAMA Forum: The State Role in Health Care Innovation

Joshua M. Sharfstein, MD

Joshua M. Sharfstein, MD

A couple of weeks ago, the Centers for Medicare & Medicaid Services (CMS) announced a new round of grants from the Center for Medicare and Medicaid Innovation (CMMI). If you didn’t pay much attention to the announcement, it’s worth a second look.

Many are familiar with CMMI’s earlier awards to health care organizations to support transformation and improved value. These grants, totaling about $1 billion, are sparking all sorts of creative changes across the health care system. In Maryland, for example, Johns Hopkins received $20 million to provide comprehensive, coordinated care to adults with chronic illness in East Baltimore. The insurer CareFirst received $24 million to strengthen primary care and chronic disease management in medical homes for more than 25 000 Medicare patients.

The most recent grants went to states to support policies and approaches that can transform payment and delivery of care. Large grants of $30 million or more went to Oregon, Minnesota, Arkansas, Massachusetts, Maine, and Vermont. Smaller planning grants went to 25 states, including Maryland. The summary page is worth a read to see what the future of health care may hold.

Although all of the grants are relevant to Medicare and Medicaid, many states are moving forward with innovations that will involve all payers. Arkansas will be receiving $42 million to enhance primary care for a majority of state residents. Minnesota will receive $45 million to expand accountable care models across payers and across the state. In Maryland, we are going to build a model for “community-integrated medical homes” that integrates comprehensive primary care with population health surveillance. We anticipate using data from our health information exchange—a statewide network that allows health care professionals to share clinical data—to develop maps of preventable illness, enabling public health and clinical teams to coordinate intervention.

The new grants illustrate that states have a pivotal role to play in establishing a common framework for reform—like a state highway system that allows far more development and progress than the federal system alone. Success requires bringing groups together for input and plan design. Many states are planning substantial opportunities for public and professional input.

The grants also reveal how CMS and the administration prioritize partnerships with states. Solutions involving both public and private payers that truly transform care can provide long-lasting and unexpected benefits to Medicare, Medicaid, the federal employee health benefit program, and other federal investments in health.

In Maryland we have a health care delivery reform workgroup that includes physicians, public health officials, business owners, union representatives, hospital executives, and others. We’ve developed a website that outlines local innovative clinical and financial initiatives. We’ll be building on these efforts as we work to improve value and outcomes from our health care system.


About the author: Joshua M. Sharfstein, MD, is Secretary of the Maryland Department of Health and Mental Hygiene. He has previously served as the Principal Deputy Commissioner of the US Food and Drug Administration and as Commissioner of Health for Baltimore. A pediatrician, he lives with his family in Baltimore.

About The JAMA Forum: To provide ongoing coverage throughout this election year, JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide insight about the political aspects of health care. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.

Categories: Caring for the Uninsured and Underinsured, Health Policy, Public Health, The JAMA Forum