Maine, Massachusetts, Minnesota, New Hampshire and Wisconsin share a bragging right, besides their frigid winters: quality healthcare.
These states were among those that performed best on more than 250 measures of healthcare quality and access, according to newly updated information from the federal Agency for Healthcare Research and Quality.
That information also showed how widely healthcare quality varies by state, a perhaps unsurprising result given the growing recognition that ZIP code is a more accurate predictor of health than genetic code.
These disparities are emerging from the expanding treasure trove of data on healthcare quality, required or gathered by government and non-governmental groups alike. The measures on quality of care by state were pulled from AHRQ's 2015 National Healthcare Quality and Disparities Report and covered a spectrum of categories that affect or reflect healthcare quality, such as the prevalence of certain diseases, the insurance status of populations and access to primary and specialty care.
States were judged by how close they were to hitting “achievable” benchmarks, set in part by top-performing states, on those measures. If they had not achieved 50% of the benchmark, states were considered “far away.” In metrics where states fell between 50% and 90% of the benchmark, they were considered “close.” Hitting 90% of the benchmark value or above was considered “achieved.” The actual number of benchmarks reported by state varied, with some reporting up to 98% and others 86%.
How states fare against each other depends in part on how data are broken down.
In terms of benchmarks achieved, Maine bested other states, with 96. Massachusetts and Minnesota followed closely, each with 95.
At the other end of the spectrum were Wyoming (52 benchmarks achieved) and New Mexico and Arkansas (each with 53).
A slightly different picture emerged when states were ranked by how many benchmarks they were “far away” from hitting. On that scale, California ranked lowest, with 72 benchmarks, followed by Arkansas with 64.
With 13, New Hampshire had the fewest benchmarks it was far from achieving, followed by Idaho with 16.
Although the data point out disparities by state, they don't reveal discrepancies within them, and it takes a deeper dive into the metrics to determine which specific areas of quality a state fared well or poorly. A host of factors—insurance rates, state wealth, population demographics, geography—play into these different outcomes.
Dr. Sergio Aguilar-Gaxiola, the director of the Center for Reducing Health Disparities at the University of California Davis Health System, likes to point to what he calls the “five A's”: Availability, accessibility, appropriateness of service, affordability and advocacy.
All of those can vary depending on where someone lives. “There is a concentration of the health-related workforce, from primary-care doctors to nurses, physicians, etc., in the urban areas,” Aguilar-Gaxiola said. Rural areas lag by comparison, he added.
States that traditionally have had lower rates of insured people will also suffer in quality of care, he said. When people avoid getting care because they lack insurance, that translates to less revenue for healthcare systems that, theoretically, could be used to invest in improved services.
“It also has an impact on the type of care that is delivered,” Aguilar-Gaxiola said. “If people cannot afford services, they will tend to go to the emergency department to get much-needed care, but that usually happens when people are falling apart,” when emergency care is not necessarily the most appropriate, he said.
Thanks to the growing amount of data, states are paying more attention to the quality of care within their borders, said Martha King, the health program group director for the National Conference of State Legislators.
“We believe that legislators are taking greater interest in healthcare quality issues,” King said. As value-based reimbursement models come into play, “state legislators desire to use public resources efficiently and effectively and are learning from each other about state policy strategies to improve their health care systems.”