Accountable Health Communities: Insights from State Health Reform Initiatives
The growing recognition that local factors are powerful determinants of population health and health system performance has led researchers and policy-makers to explore approaches to strengthening community-level governance.
Three states — Colorado, Minnesota, and Oregon — have health reform plans that envision evolving roles at the community-level in health system oversight and financing. This paper examines these state approaches with emphasis on six design elements: breadth of vision, local leadership, delivery system integration, payment reform, accountability, and investment strategy for addressing non-health determinants. While substantial uncertainty remains, these initiatives suggest that community-level engagement in health reform –- accountable health communities -- offers promise.