BOX 5-6

Case Study: Prescription for Pennsylvania

A Governor’s Leadership Improves Access to Care for Residents of a Rural State

When Pennsylvania Governor Edward Rendell took office in 2003, one-twelfth of the state’s 12 million residents had no access to health care, 80 percent of health care expenditures went to treating chronic illnesses, and $3 billion was spent annually on avoidable hospitalizations of chronically ill patients. Pennsylvanians were 11 percent more likely than all other Americans to use the emergency room (ER).

If we look at the workforce and the health care needs of an aging population, we’re insane if we don’t try to figure out how we can make sure that we have an adequate number of [clinicians] with the skill and knowledge to work together.

—Ann S. Torregrossa, Esq., director, Governor’s Office of Health Care Reform for the Commonwealth of Pennsylvania

On his first day in office, Governor Rendell established the Office of Health Care Reform to begin to address residents’ access to affordable, high-quality health care. In January 2007 he announced a major new blueprint for that reform, Prescription for Pennsylvania (known as Rx for PA,, which would promote access to care for all Pennsylvanians and reduce the state’s skyrocketing health care expenses.

In the 3-plus years since, many initiatives have been undertaken, including

  • expanding health insurance coverage for the uninsured;

  • improving access to electronic health information through the Pennsylvania Health Information Exchange;

  • establishing a chronic illness commission, which in 2008 recommended, among other proposals, the patient-centered medical home;

  • addressing workforce shortages through the Pennsylvania Center for Health Careers;

  • establishing seven “learning collaboratives” that involve about 800 providers and 1 million patients and teach a variety of providers to collaborate on primary care teams; and

  • expanding the legal scope of practice for physician assistants, advanced practice registered nurses (APRNs), clinical nurse specialists, certified nurse midwives, and dental hygienists (although legislation is still needed to allow APRNs to prescribe medications independently).

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