Too Little Preventive Care. Slightly less than half of U.S. adults are up-to-date with preventive care recommended by the U.S. Preventive Services Task Force. Not surprisingly, the poor and uninsured figure prominently in this group, but even among adults earning four times the poverty rate, only 56 percent received appropriate preventive care.

Spotty Chronic Care Management. Proper management of chronic conditions is essential to good care, and is an especially important task as the population ages. The good news is that the proportion of the population with their diabetes adequately controlled has improved modestly in the last five years. The bad news is that this varies widely, ranging from 79 percent in the best privately insured plans, to 23 percent in the bottom 10 percent of Medicaid managed care plans.

Inadequate Coordination. Coordination of patient care throughout the course of treatment and across various sites of care helps to ensure appropriate follow-up treatment, minimize the risk of error, and prevent complications. But about a third of adults and more than half of all children did not have a medical home with a physician who is easily accessible and a central source of care and referrals to specialists.

Ensuring coordination of care is especially critical at the time of discharge from a hospital. The Commission's scorecard found that patients with congestive heart failure received written care instructions when discharged only half the time—with a gap of 80 percentage points between the top and bottom 10 percent of hospitals. Failure to manage conditions after discharge can result in trips to the emergency room or rehospitalization, with associated human and financial costs.