Im­prov­ing re­gional score­cards will take look­ing to top per­form­ers

Im­prov­ing re­gional score­cards re­quires work­ing to­gether

Modern Healthcare - - NEWS - Dr. Chris­tine Cas­sel

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

Lead­ers of sys­tems in regions that ranked at the bot­tom must look to top-per­form­ers for real-world so­lu­tions.

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.

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