Medicaid and State Level Health Transformations

I recently guest lectured on Medicaid and state level health transformation at a George Mason University public policy class.

To start, I led the class through a discussion of how states differ from each other around 14-plus factors related to healthcare delivery, financing, policy, and politics. In this discussion we talked about the importance of policy makers appreciating those factors as they consider how to improve health, and the different routes states have taken for Medicaid improvements and expansion. (See picture of white board below.)

We had a great discussion, and I emphasized the importance of both multi-stakeholder alignment, and health information systems that can provide data for transparency and accountability – which together are fundamental to health improvement and reform efforts. Later in the class we talked about how all the state and federal health reform and improvement efforts have transparency and accountability at their core, and how decision making comes down to people and relationships. Continuing that theme, we discussed how healthcare is local, and for most states the relevant geographic “unit” for transformation of healthcare delivery, public health, and the social determinants of health is the city, community, or region – depending upon how each of those terms is defined.

One of my favorite parts of this class was talking with the students about the intersection of policy and politics. We talked about how the baseline for improvement/reform efforts are the 14-plus factors discussed at the beginning of the class, and the need for policy makers and implementers – such as the students in their current and future work lives – to keep focused on what measurable objectives they are trying to accomplish, i.e., not just on processes disconnected from outcomes. (See slide below.)

Thoughts or comments?

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