Lessons Learned from State Efforts to Slow and Shift Health Care Spending 

Abstract

State governments have created a pathway to improve health care affordability by setting targets (or benchmarks) for annual cost growth. Some of these states have concurrently set targets for primary care investment and the adoption of alternative payment models, reflecting the theory that these goals are mutually supportive and their parallel achievement can result in improved health outcomes. This report describes the experiences of states that have designed and implemented policies to pursue these multiple targets and gathers lessons from their experiences to inform future policy development. Interviews with state officials and a multi-state convening revealed the strategies states used to establish their targets and their experiences implementing them. Officials described challenges to implementation and efforts to overcome them. Three major themes emerged:

1. Multi-stakeholder alignment is critical; achieving it requires a clear, shared vision and close, ongoing collaboration.
2. The shared vision should provide a framework to articulate the multiple goals holistically.
3. Enforcement and accountability can be messy and non-linear; creativity, patience, and fortitude are common attributes of the most successful approaches.

The states’ experiences can serve as a map for other states interested in using the complementary strategies of cost growth, primary care investment, and alternative payment model targets to make health care more affordable and improve outcomes.