If the existing healthcare delivery system is not delivering what the public policy people think is needed, the states can call new infrastructure into being that will deliver it: by paying for its development, and assuring an on-going stream of revenue afterwards to sustain it.
The states of Washington and Ohio have both created new healthcare system infrastructure to deliver specific kinds of services in order to improve medical quality and life/employment outcomes for people who get injured at work. Each of these states designed what they thought was needed, got the funding to develop it, and put it out to bid so that the infrastructure/service innovation would actually be carried out by the private sector.
Washington saw the need for community-based organizations that would encourage and reward adoption of specific best practices. So Washington created a request for proposals that described their vision of what we now call a COHE, and solicited bids from private entities that were willing to deliver the services. Once established, the COHEs are supposed to be economically self-sustainable -- able to live on the fees they receive for the services they deliver.
Likewise, Ohio recognized that it needed to create the capability to organize and manage the delivery of worker's compensation healthcare. The state government created a request for proposals that described what they wanted the private sector to do, and took bids from private entities that were interested and qualified to deliver the services. Washington also made a commitment to ensure that these changes met the needs of both workers and employers by implementing these changes region by region rather than all at once, and measuring the impact of these changes through on-going rigorous evaluation and public accountability.
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