VIEW FROM HERE: No Longer Trying to Have it Both Ways: Measuring Total Health Care Costs

Christopher F. Koller, President of the Milbank Memorial Fund


Welcome to health care’s economic wonderland:

“Health care costs are killing employers and the government budget.”
“Health care jobs are the key to our economic recovery.”
“We want to lure more high-paying biotech jobs into our community.”

These contradictory statements often peacefully coexist in the magical reality of this wonderland. When I was health insurance commissioner in Rhode Island, the same leaders who urged me to deny rate increases to insurers also championed any growth in health care jobs and vied to attend the next ribbon-cutting ceremony for a hospital expansion.

A few states, though, are trying to create a new reality, changing the way health care is provided and paid for.

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New Report: States Tackle Health Care Cost Measurement

Dollars spent on health care are dollars not available for other uses. Understanding the rate at which costs are growing—and the growth rate the economy can bear—is important for the financial health of any state. A new Milbank Memorial Fund report, “State Models for Health Care Cost Measurement: A Policy and Operational Framework,” looks at total cost of care measurement activities in four states, rates of cost increase over time, and the policy priorities in each state that are driving the activity.

Read the report

Issue Brief: Population Health and Medicaid Delivery System Reforms

Everyone is talking about "population health" these days. And increasingly, states are looking at ways to incorporate population health goals into delivery system reform in order to improve health outcomes in their communities.

An issue brief published in March by the Milbank Memorial Fund looks at how accountable care collaboratives, including Medicaid accountable care organizations (ACOs) or other ACO-like models, offer prime opportunities for states to meld population health and payment and delivery system reforms. The paper was commissioned by the Milbank Memorial Fund-supported Reforming States Group, a bipartisan, voluntary group of state health policy leaders from both the executive and legislative branches who, with a small group of international colleagues, work on practical solutions to pressing problems in health care. The issue brief offers state strategies for promoting Medicaid ACOs that improve the health of populations—including case studies from three states.

Read the issue brief


About the Milbank Memorial Fund

The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience. Founded in 1905, the Fund engages in nonpartisan analysis, collaboration, and communication on significant issues in health policy. It does this work by publishing high-quality, evidence-based reports, books, and The Milbank Quarterly, a peer-reviewed journal of population health and health policy; convening state health policy decision makers on issues they identify as important; and building communities of health policymakers to enhance their effectiveness.


Milbank Memorial Fund | 645 Madison Avenue, 15th Floor | New York, NY 10022 | Tel: 212-355-8400 | Fax: 212-355-8599

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