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Population Health Scorecard Shows Geographical Divides in Quality

Population health rates and care quality levels vary significantly across the country, new data from the Commonwealth Fund shows.

By Jennifer Bresnick

- Much of the nation gets a passing grade for care quality, access, and overall population health, according to new data from the Commonwealth Fund, but striking differences in performance, outcomes, and affordability of basic services persist between geographical regions.

Population health, care quality, and variations in care access

Patients who live in the highest-performing areas of the country are up to thirteen times more likely to experience satisfactory care than those at the other end of the spectrum, the report said, and broad variations in insurance coverage rates persist even after the implementation of the Affordable Care Act.

“Many communities are showing signs of getting healthier, and that is encouraging,” said Commonwealth Fund President David Blumenthal, MD.  Nearly all communities included in the survey improved more often than they worsened, indicating overall positive progress towards healthier lives for patients.

The number of adults who could not afford to receive care in the past year declined significantly in the majority of regions, while children and adults are both much more likely to have insurance coverage due to the ACA.  At-risk adults are more likely, overall, to have access to medical care, though they may not have steady relationships with a particular facility or primary care provider.

Communities have made the most progress with care quality indicators, such as the number of home health patients with improved mobility, 30-day mortality rates and readmissions to the hospital, and the number of nursing home residents using an antipsychotic medication.  High-risk medication use among elderly patients, as well as contraindicated prescriptions, have both decreased across the majority of communities.

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Many of these performance measures fall in line with clinical quality measures endorsed by CMS and regulatory programs such as meaningful use, which may indicate that overall efforts to improve population health management and patient safety are having a measurable impact.

“It shows that with the right policies and actions we can make our health care system work for all of us,” Blumenthal said.

While increased availability of affordable care and greater attention to quality and patient safety have produced meaningful results in many communities, progress is largely dependent on where patients call home.

The highest quality care can be found in Hawaii, New England, certain Midwest states, and the San Francisco area of California, while states in the South and Western regions of the country are still struggling to provide optimal care to their patients.

This may be due, in part, to significant differences in the rates of insured patients.  While only four percent of working-age adults in Massachusetts are uninsured, that number jumps to almost twenty-five percent in Texas and areas of the Southeast. 

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Children in Odessa, Texas, are ten times less likely than those in Boston to have health insurance.  Adults in McAllen, Texas, are twelve times less likely than those in Worcester, Massachusetts, to be insured.

The wide gulf in insurance rates, coupled with regional variations in care delivery and the distribution of low-income patients, have contributed to significant differences in health status and outcomes for all types of patients.

Infants born in areas of California, for example, have a mortality rate of three per 1000 live births, while children in parts of the Deep South experience a 10 in 1000 mortality rate.  Even within the same state, quality and access to care may be drastically different.  Patients in the Traverse City area of Michigan experience early deaths from treatable conditions at a rate of 64 per 100,000 people, yet Dearborn residents are likely to succumb at a rate of 142 per 100,000 patients.

High-risk nursing home patients are 11 times more likely to experience pressure sores in Gulfport, Mississippi than they are in San Luis Obispo, California.  Elderly patients in Texarkana, Arkansas, are three times are likely to receive a contraindicated medication than those in Grand Forks, North Dakota.

“There is still a lot of variation, and every community has room to improve,” said David Radley, researcher for the Commonwealth Fund’s Tracking Health System Performance program and lead author of the report. “But it is striking to see the early effects of the Affordable Care Act at the local level, as people increasingly get coverage and care and quality improves.”

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The report predicts that if the majority of low-performing areas were able to meet the benchmarks set by communities at the top end of the spectrum, 19 million more adults would gain access to insurance coverage and 18 million adults might be able to access necessary care without being limited by cost.  Eleven million more adults could receive recommended cancer screenings, while 26 million would be able to keep current with recommended vaccines.

Raising the level of care quality across the spectrum would produce 1.4 million fewer unnecessary emergency department visits by Medicare beneficiaries, and 100,000 patients would avoid premature deaths from conditions that could be detected and treated earlier on.

“Moving forward, we hope that local areas will integrate the lessons from this scorecard into their efforts to ensure that everyone has health insurance, can afford the care they need, and can get the right care at the right time,” Blumenthal concluded.

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