Aiming

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Aiming

Higher

Results from

a Scorecard on

State Health System

Performance

2015 Edition

Douglas McCarthy, David C. Radley,

and Susan L. Hayes

December 2015

The

COMMONWEALTH

FUND


overview

On most of the

42 indicators,

more states improved

than worsened.

The fourth Commonwealth Fund Scorecard

on State Health System Performance tells

a story that is both familiar and new.

Echoing the past three state scorecards,

the 2015 edition finds extensive variation

among states in people’s ability to access

care when they need it, the quality of care

they receive, and their likelihood of living

a long and healthy life. However, this

scorecard—the first to measure the effects

of the Affordable Care Act’s 2014 coverage

expansions—also finds broad-based

improvements. On most of the 42 indicators,

more states improved than worsened.

Access and

Affordability

prevention and

treatment

Avoidable

Hospital Use

and Cost

By tracking performance

measures across

states, this scorecard

can help policymakers,

health system leaders,

and the public identify

opportunities and set

goals for improvement.

The 50 states and the

District of Columbia are

measured and ranked on

42 indicators grouped

into five dimensions:

access and affordability,

prevention and treatment,

avoidable hospital use

and cost, healthy lives,

and equity. Individual

indicators measure things

like rates of children or

adults who are uninsured,

hospital patients who

get information about

how to handle their

recovery at home, hospital

admissions for children

with asthma, and

breast and colorectal

cancer deaths, among

many others.

healthy

lives

equity


highlights from

the scorecard

The top-ranked states are Minnesota,

Vermont, Hawaii, Massachusetts,

Connecticut, New Hampshire, and

Rhode Island. These states were also

leaders in the 2014 scorecard.

Washington moved up to the top quartile of state

performance for the first time in the scorecard series.

Overall, the highest-performing

states were clustered in the

Northeast and Upper Midwest.

Improvements in Access

from 2013 to 2014

The percentage of uninsured

working-age adults declined

in nearly every state and

by 3 points or more in

39 states

The percentage of uninsured

children 18 years and younger

declined by 2 points or more in

16 states

Overall performance, 2015

Top quartile (12 states)

Second quartile (12 states + D.C.)

Third quartile (13 states)

Bottom quartile (13 states)

There are wide variations in performance, with up to an

eightfold difference between top- and bottom-ranked states.

Several of the states that

ranked in the bottom quartile of

performance—Louisiana, Tennessee,

Kentucky, and Oklahoma—were

among those that improved on the

greatest number of indicators.

National attention may be encouraging better quality of care in

hospitals and home health care settings and to more appropriate

medication use in nursing homes and doctor’s offices. However,

declining rates of preventive care in several states signal the need

for greater attention to prevention.

Overall performance, 2015

Top quartile (12 states)

Second quartile (12 states + D.C.)

Third quartile (13 states)

Bottom quartile (13 states)

The percentage of adults who

went without care because of

costs in the past year declined

by 2 points or more in

21 states

Reductions in hospital readmissions accelerated in 2012, when

the federal government began financially penalizing hospitals

with high rates of readmissions. Rates of potentially preventable

admissions to the hospital continued to fall in several states.

In recent years, health care spending growth moderated for

Medicare beneficiaries across states, while premiums for

employer-sponsored health plans continued to rise.

3 | Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition commonwealthfund.org


overall Rankings

Across Dimensions

of performance

Overall Overall performance, performance, 2015 2015

Top Top quartile quartile

Second Second quartile quartile

Third Third quartile quartile

Bottom Bottom quartile quartile

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Access & Affordability

Access & Affordability

Prevention & Treatment

Prevention & Treatment

Avoidable Hospital Use & Cost

Avoidable Hospital Use & Cost

Healthy Lives

Healthy Lives

Equity

Equity

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1 1 !"##$%&'( Minnesota !"##$%&'( Minnesota )

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3 3 .(/("" Hawaii .(/("" Hawaii )

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4 4!(%%(012%$''% Massachusetts

Massachusetts )

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Connecticut Connecticut )

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5 55$/6.(,7%1"+$ 5$/6.(,7%1"+$

New New Hampshire Hampshire )

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9 9

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Number of Indicators

Improved or Worsened

by State

No. of Indicators

WORSENED

5

5

3

2

2

1

4

3

2

1

2

4

4

2

3

2

1

3

3

3

2

4

2

4

4

1

3

2

3

4

2

3

1

1

5

2

2

3

3

3

1

2

0

4

2

4

2

3

5

3

7

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

No. of Indicators

IMPROVED

7

11

12

11

11

9

8

8

12

10

11

6

8

8

6

9

10

13

16

6

11

11

8

8

11

9

10

5

12

8

9

9

8

10

11

7

14

11

5

14

6

9

13

6

5

8

6

11

11

5

10

Notes: Based on trends for

36 of 42 total indicators;

trend data are not

available for all indicators.

Ambulatory care–sensitive

conditions among Medicare

beneficiaries from two age

groups are considered a

single indicator in tallies of

improvement. Improvement

or worsening refers to

a change between the

baseline and current time

periods of at least 0.5

standard deviations larger

than the difference in rates

across all states over the

two years being compared.

about the scorecard series

This 2015 edition of the Scorecard

on State Health System Performance

is the fourth in an ongoing series.

Previous state scorecards were

published in 2007, 2009, and 2014.

The 2014 scorecard assessed changes

from 2007 to 2012, which included

the 2007–2009 recession but stopped

short of major coverage expansions

under the Affordable Care Act (ACA).

The 2015 edition measures changes in

performance during 2013 and 2014 to

assess the effects of the ACA’s 2014

health insurance expansions,

as well as early effects of health care

delivery and payment reforms like

accountable care organizations and

financial incentives to reduce hospital

readmissions. The effects of the ACA

are not yet fully reflected in the 2015

scorecard results. It may take many

years to see the resulting changes.

Annual updates in this series will

document the trajectory of states’

performance as changes shaped by

public policy and the private market

continue to unfold.

See Methods, page 19, for a complete

description of scorecard methods and

indicators. See appendices for statespecific

rates for each indicator. Also

see a companion brief, The Changing

Landscape of Health Care Coverage and

Access: Comparing States’ Progress in

the ACA’s First Year.

5 | Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition

commonwealthfund.org

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