The United States can vastly improve its health care system simply by using tools that already are in place, according to a recent Commonwealth Fund report.
"Aiming Higher: Results from a State Scorecard on Health System Performance," used 32 quality indicators to rate states' health systems in the general areas of access, quality, potentially avoidable use of hospitals and costs of care, equity, and residents' ability to live long and healthy lives. It then ranked the individual states and identified policies and programs that boosted outcomes in high-performing states.
State Scorecard Offers Models for Improving Health System
By News Staff
7/13/2007
"If all states approached levels achieved by the top states, the cumulative result would be substantial improvement in terms of access to care, health care quality, reduced costs and healthier lives," the report says. Key to reaching such levels is affordable access to "care that is well coordinated and patient-centered," the report continues.
In general, states with the most uninsured residents scored lowest in the areas of access, unnecessary hospitalizations and costs of care, and healthy lives. However, several states operate programs that expand health coverage, improve access, increase quality, reduce costs and ease equity gaps. If lower-performing states were to implement such programs, the nation would save lives and money, say the report's authors.
Improving chronic care management would result in substantial savings, according to the report. "If annual per-person costs for Medicare in higher-cost states came down to median rates or those achieved in the lowest quartile of states, the nation would save $22 billion to $38 billion per year," the report says.
In fact, if all states achieved the outcomes of top-performing states
In general, states with the most uninsured residents scored lowest in the areas of access, unnecessary hospitalizations and costs of care, and healthy lives. However, several states operate programs that expand health coverage, improve access, increase quality, reduce costs and ease equity gaps. If lower-performing states were to implement such programs, the nation would save lives and money, say the report's authors.
Improving chronic care management would result in substantial savings, according to the report. "If annual per-person costs for Medicare in higher-cost states came down to median rates or those achieved in the lowest quartile of states, the nation would save $22 billion to $38 billion per year," the report says.
In fact, if all states achieved the outcomes of top-performing states
- 17.2 million more adults, ages 18 to 64, and nearly 4.4 million more children would have public or private health insurance;
- 8.6 million more adults would receive recommended preventive care;
- 3.6 million more adults with diabetes would receive three recommended services to prevent or delay complications from the disease;
- nearly 757,000 more children would be up-to-date on recommended doses of five key vaccines; and
- hospitals would see nearly 982,000 fewer admissions among Medicare beneficiaries, saving $5 billion a year, and nearly 198,000 fewer readmissions, saving $2.3 billion a year.
"States can look to each other for evidence of effective policies and strategies associated with higher performance," the report says. For example, top-ranked Hawaii enacted the 1974 Prepaid Health Care Act, which mandates that all employers provide insurance to all staff members who work more than 20 hours a week and pay 50 percent of the premiums. The law also provides coverage to Medicaid beneficiaries, the self-employed and people working fewer than 20 hours a week under the State Health Insurance Plan and mandates hospital, surgical, maternity and laboratory benefits as part of all plans.
Second-ranked Iowa implemented its Medicaid Patient Access Service System program in 1990. Under the program, family physicians, internists, OB-Gyns and pediatricians are primary care case managers who coordinate Medicaid patient care. The program changed where and how care was delivered and saved $66 million in an eight-year period.
Rhode Island, which ranked sixth in the State Scorecard report, implemented Rite Care, a Medicaid managed care program that has used pay-for-performance for nearly a decade. The plan rewards health plans that use performance measures and establishes medical homes for plan members. It also offers an incentive program for physicians in an effort to expand access to primary care and reduce the number of emergency room visits.
"Given that every American should have access to high-quality, equitable, and cost-effective health care, the State Scorecard was developed to help states identify ways they can improve care for their residents," writes Karen Davis, president of the Commonwealth Fund. "… Rather than create new policies from scratch, states can learn from other states' policies and programs -- many of which improve access and quality without raising health system costs," said Davis, adding "… States that set benchmarks in certain dimensions of care -- as well as states with innovative policies and programs -- offer models of care that poorer-performing states can tailor to the needs of their residents."
Second-ranked Iowa implemented its Medicaid Patient Access Service System program in 1990. Under the program, family physicians, internists, OB-Gyns and pediatricians are primary care case managers who coordinate Medicaid patient care. The program changed where and how care was delivered and saved $66 million in an eight-year period.
Rhode Island, which ranked sixth in the State Scorecard report, implemented Rite Care, a Medicaid managed care program that has used pay-for-performance for nearly a decade. The plan rewards health plans that use performance measures and establishes medical homes for plan members. It also offers an incentive program for physicians in an effort to expand access to primary care and reduce the number of emergency room visits.
"Given that every American should have access to high-quality, equitable, and cost-effective health care, the State Scorecard was developed to help states identify ways they can improve care for their residents," writes Karen Davis, president of the Commonwealth Fund. "… Rather than create new policies from scratch, states can learn from other states' policies and programs -- many of which improve access and quality without raising health system costs," said Davis, adding "… States that set benchmarks in certain dimensions of care -- as well as states with innovative policies and programs -- offer models of care that poorer-performing states can tailor to the needs of their residents."
