The attention of Americans interested in healthcare reform has largely been focused on Washington of late, but a new report from the Commonwealth Fund Commission on a High Performance Health System reminds us that examining the situation closer to home is just as important. The report's key message: Where you live in the U.S. largely determines, for better or for worse, the kind of healthcare you can expect to receive. That shouldn't be the case.
The first-of-a-kind “Scorecard on Local Health System Performance” (March 19, p. 6) looked at 306 communities nationwide, and measured factors such as avoidable trips to the hospital, preventive care and insurance coverage—finding there are large gaps between the best- and the worst-performing hospital referral regions in the nation. Hospital administrators, policymakers, insurers and others should take a hard look at the data and work collaboratively to find solutions that can help build healthier communities.
Local data such as these are essential to helping health systems understand how well they are doing compared with top-performers in terms of providing high-quality healthcare at affordable prices. And, in fact, if only the 75 regions ranked at the bottom of the scorecard improved, about 66 million Americans would be getting better care and the nation would save billions in healthcare costs.
The report found two- and even four- or five-fold variations in performance. For example, the rate at which unsafe medications are prescribed to seniors was four times higher in low-performing parts of the country compared with the best regions.
And the scorecard shows that disturbing variations in quality of care can be found even within state lines. For example, people hospitalized for heart failure in Houma, La., receive the right care 97% of the time, but only 85% of patients get the right care if you travel north about 200 miles to Monroe, La.
That same unequal pattern plays out in hospital referral regions all over the country. For example, the number of older adults who received the recommended preventive care was more than twice as high in high-performing areas of the country such as Arlington, Va., compared with bottom ranked communities such as Abilene, Texas.
Variations were also seen among our nation's cities. For example, San Francisco and Seattle scored in the in top 75 local areas and Houston and Miami ranked in the bottom 75.
But even in hospital referral regions with top marks, there is room for improvement. Philadelphia, for example, ranked third among regions with populations above 3 million. Only Boston and Minneapolis scored higher on the metrics in this scorecard.
But does that mean Philadelphia, Boston and Minneapolis can afford to rest easy when it comes to these key health factors? Not by a long shot.
For example, the report shows that Philadelphia and many other communities could do a better job when it comes to providing health insurance to all of their residents. That's a big problem because without coverage, people often cannot get the care they need. Someone with early signs of heart disease, for example, might not get the treatment he or she needs to reduce the risk of developing an advanced case of atherosclerosis.
The potential result: They land in a hospital emergency room getting costly crisis care for a heart attack that never had to happen.
The Patient Protection and Affordable Care Act will make insurance coverage available to about 31 million additional people nationwide by the year 2014, and that will help. But insurers, hospitals and other stakeholders must work together now to close this gap and others—and thus provide higher quality care for the people in our society who need it the most.
Communities can use the scorecard as a tool to identify problem areas and find solutions that will improve the health of all Americans and at the same time reduce high healthcare costs. For example, if the worst performing regions pulled scores up to those of the top ranked regions, there would be 1.4 million fewer trips to the hospital for seniors with chronic conditions that can be managed more effectively and for far less money in outpatient settings.
And if regions ranked at the bottom did a better job when it comes to providing health insurance for all residents, there would be about 30 million more adults and children in this country with crucial healthcare coverage. They would be able to get the care they need to prevent chronic and costly diseases that kill millions of Americans every year.
Leaders of healthcare systems in regions that ranked at the bottom must look to top-performers for real-world solutions to factors such as high rates of avoidable hospital admissions. But no one sector can fix multiple indicators of poor health alone. To improve an entire region's performance, healthcare providers, insurers, state and local officials, and others must work collaboratively on all the issues raised by this report.
We can no longer afford to ignore the problem areas flagged by this scorecard. Let's rise to the challenge and take action now to boost performance so that all Americans get the timely, affordable care they need to live longer, healthier lives.
Dr. Christine Cassel is president and CEO of the American Board of Internal Medicine and a member of the Commonwealth Fund Commission on a High Performance Health System.