Scorecard uncovers wide variation in care

By Bernie Monegain
11:32 AM

Commonwealth commission measures key metrics

NEW YORK – Healthcare access, cost, quality and outcomes varies widely from one community to the next, both within states and across states, depending on the performance of the healthcare system available to residents, according to a new report from the Commonwealth Fund Commission on a High Performance Health System.

Former National Coordinator for Health IT David Blumenthal, who chairs the commission acknowledges the problems, but prefers to focus on the opportunities.

“The local scorecard spotlights the opportunities and challenges facing us as we try to achieve better healthcare experiences, better health, and more affordable care,” he says. “Despite the large number of communities that lag relative to leaders, we see places with thriving healthcare systems, providing excellent care at a reasonable cost. The Affordable Care Act provides new resources and the opportunity to innovate in every state and local area. We must commit to working together to raise the bar so every community can do as well as the best among us.” adds Blumenthal who teaches healthcare policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School.

In the first scorecard measuring how 306 local U.S. areas are doing on key healthcare indicators such as insurance coverage, preventive care, and mortality rates, researchers at The Commonwealth Fund found significant differences between the best- and worst-performing localities. Major U.S. cities also showed wide disparities on many key measures of healthcare, with San Francisco and Seattle ranking among the top 75 local areas in the country, and Houston and Miami ranking in the bottom 75.

The stark differences in healthcare add up to real lives and dollars, the researchers note. According to the scorecard, 66 million people live in the lowest-performing local areas in the country. If all local areas could do as well as the top performers, 30 million more adults and children would have health insurance, 1.3 million more elderly would receive safe or appropriate medications, and Medicare would save billions of dollars on preventable hospitalizations and readmissions.

The report, "Rising to the Challenge: Results from a Scorecard on Local Health System Performance, 2012," ranks local areas on 43 performance metrics grouped into categories that include access to healthcare, healthcare prevention and treatment, potentially avoidable hospital use and cost and health outcomes. The 43 metrics include potentially preventable deaths before age 75, prevalence of unsafe medication prescribing, the proportion of adults who receive recommended preventive care, and the percentage of uninsured adults.

The report finds there is room to improve everywhere, with no community consistently in the lead on all the factors that were measured. However, there were geographic patterns: Local areas in the Northeast and upper Midwest often ranked at the top, while local areas in the South, particularly the Gulf Coast and southern central states, tended to rank at the bottom on many measures.

One of the co-authors of the report sees the scorecard as baseline by which to measure progress.

“This first local scorecard provides a baseline for how healthcare systems are performing at the local level when it comes to the most essential functions, including whether people can get the healthcare they need, whether they receive timely preventive care and treatment, how healthy they are, and how affordable healthcare is,” said Commonwealth Fund Senior Vice President Cathy Schoen, a coauthor of the report. “The scorecard is a tool for local healthcare leaders and policymakers that allows them to focus on where their healthcare systems fall short, learn from the best-performing areas, and target efforts to improve where they are needed most.”

Download the full report at: