Aiming Higher Results from a State Scorecard on Health System Performance

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Aiming Higher Results from a State Scorecardon
Health System Performance

• Douglas McCarthy
• Senior Research Advisor
• The Commonwealth Fund
• On Behalf of the Commonwealth Fund
• Commission on a High Performance Health System
• And co-authors
• October 18, 2007
• www.commonwealthfund.org

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Commonwealth Funds Commission on a High
Performance Health System

• Objective
• To move the U.S. toward a high performance health
  care system that helps everyone, to the extent
  possible, lead long, healthy, and productive
  lives
• A high performance health system is designed to
  achieve four core goals
• high quality, safe care
• access to care for all
• efficient, high value
• system capacity to innovate and improve

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National Scorecard Dimensions of a High
Performance Health System
Source Commonwealth Fund National Scorecard on
U.S. Health System Performance, 2006
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State Scorecard 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 performing states
• Ranks states on indicators and dimensions
• 32 indicators (several composites) rank states
  on each
• 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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Summary of Indicator Rankings for Texas
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State Variation Ambulatory Care Quality
Indicators
QUALITY THE RIGHT CARE
Percent
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 Childrens Health SOURCE
Commonwealth Fund State Scorecard on Health
System Performance, 2007
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State Variation Hospital Care Quality Indicators
QUALITY THE RIGHT CARE
Percent of patients who received recommended care
DATA Jha/Epstein analysis of 2004 CMS Hospital
Compare data. SOURCE Commonwealth Fund State
Scorecard on Health System Performance, 2007
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State Variation Safe and Patient-Centered Care
QUALITY SAFE, PATIENT-CENTERED CARE
Percent
DATA Surgical infection prevention 2004-2005
CMS Hospital Compare Provider communication
2003 National CAHPS Benchmarking Database
Pressure sores 2004 CMS Minimum Data
Set. SOURCE Commonwealth Fund State Scorecard on
Health System Performance, 2007
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State Variation Coordination of Care Indicators
QUALITY COORDINATED CARE
Percent
DATA Adult usual source of care 2002/2004
Behavioral Risk Factor Surveillance System Child
medical home 2003 National Survey of Childrens
Health Heart failure discharge instructions
2004-2005 CMS Hospital Compare SOURCE
Commonwealth Fund State Scorecard on Health
System Performance, 2007
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State Variation Hospital Admissions Indicators
AVOIDABLE HOSPITAL USE AND COSTS
Percent
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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HEALTHY LIVES
Mortality Amenable to Health Care by State,
2002Deaths per 100,000 PopulationU.S. Average
103.3 deaths per 100,000
Age standardized deaths before age 75 from
select causes includes ischemic heart
disease DATA Analysis of 2002 CDC Mortality
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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State Variation Selected Mortality Indicators
HEALTHY LIVES
DATA Death rates -- 2002 National Vital
Statistics System Activity limitation 2004
Behavioral Risk Factor Surveillance System.
Cancer death rates age-adjusted to US standard
population. 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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Lack of a Medical Home for Children
EQUITY
Percent of children who did not have a medical
home (national average 54)
By insurance
By income
Note Best state refers to state with smallest
gap between national average (54) and low
income/uninsured. High income means 400 of the
federal poverty level (FPL) or higher. Low income
means 0-99 of FPL. DATA 2003 National Survey
of Children's Health.
SOURCE Commonwealth Fund State Scorecard on
Health System Performance, 2007
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Summary of Key Findings and Lessons from the
State Scorecard

• Wide variation among states, huge potential to
  improve
• Two- to three-fold differences in many indicators
• Leaders generally offer benchmarks, but even the
  best states perform poorly on some indicators
• Leading states consistently out-perform lagging
  states across multiple indicators
• Suggests policies and systems linked to better
  performance
• Distinct regional patterns, but also exceptions
• Significant opportunities to address cost,
  quality, access
• Access and quality highly correlated across
  states
• Possible to have higher quality and lower costs

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Implications for Texas Gains if Texas Achieved
Top State Performance

• More People Covered
• 3.6 million more Texas adults and children would
  be insured
• More Getting the Right Care
• 878,000 more adults (50) would get cancer
  screenings flu shots
• 386,000 more diabetics would get recommended care
• 83,000 more young children would be fully
  immunized on time
• More Getting Primary Care
• 2.8 million adults and 1.3 million children would
  have a medical home
• Less Avoidable Hospital Use
• 84,000 fewer Medicare admissions for ambulatory
  care-sensitive conditions, saving 437 million
  per year
• 20,000 fewer Medicare hospital readmissions,
  saving 250 million
• 11,000 fewer nursing home residents hospitalized,
  saving 107 million
• Healthy Lives
• 7,500 fewer premature deaths (before age 75)

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High-Value Health SystemCore Strategies for
Change

• Extend health insurance coverage to all
• Pursue excellence in provision of safe,
  effective, and efficient care
• Organize the care system to ensure coordinated
  and accessible care for all
• Increase transparency and reward quality and
  efficiency
• Expand the use of information technology and
  information exchange
• Develop the workforce to foster patient-centered
  and primary care
• Encourage leadership and collaboration among
  public and private stakeholders

Source The Commonwealth Funds Commission on a
High Performance Health System Keys to
Transforming the U.S. Healthcare System
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Conclusion Aiming Higher

• Urgent need for action that takes a whole-system
  population perspective and addresses access,
  quality and efficiency

• Universal coverage/access foundation for quality
  and efficient care
• Information systems and better data are critical
  for improvement identifying gaps, monitoring
  progress
• Need for whole system approach address
  multiple areas simultaneously
• Opportunities to learn from others need for
  national and state leadership public-private
  collaboration

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Related Commission and Fund Reports

• Aiming Higher Results from a State Scorecard on
  Health System Performance (June 2007). The
  Commonwealth Fund Commission on a High
  Performance Health System.
• 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.
• Framework for a High Performance Health System
  for the United States (Aug. 2006). The
  Commonwealth Fund Commission on a High
  Performance Health System.
• Closing the Divide How Medical Homes Promote
  Equity in Health Care, Commonwealth Fund 2006
  Health Care Quality Survey (June 2007). Beal et
  al. Commonwealth Fund.
• www.commonwealthfund.org

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Visit the Fundwww.commonwealthfund.org
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Acknowledgements
Steve Schoenbaum, Executive Vice President for
Programs
Karen Davis, President, The
Commonwealth Fund
Cathy Schoen, Senior Vice President for Research
and Evaluation
Anne Gauthier, Senior Policy Director, Commission
on a High Performance Health System
Rachel Nuzum, Program Officer, State Innovations
Sabrina How, Senior Research Associate
Dina Belloff, Senior Research Analyst, Rutgers
Center for State Health Policy
Joel Cantor, Director of the Center for State
Health Policy, Rutgers University