New York, NY, June 13, 2007—There are large gaps in quality of care, access to care, avoidable hospitalizations and costs, equity and healthy lives among states, according to a new state scorecard. Issued by The Commonwealth Fund Commission on a High Performance Health System, the scorecard is the first report to assess how the health system is performing across these five dimensions on a state-by-state basis.
The striking variability across states adds up to substantial human and economic costs for the nation. The report estimates that if all states could do as well as the top states, 90,000 lives could be saved annually, 22 million additional adults and children would have health insurance and millions of older adults, diabetics and young children would receive essential preventive care. In addition, Medicare could save $22 billion a year if high cost states moved down to spending levels of the average states.
The report ranks states on 32 indicators grouped in categories that include access, quality, avoidable hospital use and costs, equity and healthy lives. While no single state performed at the top across all categories, some states far surpassed others. States in the Northeast and Upper Midwest often rank high in multiple areas. In contrast, states with the lowest rankings tend to be concentrated in the South.
"The differences we found between the top and bottom states were shocking, often a two- to three-fold variation or greater," said co-author and Commonwealth Fund Senior Vice President Cathy Schoen. "Where you live clearly matters: for access to care when you need it, the quality of care you receive, and opportunities to live healthier lives."
The report, Aiming Higher: Results from a State Scorecard on Health System Performance, compares each state to benchmarks that have already been achieved in states across the country. Although some states ranked highly on multiple indictors, the report finds that that no one or group of states scored top marks in every area.
"As policymakers and private sector leaders look at how their states did on this scorecard, it should be clear that there is room for improvement in all states," said lead author and Director of the Center for State Health Policy at Rutgers University Joel Cantor. "In key areas, even the top states aren't doing as well as they could be."
Notably, the five top ranked states overall (Hawaii, Iowa, New Hampshire, Vermont and Maine) all have high rates of insurance coverage, with nearly 90 percent of working-age adults insured. In contrast, in the five lowest ranked states (Nevada, Arkansas, Texas, Mississippi and Oklahoma) the share of adults insured ranges between 70 and 78 percent.
These findings point to improving access to care and health insurance coverage as important first steps toward ensuring that all patients get recommended care that is patient-centered, well-coordinated and efficient. In states with low rates of uninsured, adults and children are more likely to receive essential preventive and chronic care and to have an ongoing connection to care.
* Nearly 90,000 fewer deaths before the age of 75 would occur annually from conditions amenable to health care if all states achieved the level of the lowest rate state.
* The uninsured population would be cut in half if insurance rates nationwide reached insurance rates in the top states.
* Nearly 4 million more diabetics across the nation would receive basic recommended care, helping to avoid renal failure and lost limbs, and 9 million adults age 50 or older would receive essential preventive care.
* If all states reached the lowest levels of potentially preventable admissions and readmissions, these hospitalizations could be reduced by 30 percent to 47 percent and save Medicare $2 billion to $5 billion each year.
Potentially Avoidable Use of Hospitals and Costs of Care
In addition, the report underscores opportunities for states to look to each other as well as models of excellence within their own borders to inform efforts to improve. For example, in 1974, Hawaii became the first state to enact legislation requiring employers to provide health insurance to full-time workers; it now ranks first in terms of access to care. For the past decade, Rhode Island has provided incentive payments to Medicaid managed care plans that reach quality targets; it now ranks first on measures of the quality of care.
"The scorecard tells us where we are. Now we need to decide where we're going," said Commonwealth Fund President Karen Davis. "States need healthy and productive citizens. Doing better is possible but it will take commitment and action on all levels to achieve real change. The state scorecard documents that we have much to gain as a nation with coherent national and state policies that respond to the urgent need for action."
The Commonwealth Fund Commission on a High Performance Health System, formed in April 2005, seeks opportunities to change the delivery and financing of health care to improve system performance, and will identify public and private policies and practices that would lead to those improvements.
The Commission members are: James J. Mongan, M.D. (Chair), Partners HealthCare System, Inc.; Maureen Bisognano, Institute for Healthcare Improvement; Christine K. Cassel, M.D., American Board of Internal Medicine and ABIM Foundation; Michael Chernew, Ph.D., Department of Health Care Policy, Harvard Medical School; Patricia Gabow, M.D., Denver Health; Robert Galvin, M.D., General Electric Company; Fernando A. Guerra, M.D., M.P.H., San Antonio Metropolitan Health District; George C. Halvorson, Kaiser Foundation Health Plan Inc.; Robert M. Hayes, J.D., Medicare Rights Center; Glenn M. Hackbarth, J.D., Consultant; Cleve L. Killingsworth, Blue Cross Blue Shield of Massachusetts; Sheila T. Leatherman, School of Public Health, University of North Carolina; Gregory P. Poulsen, M.B.A., Intermountain Health Care; Dallas L. Salisbury, Employee Benefit Research Institute; Sandra Shewry, State of California Department of Health Services; Glenn D. Steele, Jr., M.D., Ph.D., Geisinger Health System; Mary K. Wakefield, Ph.D., R.N., Center for Rural Health, University of North Dakota; Alan R. Weil, J.D., M.P.P., National Academy for State Health Policy; and Steve Wetzell, HR Policy Association.