4 key takeaways from Commonwealth Fund's state health system scorecard

The Commonwealth Fund has released its 2017 Scorecard on State Health System performance. The scorecards take a comprehensive look at health system performance trends between 2011 and 2015.

Specifically, the Commonwealth Fund examined states based on 44 measures grouped into four categories:

• Access and affordability: Six measures, including rates of insurance coverage and out-of-pocket expenses;
• Prevention and treatment: 18 measures, including rates of preventive screening and quality data;
• Potentially avoidable hospital use and cost: Nine measures, including "hospital use that might have been reduced with timely and effective care;" and
• Healthy lives: 11 measures, including premature death and smoking rates.

Widespread improvement

Overall, the Commonwealth Fund found that "nearly all state health systems" improved across a broad array of indicators between 2013 and 2015—an improvement that Commonwealth Fund CEO David Blumenthal said was directly linked to the Affordable Care Act.

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Some key highlights from the report include:

• A general increase in health care access, particularly among states that expanded Medicaid;
• A drop in the uninsured rate in every state;
• Increased care quality in outpatient and hospital settings; and
• Lower readmission rates among Medicare beneficiaries.

Commonwealth Fund said several positive trends could be directly tied to state and federal policy interventions. "For example, the decline in hospital readmissions accelerated after the federal government began levying financial penalties on hospitals that had high rates of readmissions and created hospital improvement innovation networks to help spread best practices," the researchers wrote.

State rankings

The top 5 state health systems were:

1. Vermont;

2. Minnesota;

3. Hawaii;

4. Rhode Island; and

5. Massachusetts.

The lowest-ranked state health systems were:

47. Alabama;

48. Arkansas;

49. Louisiana;

49. Oklahoma (tied); and

51. Mississippi.

National trends

In addition to the overall rankings, the Commonwealth Fund identified four major national trends based on the scorecard:

1. All but four states—Alaska, Hawaii, New Hampshire, and Oregon—demonstrated improvement on at least twice as many measures as they reported declines on. However, all states and the District of Columbia worsened on at least one measure.
2. Overall, states that expanded Medicaid under the ACA fared better in the ranking than states that did not, particularly on measures of health care access.
3. There was an overall increase in the premature death rate, according to data compiled by the Commonwealth Fund. This uptick reverses a decades-long trend of falling premature death rates—and according to the Fund, it's largely attributable to chronic illnesses such as heart disease and, to a lesser extent, suicides and the opioid epidemic.
4. On average, the highest-performing state on any given measure scored three times higher than the lowest-performing state on that same measure, with even wider variance reported for some measures.

Comments

Blumenthal said the findings help set the bar for ACA repeal and replace efforts. "We must hold onto the gains that we have made and build on them to improve even more," he said. "We must ensure that people in every state and community can benefit from the achievements of the past five years."

That said, the Commonwealth Fund added that the scorecard data—particularly wide variation in performance across states, as well as continued disparities by race and economic status within states— are a reminder that if all states achieved high levels of performance, there would be "dramatic gains in access, quality, efficiency, and health outcomes." The Commonwealth Fund suggested a range of measures that states can take to improve their health systems such as:

• Using value-based purchasing;
• Establishing rules to ensure equitable access and competitive insurance markets;
• Promoting interoperability;
• Supporting organizations that address the social determinants of health; and
• Expanding the primary care workforce (Haefner, Becker's Hospital Review, 3/18; Radley et al., Commonwealth Fund scorecard, accessed 3/20; Cheney, HealthLeaders Media/MedPage Today, 3/19).

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