Many states across the U.S. are improving on quality metrics and preventive care, but wide differences among states still persist, according to the Commonwealth Fund’s 2015 state health system scorecard.
The latest edition of the state scorecard—the first one in the Commonwealth Fund’s series to reflect a full year of the Affordable Care Act’s major health insurance expansions—ranks the healthcare systems of every state and the District of Columbia based on 42 indicators of healthcare access, quality, costs, and outcomes.
Thirty-six of the 42 indicators are used to reveal trends over time. In addition to the scorecard, there is an online interactive map enabling users to view and compare states’ scorecard results. A companion brief, meanwhile, describes state-by-state trends in access to healthcare.
One main finding was that in 23 states, hospital readmission rates fell by two percentage points or more among Medicare beneficiaries who were discharged from the hospital and sent to skilled nursing facilities for post-acute care. Looking nationwide at all Medicare enrollees, the scorecard found a reduction in hospital readmissions that accelerated when the Medicare program began financially penalizing hospitals with high rates of readmissions in 2012.
The states that had the highest readmission rates saw some of the biggest declines. What’s more, the scorecard found that in 45 states, patients hospitalized for heart attack, heart failure, or pneumonia were substantially less likely to die within 30 days of their hospital stay compared to an earlier measurement baseline.
Stark differences in performance persisted among states on many indicators. In the overall rankings, the leading and lagging states remained the same from the previous scorecard, however. Minnesota, Vermont, Hawaii, and Massachusetts again ranked at the top. The four lowest-ranking states were Louisiana, Arkansas, Oklahoma, and Mississippi.
Four low performing states improved on a number of measures: Louisiana on 16, Oklahoma on 14, and Kentucky and Tennessee on 13. Tennessee didn’t lose ground on any measure. Colorado, Florida, Kansas, New York, North Carolina, Missouri, and South Carolina each got worse on only one measure while improving on between six and 10 measures.
Further, regarding healthcare access, in addition to substantial gains in health insurance coverage for adults, that brief finds that the uninsured rate for children age 18 and under fell in a majority of states and declined by at least two percentage points in 16 states. In addition, adults in 2014 were less likely than in 2013 to say that costs stopped them from going to a doctor when they needed healthcare, with 21 states seeing an improvement of two percentage points or more on this indicator.
“These are the most substantial and widespread state improvements in access to care we’ve seen since we created the state scorecard series in 2007,” Commonwealth Fund President David Blumenthal, M.D, said in a statement. “While there are still wide differences among states, and performance has worsened in some instances, policy changes like those in the Affordable Care Act, incentives to improve healthcare quality and safety, and provider-led efforts are beginning to bear fruit.”