States experiment with reform, but gaps suggests some national changes needed

Vermont scores high marks for a new experiment in coordinating care, as well as the overall quality of its health system. The gap between Vermont and lower performing states, however suggests to some that states may struggle to reform health care on their own. Other reports consider states that have made independent efforts.

The Associated Press/Washington Post: Educating patients and using payments to encourage providers is "health care at its most basic, but in some ways it's revolutionary." Around 85 percent of Vermonters over age 64 have one or more chronic conditions. A pilot program that began in 2003 is helping keep patients healthier, and has already lowered emergency room visits (Ring, 10/11).

The Denver Post: CoverColorado insures nearly 10,000 people who would have to pay 40 percent more than the average resident for insurance. In other words, "Colorado already has a public option in health care — it's just exclusive to sick people who have been rejected by private insurance companies." As federal lawmakers back away from creating a national public option, state officials are contemplating the costs and impact of expanding CoverColorado (Brown, 10/12).

The Boston Globe: "The state's ambitious plan to shake up how providers are paid could have a hidden price for patients: Controlling Massachusetts' soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want." A commission in July suggested changing the "fee-for-service" payment system to one that would instead pay an annual per-patient fee (Kowalczyk 10/11).