Transcript Results from a Scorecard on Local Health System Performance

Rising to the Challenge:
Results from a Scorecard on Local Health
System Performance, 2012
David Radley and Cathy Schoen
On behalf of the Commonwealth Fund Commission on a High
Performance Health System
www.commonwealthfund.org
March 13, 2012
Embargoed: Not for release before 12:01 ET Wednesday, March 14, 2012
2
2012 Local Scorecard: Key Findings
• Where you live Matters
– Wide variation across 306 local areas on access, care,
outcomes, and costs
– Two to three-fold variations on many key indicators
– Often wide variation between communities in the same state
– Leaders offer benchmarks and targets to improve
• Strong geographic patterns
– Leading areas often in the Northeast and Upper Mid-West
– Regional patterns vary by dimension
• Dimensions of health system performance are interrelated
– Access, care and healthy lives correlated across communities
– Prevention and treatment related to avoidable costs
• Opportunities for all communities to improve
– No local area consistently leads all key indicators
– Potential gains in health, care experiences and lower costs
with strategic local action, supported by national reforms
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Overall Health System Performance
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
4
2012 Local Scorecard Summary of Health
System Performance Avoidable
Top Quartile
2nd Quartile
3rd Quartile
Bottom Quartile
Missing Data
Bottom
Performing HRRs
Top
Performing HRRs
1
2
3
4
Overall
Population
Rank
Count
1
St. Paul, MN 1,077,980
2
Dubuque, IA
154,083
3
Rochester, MN
418,800
4
Minneapolis, MN 3,237,168
5
Appleton, WI
333,220
6
Santa Rosa, CA
488,469
7
La Crosse, WI
350,219
7
St. Cloud, MN
260,500
9
Manchester, NH
893,654
9
San Mateo County, CA
820,908
11
Cedar Rapids, IA
299,158
12
Green Bay, WI
510,108
12
Lancaster, PA
666,199
294
295
295
297
298
298
300
301
301
303
304
304
306
Lexington, KY
Florence, SC
Tupelo, MS
Meridian, MS
Oklahoma City, OK
Shreveport, LA
Jackson, MS
Alexandria, LA
Texarkana, AR
Beaumont, TX
Hattiesburg, MS
Oxford, MS
Monroe, LA
1,518,597
359,716
394,380
201,585
1,879,596
700,013
1,070,263
292,937
261,650
464,624
316,829
152,428
270,188
Prevention
Hospital
& Treatment Use & Cost
Access
Healthy
Lives
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
4
4
4
3
4
4
4
4
4
3
4
3
4
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Access
5
Percent of Adults Ages 18-64 Uninsured,
2009-2010
HRR = hospital referral region
DATA: U.S. Census Bureau, 2009-10 American Community Survey
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Access
Percent of Children Ages 0-17 Uninsured,
2009-2010
HRR = hospital referral region
DATA: U.S. Census Bureau, 2009-10 American Community Survey
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
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Access
7
Prevention and Treatment Score
Better Access is Associated with Better
Prevention & Treatment
Access Score
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Access
8
Better Access is Associated with Better
Prevention & Treatment
Overall Performance on
Access
Overall Performance on
Prevention & Treatment
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Prevention & Treatment
9
Performance Varies Among Top-Ranked
Local Areas in Prevention & Treatment
1
2
3
4
Top Quartile
2nd Quartile
3rd Quartile
Bottom Quartile
Missing Data
Dimension
Rank
1
1
3
3
3
3
3
3
3
10
10
10
10
14
14
14
14
14
14
14
Local Area
Manchester, NH
Wausau, WI
Bangor, ME
Boston, MA
Cedar Rapids, IA
Lancaster, PA
Neenah, WI
Portland, ME
Worcester, MA
Appleton, WI
Arlington, VA
Dubuque, IA
Rochester, MN
Boulder, CO
Grand Rapids, MI
Lebanon, NH
Marshfield, WI
Mason City, IA
St. Cloud, MN
Traverse City, MI
Adult Usual
Adult
Diabetic
InapproSource of Preventive Preventive
priate
Care
Care
Care
Prescribing
1
2
1
1
2
1
2
1
1
1
3
3
3
3
1
1
3
1
3
1
1
1
1
1
2
2
1
1
1
2
1
1
1
2
1
1
3
2
1
1
1
0
1
1
1
2
1
1
1
1
1
0
1
0
2
1
1
0
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
2
1
1
1
1
2
Hospital 30day
Mortality
Hospital
Quality
1
1
1
2
1
2
3
1
2
1
2
3
4
3
1
3
2
2
4
1
4
3
2
1
1
1
2
2
1
4
1
3
1
2
3
3
3
4
1
1
Patient
Hospital
Discharge
Care
Instructions
Experience
1
2
1
2
2
4
1
1
4
1
4
1
1
1
1
1
1
2
1
1
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
1
1
1
1
1
1
1
1
1
1
3
1
1
1
1
1
1
1
2
1
Home
Health
Quality
Nursing
Home
Quality
3
2
1
2
4
3
4
1
3
4
1
3
4
4
3
3
3
4
4
3
Late or no
hospice
1
1
1
1
2
1
1
1
1
2
1
1
1
1
1
1
1
1
1
3
2
2
4
3
1
1
1
4
3
1
1
1
3
1
1
4
3
1
4
2
Prevention & Treatment
10
Usual Source of Care and Preventive
Care
Percent
Best HRR
100
93
Top 90th %ile
Median
Bottom 10th %ile
Worst HRR
89
82
74
69
59
59
56
51
50
45
44
38
37
26
0
Adults with a usual source of care
Adults age 50+ received
recommended screening and
preventive care
27
Adult diabetics received three
recommended diabetes services
HRR = hospital referral region
DATA: Adults with usual source of care—2009-10 BRFSS; Adults received preventive care—2008 & 2010 BRFSS; Adult diabetic
recommended care—2008-10 BRFSS
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Prevention & Treatment
Prescription of Potentially Unsafe
Medications, Medicare Beneficiaries 2007
HRR = hospital referral region
DATA: 2007 Medicare Part D 5% Data. Beneficiaries who received at least one drug that should be avoided for the elderly.
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
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Prevention & Treatment
12
Hospital Clinical Care and
Responsiveness to Patients
Percent
Best HRR
100
100 98
95
Top 90th %ile
99
90
97
96
Median
94
88
77
Bottom 10th %ile
89
86
83
79
Worst HRR
74
71
67
63
59
53
50
0
Patients hospitalized for
heart failure who received
recommended care
Surgical patients received Patients given information
appropriate care to prevent about what to do during their
complications
recovery at home
HRR = hospital referral region
DATA: 2010 CMS Hospital Compare
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Hospital staff always
managed pain well,
responded when needed
help, and explained
medicines
Prevention & Treatment
13
High-risk nursing home residents with
pressure sores (%)
Nursing Home Pressure Sores and Admission
to Hospital from Nursing Homes
Long-stay nursing home residents with a hospital admission (%)
HRR = hospital referral region
DATA: Residents with pressure sores—2008-09 MDS; Residents with hospital admission—2008 MEDPAR, MDS
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Potentially Avoidable Hospital Use & Cost
Overall Performance on Potentially
Avoidable Hospital Use & Cost
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
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Potentially Avoidable Hospital Use & Cost
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Potentially Avoidable Hospital Admissions
Percent
Best HRR
Top 10th %ile
Median
Bottom 90th %ile
Worst HRR
50
47
37
32
28
27
25
25
22
20
20
18
19
15
12
12
6
0
Readmissions within 30 days of discharge as
percent of all admissions among Medicare
beneficiaries
Long-stay nursing home residents
hospitalized within 6-month period
Home health care patients with a hospital
admission
HRR = hospital referral region
DATA: Readmissions within 30 days of discharge—2008 Medicare claims as reported by IOM; long-stay nursing home residents hospitalized—
2008 MEDPAR, MDS; Home health care patients with hospital admission—2010-11 OASIS as reported by CMS Home Health Compare.
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Potentially Avoidable Hospital Use & Cost
Potentially Avoidable Emergency Department
(ED) Use Among Medicare Beneficiaries
All ED Visits
All Other
ER Visits
67%
Emergent,
but
Primary
Care
Treatable
20%
NonEmergent
13%
Potentially Avoidable ED Visits
HRR = hospital referral region
DATA: 2009 5% Medicare SAF
NOTE: Potentially avoidable emergency department (ED) visits are considered either non-emergent, where treatment was not required within
12 hours, or emergent but primary care treatable, where care was needed within 12 hours, but the service provided in the ED could have been
provided in a primary care setting.
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
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Potentially Avoidable Hospital Use & Cost
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Commercially Insured and Medicare Spending per Enrollee,
Relative to U.S. Median Spending for each population
HRR = hospital referral region
DATA: Commercial – 2009 Thomson Reuters MarketScan Database, analysis by M.Chernew, Harvard Medical School. Medicare – 2008
Medicare claims as reported by IOM . Ratio lower than 1.0 indicate percent lower than average; ratio higher than 1.0 indicate percent higher than
average. Median spending determined separately for the commercially insured and Medicare populations
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Healthy Lives
18
Mortality Potentially Preventable by Health Care
Deaths per 100,000 Population, 2005‒2007
All Races
White Race
HRR = hospital referral region
DATA: 2005-07 Vital statistics. Age-standardized death rates before age 75 for causes potentially preventable with timely effective care, including
ischemic heart disease, diabetes, stroke, bacterial infections and screenable cancers.
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Healthy Lives
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Healthy Lives Indicators
Percent
Best HRR
Top 10th %ile
Median
Bottom 90th %ile
Worst HRR
60
46
42
40
36
36
31
30
24
24
24
19
20
13
16
15
3
Adults who smoke
18
10
6
0
30
28
6
Adults ages 18-64 who are Adults ages 18–64 who have Adults who report fair/poor
obese
lost 6+ teeth due to tooth health status, 14 or more bad
mental health days, or who
decay, infection, or gum
have health-related activity
disease
limitations
HRR = hospital referral region
DATA: 2009-10 BRFSS
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
Healthy Lives
20
People who report fair/poor health healthrelated activity limitations (%)
Better Access is Associated with fewer Adults
Reporting Poor Health or Health-Related Limitations
Access Score
HRR = hospital referral region
DATA: Adults Reporting Poor Health or Health-Related Limitations 2009-10 BRFSS
SOURCE: Commonwealth Fund Local Scorecard on Health System Performance, 2012
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Poverty and Health System Performance
• High-poverty rates associated with worse access,
lower rates of preventive care and poor health
– Better access should improve care, lives and
health system performance for communities
• Income not always predictive of performance
– Some low-income communities perform better
than expected
– Some high-income communities perform worse
than expected on care, costs and healthy lives
• Link between income weakest for two dimensions:
– Prevention and Treatment
– Potentially Avoidable Hospital Use & Cost
National Gains if All Local Areas
Achieved Top Rates of Performance
• More people insured and with a primary care source:
– 30 million more adults and children insured
– 25 million more adults with a usual source of primary care
• More receive recommended preventive care:
– 9.4 million adults age 50+ would receive evidence-based
preventive care, including cancer screenings and
immunizations.
• Less avoidable hospital use:
– 1.4 million fewer Medicare hospital admissions and
readmissions per year; potential savings of over $8 billion a
year
• Safer use of prescriptions drugs:
– 1.3 million fewer Medicare beneficiaries would receive a
potentially unsafe or inappropriate prescription
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Summary and Implications
• Substantial opportunity to improve
– 66 million people live in lowest performing areas; 156
million live in areas that perform below average
– Scorecard offers starting point to compare and inform
strategic action to improve
– Within state variation points to potential of targeted action
• Affordable Care Act provides new resources and
tools to support states and communities
– Access is foundation for care and healthier lives
– Preventive care, payment and information resources
– Opportunity to innovate; New State Authority
• Rising to the Challenge
– Cost pressures ever more urgent to take action to improve
– Local providers and community leaders have potential to
improve care, health and costs performance
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Rising to the Challenge: Results from a
Scorecard on Local Health System
Performance, 2012
• Co-Authors
– David Radley, Sabrina K.H. How, Ashley-Kay Fryer,
Douglas McCarthy, and Cathy Schoen
• Released: March 13, 2012
• http://www.commonwealthfund.org/Maps-andData/State-Data-Center/Local-Scorecard.aspx
– Profiles for all Local Areas
– Maps for each of 43 indicators
– Interactive benchmarking tools
For More Information Visit the Fund’s
Web site at www.commonwealthfund.org
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Local Health System Scorecard Methods
• Goal: to stimulate discussion and collaboration and
inform national, state and local action
• Framework modeled on National and State Scorecards
– 4 dimensions: access; prevention and treatment; avoidable
hospital use and costs; and healthy lives
– 43 indicators; national data generally 2008-2010
• National data sources that use same definition and year
for each indicator in all 306 local areas
– Local areas defined by referral patterns (Hospital Referral
Region) rather than city or county political boundaries
• Scoring
– Each indicator scored as ratio to the top 1%ile
– Dimensions Rank = average of indicator scores, then ranked
– Overall Rank = average of 4 dimension ranks