Transcript THE COMMONWEALTH FUND Aiming Higher A State Scorecard on Health System Performance Cathy Schoen Senior Vice President The Commonwealth Fund Alliance for Health Reform June 15, 2007 On behalf of.

THE
COMMONWEALTH
FUND
Aiming Higher
A State Scorecard on Health System Performance
Cathy Schoen
Senior Vice President
The Commonwealth Fund
Alliance for Health Reform
June 15, 2007
On behalf of Rutgers University Center for State Health Policy
and Commonwealth Fund Co-Authors
www.commonwealthfund.org
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Purpose and Methods
• Aims to stimulate discussion, collaboration, and policy
action
• Modeled on National Scorecard
– 5 dimensions: access, quality, avoidable hospital use
and costs, equity, and healthy lives
– Contrasts to highest performers
• Ranks states on indicators and dimensions
– 32 indicators
– Dimension rank = average of indicator ranks
– Overall rank = average of dimension ranks
• Equity
– Gaps for vulnerable group (income, insurance,
race/ethnicity) on subset of 11 indicators
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Aiming Higher: Key Findings
• Wide variation among states, huge potential to improve
– Two to three-fold differences in many indicators
– Leaders offer benchmarks
• Leading states consistently out-perform lagging states
– Suggests policies and systems linked to better
performance
– Distinct regional patterns, but also exceptions
• Access and quality highly correlated across states
• Significant opportunities to address cost, quality, access
– Quality not associated with higher cost across states
• All states have room to improve
– Even best states perform poorly on some indicators
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Gains to Nation if All States Achieved Top State
Performance
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• More People Covered
– 22 million additional adults and children insured
• More Getting the Right Care
– Nearly 9 million additional adults (50+) and 4 million
diabetics would receive recommended care
– 750,000 children immunized
• More Getting Primary Care
– 22 million adults and 10 million children with primary care
• Less Avoidable Hospital Utilization
– More than 1 million fewer Medicare hospital admissions and
readmissions per year (Savings of $5 billion+ per year)
• Costs
– $22 billion annual Medicare savings if high cost states came
down to average
• Healthy Lives
– 90,000 fewer premature deaths
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QUALITY
• Getting the Right Care
• Coordinated Care
• Patient-Centered Care
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QUALITY: THE RIGHT CARE
State Variation: Ambulatory Care Quality Indicators
Percent
Best State
Top 5 States Avg
All States Median
94
100
65
50
Bottom 5 States Avg
50 49
40
33 33
88
82
71
59
42
67
Worst State
75 73
59
48 46
32 29
0
Adults age 50+
Adult diabetics
Children ages
Children with
received
received three
19–35 months
dental and medical
recommended
recommended
received five
preventive care
preventive care
diabetes services
vaccines
visits
DATA: Adult preventive care – 2002/2004 BRFSS; Adult diabetic preventive care – 2002/2004 BRFSS; Child vaccines – 2005
National Immunization Survey; Child medical and dental visits – 2003 National Survey of Children’s Health
SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007
QUALITY: THE RIGHT CARE
State Variation: Hospital Care Quality Indicators, 2004
Percent of patients who received recommended care
Best State
100
88 88
Top 5 States Avg
97 97
83
79 79
All States Median
93
89 88
Bottom 5 States Avg
91 90
84
75
Worst State
82 81
66
74
67 64
50
0
All three conditions
Acute myocardial
Congestive heart
Pneumonia
(10 indicators)
infarction
(5 indicators)
failure
(2 indicators)
(3 indicators)
DATA: 2004 CMS Hospital Compare
SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007
QUALITY: THE RIGHT CARE
State Variation: Surgical Infection Prevention, 2005
Percent of adult surgical patients who received appropriate timing of
antibiotics to prevent infections*
100
90
83
70
57
50
50
0
Best State
Top 5 States
All States
Bottom 5
Avg
Median
States Avg
* Comprised of two indicators: before and after surgery.
DATA: 2005 CMS Hospital Compare
SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007
Worst State
QUALITY: COORDINATED CARE
State Variation: Coordination of Care Indicators
Percent
Best State
100
Top 5 States Avg
89 88
All States Median
Bottom 5 States Avg
Worst State
81
71
66
67 64
61 60
49
48
50
36 34
26
21
0
Adults with a usual source
Children with a medical
Heart failure patients
of care
home
given discharge
instructions
DATA: Adult usual source of care – 2002/2004 BRFSS; Child medical home – 2003 National Survey of Children’s Health;
Heart failure discharge instructions – 2004-2005 CMS Hospital Compare
SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007
AVOIDABLE HOSPITAL USE AND COSTS
State Variation: Hospital Admissions Indicators
Percent
Best State
Top 5 States Avg
All States Median
Bottom 5 States Avg
Worst State
46
50
39
25
13 14
18
27
23 25
22 24
17 18
16
8 9
7 8
18
20
12
0
Medicare
Nursing home
Nursing home
Home health patients
beneficiaries
residents admitted to
residents readmitted
admitted to hospital
readmitted to hospital
hospital
to hospital within 3
within 30 days
months
DATA: Medicare readmissions – 2003 Medicare SAF 5% Inpatient Data; Nursing home admission and readmissions – 2000
Medicare enrollment records and MedPAR file; Home health admissions – 2004 Outcome and Assessment Information Set
SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007
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EQUITY
• Based on gaps between most
vulnerable to national average
– Low-income (below 100% or 200% of
poverty)
– Uninsured
– Racial, ethnic minority
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EQUITY
Lack of Recommended Preventive Care by Income and
Insurance
Percent of adults age 50+ who did not receive recommended preventive care
By income
>200% of poverty
By insurance
200% of poverty or less
Insured
100
54
50
61
48
56
0
87
78
76
71
Uninsured
59
65
54
60
National
Top 5
Bottom 5
National
Top 5 States
Bottom 5
Average
States
States
Average
Average
States
Average
Average
Average
Note: Top 5 states refer to states with smallest gap between national average and low income/uninsured. Bottom 5 states refer to
states with largest gap between national average and low income/uninsured.
DATA: 2002/2004 BRFSS
SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007
HEALTHY LIVES
Mortality Amenable to Health Care by Race,
National Average and State Variation
Deaths* per 100,000 Population
300
White
Black
Overall U.S. Average = 103 deaths per 100,000
232
250
194
200
184
150
100
123
94
84
89
110
50
0
National Average
Top 5 States
Average
All States Median
Bottom 5 States
Average
*Age-standardized deaths before age 75 from select causes; includes ischemic heart disease
Note: Top 5 states refer to states with smallest gap between national average and black. Bottom 5 states refer to states with largest
gap between national average and black.
DATA: Analysis of 2002 CDC Multiple Cause-of-Death data files using Nolte and McKee methodology, BMJ 2003.
SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007
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Aiming Higher
Urgent need for action that takes a wholesystem population perspective and
addresses access, quality and efficiency
• Universal coverage with meaningful access:
foundation for quality and efficient care
• Wide variations point to opportunities to learn
• Information systems and better information are
critical for improvement
• National leadership and public and private
collaborative improvement initiatives
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Acknowledgments:
Rutgers University Center for State Health
Policy and The Commonwealth Fund Co-Authors
Joel C. Cantor, ScD
Director,
Rutgers University
Center for State Health
Policy
Sabrina How, MPA
Research Associate,
The Commonwealth
Fund
Dina Belloff, MA
Senior Research Analyst,
Rutgers University Center
for State Health Policy
Douglas McCarthy, MBA
Senior Research Advisor,
The Commonwealth Fund
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Related Commission Reports
•
Why Not the Best? Results from a National Scorecard on U.S.
Health System Performance (Sept. 2006). The
Commonwealth Fund Commission on a High Performance
Health System.
•
“U.S. Health System Performance: A National Scorecard”
(Sept. 20, 2006). C. Schoen, K. Davis, S. K. H. How, and S. C.
Schoenbaum. Health Affairs Web Exclusive.
•
The Agency for Healthcare Research and Quality's 2006
National Healthcare Quality Report (March 2007). S. C.
Schoenbaum, D. McCarthy, and C. Schoen.
•
Public Views on Shaping the Future of the U.S. Health
System (August 2006). C. Schoen, S. K. H. How, I. Weinbaum,
J. E. Craig, Jr., and K. Davis.
•
Framework for a High Performance Health System for the
United States (August 2006). The Commonwealth Fund
Commission on a High Performance Health System.
For these and other Commonwealth Fund Reports visit
the Fund website:
www.commonwealthfund.org
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