The NCSL Blog


By Ashley Noble

Did you know that the average state spends more than 30 percent of its annual budget on health care?

Doctors in huddleAround the nation, states are implementing innovative strategies to “bend the cost curve” while ensuring that Americans have access to high-quality care.

For example, Arkansas requires plans sold on the health insurance marketplace to participate in a program to reform health care payment systems. In Florida, enrollees in Medicaid managed care plans receive credits toward the purchase of health care-related products in return for participating in an optional list of 19 healthy behaviors.

These and other state-tested strategies are detailed in a new NCSL issue brief, Improving the Health Care System: Seven State Strategies. The publication cites a half-dozen inefficiencies in the current health care system that contribute to ever-rising prices and subpar care. According to the Institute of Medicine, roughly 30 percent of health care spending in 2009 was wasted on such inefficiencies.

As first line-innovators in health policy, states have implemented numerous strategies in an attempt to eliminate health system inefficiencies. NCSL’s report identifies seven overarching strategies, including:

  1. Alternative payment models.
  2. Using data to identify the actual costs of care and increase price transparency.
  3. Coordinated, patient-centered care.
  4. Focusing resources on the sickest patients.
  5. Integrating behavioral and primary health care.
  6. Investing in preventive medicine.
  7. Improving patient safety in medical settings.


In addition to identifying overarching strategies, the report offers multiple options under each strategy for policymakers to consider, as well as examples from several states. For example, in Section 2, Dig Up the Data, the report discusses the potential advantages of encouraging transparency in the prices of medical treatments, while highlighting Nebraska’s 2014 Health Care Transparency Act and Utah’s 65 million treatment claims in its All Payer Database as examples of state action in this area.

For section 4, NCSL examined the efforts of the Camden Coalition in New Jersey, which tracks areas with high concentrations of people who utilize local health services heavily. The Coalition connects such “super utilizers” with a broad range of resources, resulting in decreased hospitalizations. In section 7, the brief highlights the New York requirement to report hospital acquired infections, which has been recognized by the National Conference of Insurance Legislators (NCOIL) as a national model. 

Readers can access the full report here.

Ashley Noble is a policy specialist in NCSL's Health program.

Contact Ashley.


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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.