Milbank Reports

Milbank Reports examine the significance of and evidence to address single or closely related issues in health care. Notable reports have addressed, for instance, long-term care for the elderly, the future of academic medicine, emergency preparedness, and evolving models of integrating behavioral health and primary care. These reports are evaluated in draft by decision makers and practitioners in health care and public health as well as by researchers. Reports have frequently emerged from conversations and meetings with decision makers.

How Can States Support an Aging Population? Actions Policymakers Can Take

Lindsay Goldman and Robert Wolf
June 8, 2016

It is projected that by 2050, 83.7 million Americans will be over the age of 65, almost double the number who were that age in 2012. During its fall 2015 meetings, the Milbank Memorial Fund’s Reforming States Group turned its attention to the topic, partnering with The New York Academy of Medicine to develop sessions focused on some of the major challenges and opportunities facing states as they look at ways to support an aging population. The report provides a review of the issues discussed at the meetings, as well as recommendations for state policy interventions.

Investing in Social Services for States' Health: Identifying and Overcoming the Barriers

Erika Rogan and Elizabeth Bradley
May 20, 2016

More and more attention is being paid to the social determinants of health—the conditions in which people are born, grow, work, live, and age, including factors such as income support, education, transportation, and housing—and their contribution to health and well-being. Despite all the evidence about how the factors affecting our health dwarf the impact of the health care we receive, it remains a challenge for state leaders to act. Why don’t state budgets reflect what we know about improving the health of populations? What are examples where, in spite of the barriers, these challenges are being overcome? This report attempts to answer these questions. Based on focused discussions with state and local public health sector leaders, the report identifies the root causes for states not making overall budget and policy decisions that optimize their population’s health.

Evolving Models of Behavioral Health Integration: Evidence Update 2010-2015

Martha Gerrity
May 12, 2016

Behavioral health integration (BHI), the integration of primary care and behavioral health through the collaborative care management model, remains an approach to treatment that appears to improve the health outcomes for people with mental and medical disorders. Since 2010, when the Milbank Memorial Fund published its first BHI report, “Evolving Models of Behavioral Health Integration in Primary Care,” the field has advanced conceptually, and there has been a proliferation of research. This new report provides an updated scan of the literature over a five-year period (2010 to 2015), identifying changes and remaining gaps in the evidence. It also identifies resources to assist policymakers and health care planners in selecting, implementing, and sustaining BHI models.

Assessing the Effects of Primary Care Transformation: Emerging Themes and Practical Strategies to Strengthen the Evidence

Nancy McCall and Kristin Geonnotti
March 30, 2016

The 18 projects involved in the Milbank Memorial Fund’s Multi-State Collaborative (MC) are engaged in multi-payer primary care transformation—and learning how to do it better. Assessing their own projects and acting on those findings have been important components of the MC programs. To help MC members learn how to do better evaluations and improve the effectiveness of their projects, the Fund engaged Mathematica Policy Research to develop this report and “evaluate the evaluations.”

The Role of State Medicaid Directors: A Leadership Imperative

Andy Allison
September 28, 2015

Developing effective Medicaid leadership and organizational structure is one of the paramount challenges facing governors and legislatures. The size and scope of these programs raise questions about the way they are run and organized. In this report, Andy Allison, a former Medicaid director in two states, looks at current trends in Medicaid policy, organization, and leadership—including a review of corporate management theory and practice—and examines the program’s organization in state government and the roles, responsibilities, and expectations of program leadership.

State Models for Health Care Cost Measurement: A Policy and Operational Framework

Rachel Block
April 8, 2015

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. This report looks at total cost of care measurement activities in four states and the policy priorities in each state that are driving the activity.

All Aboard: Engaging Self-Insured Employers in Multi-Payer Reform

Kristof Stremikis
February 17, 2015

Arkansas, Minnesota, Oregon, and Vermont are at the forefront of state efforts to coordinate value-based payment approaches across multiple public and private payers. In this report, the Pacific Business Group on Health (PBGH) has partnered with the Milbank Memorial Fund to assess the development of these state-level, multi-payer delivery system and provider payment reform projects.

Integrating Primary Care into Behavioral Health Settings: What Works for Individuals with Serious Mental Illness

Martha Gerrity
December 17, 2014

For two decades, research has shown that behavioral health integration (BHI)—a patient-centered approach in which behavioral health and medical providers work together to provide care—can benefit patients with depression and anxiety disorder. Much less is known about behavioral health integration models that target people with serious mental illness. This report examines the evidence concerning the integration of primary care into behavioral health settings for this population.

Aligning Payers and Practices to Transform Primary Care: A Report From the Multi-State Collaborative

Lisa Dulsky Watkins
August 14, 2014

We are learning two things about restructuring health care in the United States in the post-Affordable Care Act (ACA) environment: Primary care transformation is essential to a well-performing health care delivery system and payment reform works best when it is consistent across payers. These things are easier said than done, but the evidence and experience indicate they are possible. This report describes the efforts of states to take on these challenges.

Health Worker Shortages and Global Justice

Paula O'Brien and Lawrence O. Gostin

Evolving Models of Behavioral Health Integration in Primary Care

Chris Collins, Denise Levis Hewson, Richard Munger, and Torlen Wade

Better Health, Not Just Better Health Care: A Prescription for Progress from the Big Cities Health Coalition

David Kohn

Healthy States/Healthy Nation: Essays for a New Administration and a New Congress

Written by members of the Reforming States Group
Co-published with the Reforming States Group

Evidence-Based Maternity Care: What It Is and What It Can Achieve

Carol Sakala and Maureen P. Corry
Co-published with Childbirth Connection and the Reforming States Group

Medical Regulatory Authorities and the Quality of Medical Services in Canada and the United States

Co-published with the Federation of Medical Regulatory Authorities of Canada and the Federation of State Medical Boards

Improving Population Health: The Uses of Systematic Reviews

Melissa Sweet and Ray Moynihan
Produced in Collaboration with the Centers for Disease Control and Prevention (CDC)

Regulating Medical Services in China

Hong Wang, Yanfeng Ge, and Sen Gong
Co-published with the Department of Social Development, Development Research Center (DRC), the State Council of P.R. China

Public Housing and Supportive Services for the Frail Elderly: A Guide for Housing Authorities and Their Collaborators

Co-published with the Council of Large Public Housing Authorities

2005 Robert H. Ebert Memorial Lecture Emerging and Re-emerging Infectious Diseases: The Perpetual Challenge

Anthony S. Fauci

The Future of Academic Medicine: Five Scenarios to 2025

The International Campaign to Revitalise Academic Medicine

2002-2003 State Health Expenditure Report

Co-published with the National Association of State Budget Officers and the Reforming States Group

2003 Robert H. Ebert Memorial Lecture A Revisionist View of the Integrated Academic Health Center

Judith Rodin

Using Health Research in Policy and Practice: Case Studies from Nine Countries

Ray Moynihan
Co-Published with AcademyHealth

Evidence-Based Mental Health Treatments and Services: Examples to Inform Public Policy

Anthony F. Lehman, Howard H. Goldman, Lisa B. Dixon, and Rachel Churchill

Emergency Preparedness, Bioterrorism, and the States: The First Two Years after September 11

Gerald Markowitz and David Rosner

Addressing the HIV/AIDS Pandemic: A U.S. Global AIDS Strategy for the Long Term

Co-published with the Council on Foreign Relations

Evaluating Health Services: A Reporter Covers the Science of Research Synthesis

Ray Moynihan

Making Sense of the System: How States Can Use Health Workforce Policies to Increase Access and Improve Quality of Care

Edward Salsberg
Co-published with the Reforming States Group

Food Safety Updated: Developing Tools for a More Science- and Risk-Based Approach

Michael R. Taylor, Margaret O'K. Glavin, J. Glenn Morris, Jr., and Catherine E. Woteki
Co-published with Resources for the Future

Implementing the Resident Assessment Instrument: Case Studies of Policymaking for Long-Term Care in Eight Countries


September 11 and the Shifting Priorities of Public and Population Health in New York

David Rosner and Gerald Markowitz

2000–2001 State Health Care Expenditure Report

Co-published with the National Association of State Budget Officers and the Reforming States Group

Rebalancing Long-Term Care in New Jersey: From Institutional toward Home and Community Care

Susan C. Reinhard and Charles J. Fahey

Proactive Hazard Analysis and Health Care Policy

John E. McDonough
Co-published with ECRI

Achieving Better Health Outcomes: The Oregon Benchmark Experience

Howard M. Leichter and Jeffrey Tryens

2001 Robert H. Ebert Memorial Lecture Health Care Quality and How to Achieve It

Kenneth I. Shine

Value Purchasers in Health Care: Seven Case Studies


Health Policies for the 21st Century:
Challenges and Recommendations for the U.S. Department of Health and Human Services

Jo Ivey Boufford and Philip R. Lee

Informing Judgment: Case Studies of Health Policy and Research in Six Countries

Co-published with the Cochrane Collaboration

Conflict and Violence in the Food Safety Workplace


Why Health Is Important to U.S. Foreign Policy

Jordan S. Kassalow
Co-published with the Council on Foreign Relations

1998–1999 State Health Care Expenditure Report

Co-published with the National Association of State Budget Officers and the Reforming States Group

When Care Becomes A Burden: Diminishing Access to Adequate Nursing

Claire M. Fagin

The Origins and Implementation of BadgerCare: Wisconsin's Experience with the State Children's Health Insurance Program (SCHIP)

Coimbra Sirica

Accountability through Information: What the Health Care Industry Can Learn from Securities Regulation

William M. Sage

Pioneer Programs in Palliative Care: Nine Case Studies

Co-published with the Robert Wood Johnson Foundation

The Education of Medical Students: Ten Stories of Curriculum Change

Co-published with the Association of American Medical Colleges

Long-Term Care for the Elderly with Disabilities: Current Policy, Emerging Trends, and Implications for the Twenty-First Century

Robyn I. Stone

Better Information, Better Outcomes: The Use of Health Technology Assessment and Clinical Effectiveness Data in Health Care Purchasing Decisions in the United Kingdom and the United States


Genetics in Medicine: Real Promises, Unreal Expectations. One Scientist's Advice to Policymakers in the United Kingdom and the United States

Steve Jones

Towards an International Consensus on Policy for Long-Term Care of the Ageing

Co-published with the Ageing and Health Programme of the World Health Organization

Effective Public Management of Mental Health Care: Views from States on Medicaid Reforms That Enhance Service Integration and Accountability

Co-published with the Bazelon Center for Mental Health Law

Preventing Violence Against Women and Children
Ronald B. Taylor