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  • Washington Health Policy Week in Review - The Commonwealth Fund
    Multimedia Grants Fellowships Grants Fellowships Programs Applicant Resources Grantee Resources Publications Newsletters Washington Health Policy Washington Health Policy Week in Review e Alerts and Newsletter Sign up Refine Your Search Close filters Mission The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access improved quality and greater efficiency particularly for society s most vulnerable including low income people the uninsured minority

    Original URL path: http://authoring.commonwealthfund.org/publications/newsletters/washington-health-policy-in-review (2016-04-30)
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  • International Health News Briefing - The Commonwealth Fund
    Center Multimedia Grants Fellowships Grants Fellowships Programs Applicant Resources Grantee Resources Publications Newsletters International Health News International Health News Briefing e Alerts and Newsletter Sign up Refine Your Search Close filters Mission The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access improved quality and greater efficiency particularly for society s most vulnerable including low income people the uninsured minority Americans

    Original URL path: http://authoring.commonwealthfund.org/publications/newsletters/international-health-news-briefing (2016-04-30)
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  • Quality Matters Archive - The Commonwealth Fund
    Center Multimedia Grants Fellowships Grants Fellowships Programs Applicant Resources Grantee Resources Publications Newsletters Quality Matters Archive Quality Matters Archive e Alerts and Newsletter Sign up Refine Your Search Close filters Mission The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access improved quality and greater efficiency particularly for society s most vulnerable including low income people the uninsured minority Americans young

    Original URL path: http://authoring.commonwealthfund.org/publications/newsletters/quality-matters (2016-04-30)
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    Original URL path: http://authoring.commonwealthfund.org/account/log-in?view=modal&returnUrl=/publications/health-system-scorecards (2016-04-30)
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  • Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition - The Commonwealth Fund
    hospital patients who get information about how to handle their recovery at home hospital admissions for children with asthma and breast and colorectal cancer deaths among many others The top ranked states are Minnesota Vermont Hawaii Massachusetts Connecticut New Hampshire and Rhode Island These states were also leaders in the 2014 Scorecard There are wide variations in performance with up to an eight fold difference between top and bottom ranked states National attention may be encouraging better quality of care in hospitals and home health care settings and to more appropriate medication use in nursing homes and doctor s offices However declining rates of preventive care in several states signal the need for greater attention to prevention Reductions in hospital readmissions accelerated in 2012 when the federal government began financially penalizing hospitals with high rates of readmissions Rates of potentially preventable admissions to the hospital continued to fall in several states In recent years health care spending growth moderated for Medicare beneficiaries across states while premiums for employer sponsored health plans continued to rise State Scorecard Finds Progress in Reducing Hospital Readmissions Select a dimension name to open a PDF with highlights from each report area ABOUT THE SCORECARD This 2015 edition of the Scorecard on State Health System Performance is the fourth in an ongoing series Previous State Scorecards were published in 2007 2009 and 2014 The 2014 Scorecard assessed changes from 2007 to 2012 which included the Great Recession but stopped short of major coverage expansions under the Affordable Care Act The 2015 edition measures changes in performance during 2013 and 2014 to assess the effects of the ACA s 2014 health insurance expansions as well as early effects of health care delivery and payment reforms like accountable care organizations and financial incentives to reduce hospital readmissions The

    Original URL path: http://authoring.commonwealthfund.org/publications/fund-reports/2015/dec/aiming-higher-2015 (2016-04-30)
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  • Aiming Higher: Results from a Scorecard on State Health System Performance, 2014 - The Commonwealth Fund
    the private market than in Medicare which saw a historic moderation in spending Troubling disparities and gaps in care persisted for children and other vulnerable populations For children changes in health system performance were mixed There have been some promising gains in recent years such as a lower rate of asthma hospitalizations But troubling declines on other health care indicators such as the proportion of children with a primary care medical home emphasize the need for continued diligence to secure the health of future generations Disparities in health care and outcomes remained wide between vulnerable and more advantaged groups within all states While states made progress in reducing disparities in premature mortality and certain other key Scorecard indicators disparities also widened for others such as poor health related quality of life Widespread geographic variations in health system performance persist providing benchmarks and illustrating opportunities to do better There were two to eightfold gaps between leading and lagging states on multiple indicators of health care access quality prevention costs and outcomes Exhibit 2 Although the range between top and bottom performing states remained wide on most indicators the gap narrowed for several of the key indicators on which there was also widespread state improvement illustrating that lagging states can close the gap even as top states improve The top performing states Minnesota Massachusetts New Hampshire Vermont and Hawaii lead the nation across most dimensions of care and have done so over time Exhibits 3 and 4 Their consistently high performance may be the result of their willingness and wherewithal to address health system change with focused initiatives spanning the public and private sectors Opportunities for improvement abound Even leading states did not perform consistently well or consistently improve across all performance indicators How National Policies Combined with State and Local Action Can Spur Better Performance It is notable that those indicators in which more than half the states improved have been the focus of national as well as state policy and attention Health care gains for Medicare beneficiaries in the quality and use of hospital care occurred in the majority of states providing a platform for further state and local action States can build on national policy as they did by expanding children s coverage through the federal state Children s Health Insurance Program to influence health system performance in many ways such as by promoting accountable care in Medicaid and value based purchasing of coverage for state employees and by supporting collaboration among public and private stakeholders to consistently measure and improve care Looking Toward the Future Findings from the Scorecard on State Health System Performance 2014 signal both promise and caution for the future Massachusetts experience with insurance coverage expansion suggests that cost related barriers to care should ease for individuals and families who gain coverage under the Affordable Care Act 3 This increased access in turn should support broader improvements in quality of care and health status 4 It is possible however that geographic disparities in performance will

    Original URL path: http://authoring.commonwealthfund.org/publications/fund-reports/2014/apr/2014-state-scorecard (2016-04-30)
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  • Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013 - The Commonwealth Fund
    particularly those related to access prevention and treatment These leading states had among the lowest rates of uninsured adults contributing to more positive health care and health outcomes At the other end of the spectrum the Southern and South Central states often lagged other states Exhibit 2 The 12 states in the lowest quartile performed below average for more than half of the available performance indicators All these states have high uninsured rates low rates of preventive care high rates of potentially avoidable hospital use from complications of disease and significantly worse health outcomes on multiple indicators Notably states at the bottom have among the highest poverty rates with nearly half their total population having a low income under 200 of poverty or at most a high school education With such a high share of the state population s health and well being at risk even modest gains would represent substantial gains for the entire state in healthier more productive lives and potentially lower costs of health care For such high poverty states federal resources to expand coverage and invest in local health systems offer significant new opportunities to improve their population s health and care experiences All states have room to improve No state was in the top quartile or top half of the range of states for all 30 indicators and nine of the 10 top ranked states overall had at least four indicators in the bottom half of the state distribution Income related health care disparities exist within states and across all areas of health system performance To establish benchmarks for performance the Scorecard also compared experiences of low income or less educated populations in each state to those with higher income i e above 400 of poverty or more education i e college degree or higher Lower income populations are at increased risk of experiencing worse access lower quality care particularly in outpatient settings and worse health outcomes compared to those with higher incomes in their home state Income related disparities were most pronounced on measures of access prevention potentially unsafe prescription medication and health outcomes In all states low income adults age 50 or older were less likely to receive preventive care than were higher income adults reflecting in part the much higher rates of low income adults who are uninsured In Kentucky Idaho and California for example rates of preventive care among higher income older adults were double the levels reported by those with low incomes However care patterns continue to differ by income even when adults are insured The Scorecard reveals a pattern across all states except Hawaii of low income Medicare beneficiaries being at greater risk than higher income beneficiaries for receiving medications generally not recommended because of age or health In all states premature death rates were markedly higher among those with a high school education or less than they were for the college educated In 42 states years of potential life lost before age 75 for college educated residents age

    Original URL path: http://authoring.commonwealthfund.org/publications/fund-reports/2013/sep/low-income-scorecard (2016-04-30)
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  • Rising to the Challenge: Results from a Scorecard on Local Health System Performance, 2012 - The Commonwealth Fund
    total health care costs at the community level examination of the sources of variation and development of efforts to improve and track total costs and affordability over time Leading local areas often perform consistently well on multiple indicators across dimensions of performance The local areas that scored in the top quartile of overall health system performance often performed well on multiple indicators and across dimensions In fact many of the top ranked places performed in the top quartile on each of the four dimensions A confluence of factors likely contributes to better performance in these areas including efforts to expand health insurance coverage state and community leadership supportive policy and a culture of collaboration and improvement In contrast areas in the bottom quartile of overall health system performance lagged relative to leaders on multiple indicators of performance Overall performance in these areas was pulled down by high uninsured rates for adults and children low rates of recommended preventive care and treatment and poor health outcomes The 10 percent of communities that performed worse overall about 30 areas tended to struggle on each dimension Still we find exceptions in all regions of the country There were no regions where every community demonstrated strong performance across all indicators Moreover there were many cases where local areas in the lowest performing regions achieved high levels of performance on certain indicators even ranking in the top half of the distribution on a dimension Learning about these places can offer insights for other communities particularly those facing similar health system or resource constraints Multiple dimensions of health system performance are interrelated Across local health care areas strong relationships between core dimensions of health system performance were evident better access was associated with higher quality better access and higher quality with improved health outcomes and poor access and lower quality with higher rates of potentially avoidable hospital admissions and higher overall costs These cross dimensional findings underscore the need for policymakers and community leaders to focus on population health and take a whole system view to improve performance The leading local areas in the access dimension were also leaders in the prevention and treatment dimension In local areas with higher rates of insurance among adults individuals were also unsurprisingly more likely to have a usual source of care and receive preventive care Areas where people reported having better access to care tended to have lower rates of death from causes potentially preventable with timely effective health care Further residents of these areas were more likely to report better health related quality of life Better quality of care as measured by prevention and treatment indicators was also associated with lower rates of potentially preventable deaths People in places that ranked in the top quartile of the prevention and treatment dimension were less likely to die from causes that were potentially preventable with timely and effective health care than those living in places that fell in the bottom quartile on this dimension Close analysis of specific indicators provides insight as to how deficiencies in access and quality contribute not only to poor outcomes but also to inefficient care as measured by potentially avoidable hospital use For example hospital admission rates among nursing home residents were lower in communities where fewer nursing home residents developed pressure sores a preventable injury suggesting there is a common pathway to improve both the quality and efficiency of care Health system performance in the nation s largest cities is highly variable About 40 percent of the U S population lives in the local health care areas representing the country s largest cities These regions are also home to many of the nation s leading academic hospitals and major health care systems providing referral centers for a global community as well as residents of the United States The Local Scorecard finds substantial performance variation across cities Having a large and diverse population does not necessarily lead to poor health system performance Among the nation s largest urban areas Boston Minneapolis and St Paul the San Francisco Bay area Alameda County San Mateo County and San Francisco Seattle and Arlington Va all scored in the top quartile for overall health system performance Cities performance on individual indicators varied with some exceeding benchmark performance and many other cities lagging In most of the largest cities 30 day readmission rates potentially avoidable hospitalization rates for ambulatory care sensitive conditions and per capita Medicare spending taking into account differences in local wages and costs of graduate medical education were high relative to the median rate for all local areas in the country Socioeconomic factors particularly high poverty rates are associated with some aspects of health system performance but not all There are significant variations within areas with low levels of poverty as well as within areas with high poverty levels Local areas with high poverty rates tended to have poorer access lower rates of preventive care and higher rates of potentially avoidable hospital admissions and readmissions High rates of poverty were also associated with poor health outcomes especially those for which timely access to care and population health interventions can make a positive difference Yet dividing local areas into relative high or low income groups the Local Scorecard finds significant variation in performance within both types of communities On prevention and treatment as well as other dimensions high income communities were not always in the top half of the performance distribution and low income communities were not always in the bottom half The way local health care systems are organized and care is delivered makes a difference Overall communities with the highest rates of poverty had among the highest uninsured rates and lowest rates of preventive care pulling down their overall performance rankings These areas also tended to have higher rates of potentially preventable deaths and higher rates of disability and poor health Among these at risk communities the association between poor access and poor health outcomes was particularly notable and highlights the importance of national and state

    Original URL path: http://authoring.commonwealthfund.org/publications/fund-reports/2012/mar/local-scorecard (2016-04-30)
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