Results from the Commonwealth Fund Scorecard on State Health System Performance. Douglas McCarthy. Senior Research Director The Commonwealth Fund

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1 AIMING HIGHER: Results from the Commonwealth Fund Scorecard on State Health System Performance EDITION APPENDIX David C. Radley Senior Scientist The Commonwealth Fund Douglas McCarthy Senior Research Director The Commonwealth Fund Susan L. Hayes Senior Research Associate The Commonwealth Fund The following appendix is part of a Commonwealth Fund report, D. C. Radley, D. McCarthy, and S. L. Hayes, Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance, Edition (The Commonwealth Fund, March ), available on the Fund s website at: commonwealthfund.org/interactives//mar/state-scorecard/. MARCH

2 APPENDIX A1. State Scorecard Data Years and Databases Indicator Past year Current year Database Access and Affordability 1 Adults ages 64 uninsured ACS PUMS 2 Children ages 0 uninsured ACS PUMS 3 Adults who went without care because of cost in past year BRFSS 4 Individuals under age 65 with high out-of-pocket medical costs relative to their annual household income a - CPS ASEC 5 At-risk adults without a routine doctor visit in past two years BRFSS 6 Adults without a dental visit in past year BRFSS Prevention and Treatment Adults with a usual source of care BRFSS 8 Adults with age- and gender-appropriate cancer screenings BRFSS Adults with age-appropriate vaccines BRFSS Children with a medical home a / NSCH Children with a medical and dental preventive care visit in the past year a / NSCH Children with emotional, behavioral, or developmental problems who received needed mental health care in the past year a / NSCH Children ages 35 months who received all recommended doses of seven key vaccines NIS Medicare beneficiaries who received at least one drug that should be avoided in the elderly 5% Medicare enrolled in Part D Medicare beneficiaries with dementia, hip/pelvic fracture, or chronic renal failure who received a prescription drug that is contraindicated for that condition 5% Medicare enrolled in Part D Medicare fee-for-service patients whose health provider always listens, explains, shows respect, and spends enough time with them CAHPS (via AHRQ National Healthcare Quality Report) Risk-adjusted -day mortality among Medicare beneficiaries hospitalized for heart attack, heart failure, pneumonia, or stroke 0/ - 06/ 0/ - 06/ CMS Hospital Compare Central line-associated bloodstream infections (CLABSI), Standardized Infection Ratio CDC HAI Progress Report Hospitalized patients given information about what to do during their recovery at home HCAHPS (via CMS Hospital Compare) Hospitalized patients who reported hospital staff always managed pain well, responded when needed help to get to bathroom or pressed call button, and explained medicines and side effects HCAHPS (via CMS Hospital Compare) Home health patients who get better at walking or moving around OASIS (via CMS Home Health Compare) Home health patients whose wounds improved or healed after an operation OASIS (via CMS Home Health Compare) High-risk nursing home residents with pressure sores (Q2-Q4) (Q2-Q4) MDS (via CMS Nursing Home Compare) Long-stay nursing home residents with an antipsychotic medication (Q2-Q4) (Q2-Q4) MDS (via CMS Nursing Home Compare) Avoidable Hospital Use and Cost Hospital admissions for pediatric asthma, per 0,000 children HCUP (via AHRQ National Healthcare Quality Report) Hospital admissions among Medicare beneficiaries for ambulatory care sensitive conditions, ages 65 4, and 5 and older per 1,000 beneficiaries CCW (via CMS Geographic Variation Public Use File) 2 Medicare -day hospital readmissions, rate per 1,000 beneficiaries CCW (via CMS Geographic Variation Public Use File) Short-stay nursing home residents readmitted within days of hospital discharge to nursing home MedPAR, MDS 2 Long-stay nursing home residents hospitalized within a six-month period MedPAR, MDS Home health patients also enrolled in Medicare with a hospital admission OASIS (via CMS Home Health Compare) Potentially avoidable emergency department visits among Medicare beneficiaries, per 1,000 beneficiaries Medicare SAF 32 Total reimbursements per enrollee (ages 64) with employer-sponsored insurance Truven MarketScan 33 Total Medicare (Parts A & B) reimbursements per enrollee CCW (via CMS Geographic Variation Public Use File) Healthy Lives 34 Mortality amenable to health care, deaths per 0,000 population - - CDC NVSS: Mortality Restricted Use File 35 Years of potential life lost before age 5 CDC NVSS: WISQARS 36 Breast cancer deaths per 0,000 female population CDC NVSS: WONDER 3 Colorectal cancer deaths per 0,000 population CDC NVSS: WONDER 38 Suicide deaths per 0,000 population CDC NVSS: WONDER 3 Infant mortality, deaths per 1,000 live births CDC NVSS: WONDER 40 Adults ages 64 who report fair/poor health or activity limitations because of physical, mental, or emotional problems BRFSS 41 Adults who smoke BRFSS 42 Adults ages 64 who are obese (BMI >= ) BRFSS 43 Children ages who are overweight or obese (BMI >= 85th percentile) a / NSCH 44 Adults ages 64 who have lost six or more teeth because of tooth decay, infection, or gum disease BRFSS Note: (a) Previous data not available or its definition is not comparable over time. Note: (a) Previous data not available or its definition is not comparable over time. commonwealthfund.org March

3 APPENDIX A2. List of 44 Indicators in the State Scorecard on Health System Performance Indicator Access and Affordability Baseline Scorecard Baseline Scorecard Range of state performance Baseline Scorecard Scorecard 1 Adults ages 64 uninsured MA 2 Children ages 0 uninsured MA 3 Adults who went without care because of cost in the past year - - IA Best state(s) a 4 Individuals with high out-of-pocket medical spending b - b b - DC, DE, MD, MN, VT 5 At-risk adults without a doctor visit DC, RI 6 Adults without a dental visit in past year - - SD, VT Prevention and Treatment Adults with a usual source of care MA 8 Adults with age- and gender-appropriate cancer screenings MA Adults with age-appropriate vaccines SD Children with a medical home b / b 54 b 45-6 VT Children with a medical and dental preventive care visit in the past year b / b 68 b VT Children who received needed mental health care in the past year b / b 61 b ND Children ages 35 months with all recommended vaccines CT Elderly patients who received a high-risk prescription drug - - MN Elderly patients who received a contraindicated prescription drug - - VT Medicare patients experienced good communication with provider MN, VT Hospital -day mortality 0/ - 06/ 0/ - 06/ DE Central line-associated bloodstream infections (CLABSI), Standardized Infection Ratio HI Hospital discharge instructions for home recovery ID, NH, UT, VT, WI Patient-centered hospital care ID, SD Home health patients who get better at walking or moving around AL Home health patients whose wounds healed after an operation RI High-risk nursing home residents with pressure sores Nursing home residents with an antipsychotic medication Avoidable Hospital Use and Cost (Q2-Q4) (Q2-Q4) (Q2-Q4) (Q2-Q4) AK, ID, NH HI Hospital admissions for pediatric asthma, per 0,000 children VT Medicare admissions for ambulatory care sensitive conditions, ages HI Medicare admissions for ambulatory care sensitive conditions, age 5 and older HI 2 Medicare -day hospital readmissions, per 1,000 beneficiaries HI Short-stay nursing home residents with a -day readmission to the hospital - - AK 2 Long-stay nursing home residents with a hospital admission HI Home health patients with a hospital admission HI Potentially avoidable ED visits among Medicare beneficiaries, per 1,000 beneficiaries HI 32 Total reimbursements per enrollee (ages 64) with employer-sponsored insurance $4,48 $4, AR 33 Total Medicare (Parts A & B) reimbursements per enrollee $8,854 $8, HI Healthy Lives Data years represented U.S. average rate 34 Mortality amenable to health care (deaths per 0,000 population) MN 35 Years of potential life lost before age 5 6,4 6, MN 36 Breast cancer deaths per 0,000 female population ND 3 Colorectal cancer deaths per 0,000 population WY 38 Suicide deaths per 0,000 population DC 3 Infant mortality, deaths per 1,000 live births MA 40 Adults with poor health-related quality of life MN, ND 41 Adults who smoke UT 42 Adults who are obese CO 43 Children who are overweight or obese b / b b - 40 UT 44 Adults who have lost six or more teeth UT Notes: (a) Multiple states may be listed in the event of ties. (b) Previous data not available or its definition is not comparable over time. Indicates change between baseline and current time periods of at least 0.5 standard deviations (see Scorecard Methods). commonwealthfund.org March

4 APPENDIX A3. Change in State Health System Performance by Indicator Indicator (arranged by number of states with improvement within dimension) Access and Affordability 0 Adults ages 64 uninsured Adults who went without care because of cost in the past year Children ages 0 uninsured At-risk adults without a doctor visit Adults without a dental visit in past year Prevention and Treatment Home health patients who get better at walking or moving around Elderly patients who received a high-risk prescription drug Nursing home residents with an antipsychotic medication Elderly patients who received a contraindicated prescription drug Hospital discharge instructions for home recovery Children ages 35 months with all recommended vaccines Central line-associated bloodstream infections (CLABSI), Standardized Infection Ratio Adults with age-appropriate vaccines High-risk nursing home residents with pressure sores Adults with a usual source of care Medicare patients experienced good communication with provider Home health patients whose wounds healed after an operation Patient-centered hospital care Adults with age- and gender-appropriate cancer screenings Hospital -day mortality 1 Avoidable Hospital Use and Cost Medicare -day hospital readmissions, per 1,000 beneficiaries Short-stay nursing home residents with a -day readmission to the hospital Hospital admissions for pediatric asthma, per 0,000 children Medicare admissions for ambulatory care sensitive conditions, age 5 and older Potentially avoidable ED visits among Medicare beneficiaries, per 1,000 beneficiaries Long-stay nursing home residents with a hospital admission 5 Medicare admissions for ambulatory care sensitive conditions, ages Home health patients with a hospital admission 4 Total reimbursements per enrollee (ages 64) with employer-sponsored insurance 2 Total Medicare (Parts A & B) reimbursements per enrollee Healthy Lives Adults who smoke Breast cancer deaths per 0,000 female population Colorectal cancer deaths per 0,000 population Infant mortality, deaths per 1,000 live births Adults who have lost six or more teeth Adults who are obese 3 Adults with poor health-related quality of life 3 Suicide deaths per 0,000 population 1 Mortality amenable to health care Years of potential life lost before age 5 Number of states that: Improved a No Change b Worsened a Notes: Only Scorecard indicators with trends are shown. Trend data generally reflect the two-year period ending in or refer to Appendix A1 for additional detail (trend data were not available for all indicators). ACS = ambulatory care sensitive. ACS conditions among Medicare beneficiaries are displayed here separately for two age ranges, but counted as a single indicator in tallies of improvement. (a) Improvement or worsening refers to a change between the baseline and current time periods of at least 0.5 standard deviations. (b) Includes the number of states with no change or without sufficient data for this subpopulation to assess change over time. commonwealthfund.org March

5 APPENDIX A4. National Cumulative Impact If All States Acheived Top State Rate Indicator Insured adults,382,605 Insured children 3,,26 If all states improved their performance to the level of the best-performing state for this indicator, then: more adults (ages 64) would be covered by health insurance (public or private), and therefore would be more likely to receive health care when needed. more children (ages 0 ) would be covered by health insurance (public or private), and therefore would be more likely to receive health care when needed. Went without care because of cost,688,32 fewer adults (age and older) would go without needed health care because of cost. High out-of-pocket medical spending,852,88 fewer individuals would be burdened by high out-of-pocket spending on medical care. Adult usual source of care,, Adult cancer screening,36,48 more adults (age and older) would have a usual source of care to help ensure that care is coordinated and accessible when needed. more adults would receive age- and gender-appropriate recommended cancer screenings, including tests for colon, breast, and cervical cancers. Adult vaccines,8,850 more adults would receive age- appropriate recommended vaccines. Children with a medical home,, more children (ages 0 ) would have a medical home to help ensure that care is coordinated and accessible when needed. Children vaccines 5, more children (ages 35 months) would receive all recommended vaccines. Children with preventive medical and dental visits,6,054 more children (ages 0 ) would receive annual preventive medical and dental care visits each year. Medicare received a high-risk drug 1,066,0 fewer Medicare beneficiaries would receive an inappropriately prescribed medication. Preventable hospital admissions among children 5,0 fewer children (ages 2 ) would be hospitalized for asthma exacerbations. Hospital readmissions 4,833 fewer hospital readmissions would occur among Medicare beneficiaries (age 65 and older). Potentially avoidable emergency department visits 1,46,533 Mortality amenable to health care 0,032 fewer emergency department visits for nonemergent or primary care treatable conditions would occur among Medicare beneficiaries. fewer premature deaths (before age 5) might occur from causes that are potentially treatable or preventable with timely and appropriate health care. Breast cancer deaths,4 fewer women would die from breast cancer. Colon cancer deaths,842 fewer individuals would die from colon cancer. Suicides,581 fewer individuals would take their own lives. Infant mortality,08 more infants would live to see their first birthday. Adults who smoke,584,5 fewer adults would smoke, reducing their risk of lung and heart disease. Adults who are obese,53,3 Children who are overweight or obese 3,0,24 fewer adults would be obese, with body weights that increase their risk for disease and long-term complications. fewer children (ages ) would be overweight or obese, thus reducing the potential for poor health as they transition into adulthood. Adults with tooth loss,80,400 fewer adults (ages 64) would have lost six or more teeth to decay, infection, or gum disease. commonwealthfund.org March

6 APPENDIX B1. Summary of State Rankings in Current and Previous Scorecards Access and Affordability dimension Scorecard rankings Prevention and Treatment dimension Avoidable Use and Cost dimension Healthy Lives dimension Overall ranking in the baseline Scorecard overall ranking b State Overall ranking Equity dimension time period a Alabama Alaska Arizona Arkansas California 35 5 Colorado Connecticut Delaware 5 District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas 2 Kentucky Louisiana Maine 2 Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey 45 New Mexico New York 32 6 North Carolina North Dakota Ohio Oklahoma Oregon 35 3 Pennsylvania 2 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington 5 West Virginia Wisconsin 2 Wyoming Notes: (a) The baseline period generally reflects two years prior to the time of observation for the latest year of data available. (b) The Scorecard Ranking is not based on the same set of indicators used to calculate the Scorecard and Scorecard Baseline rankings. Rather, it represents the time period evaluated in the Scorecard, generally encompassing the years. commonwealthfund.org March

7 APPENDIX B2. Summary of Indicator Rankings by State Overall ranking State No. of indicators scored (of 44) Top 5 states Top quartile 2nd quartile 3rd quartile Bottom Bottom 5 quartile states No. of indicators with trend (of 3) No. of indicators improved No. of indicators worsened 4 Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Net change Notes: Improvement or worsening refers to a change between the baseline and current time periods of at least 0.5 standard deviations. Ambulatory care sensitive conditions among Medicare beneficiaries are displayed here separately for two age ranges, but counted as a single indicator in tallies of improvement. commonwealthfund.org March

8 APPENDIX C1. Access & Affordability: Dimension and Indicator Ranking Overall performance Top quartile Second quartile Third quartile Bottom quartile Data not available Uninsured adults (ages 64) Uninsured children (ages 0 ) Went without care because of cost High out-of-pocket medical spending At-risk adults without a doctor visit 1 Vermont Massachusetts Minnesota Rhode Island Connecticut Delaware District of Columbia Iowa Hawaii Maryland New Hampshire Pennsylvania Michigan New York Wisconsin New Jersey Ohio Illinois Kentucky Washington Maine Virginia Colorado California West Virginia Kansas South Dakota Nebraska Oregon North Dakota Missouri North Carolina Indiana Alabama Wyoming South Carolina Montana New Mexico Tennessee Utah Alaska Florida Georgia Louisiana Arizona Arkansas Idaho Nevada Mississippi Oklahoma Texas No dental visit in past year commonwealthfund.org March

9 APPENDIX C2. Access & Affordability: Dimension Ranking and Indicator Rates Adults ages 64 uninsured Children ages 0 uninsured Adults who went without care because of cost in the past year Individuals with high outof-pocket medical spending At-risk adults without a doctor visit Adults without a dental visit in past year - United States % % 8% 5% % % % % % % % Alabama 5 3 Alaska Arizona Arkansas 6 5 California 8 4 Colorado 4 Connecticut Delaware 8 5 District of Columbia Florida 2 Georgia Hawaii Idaho 6 Illinois 5 3 Indiana Iowa 5 4 Kansas 5 Kentucky Louisiana 6 4 Maine 5 6 Maryland Massachusetts Michigan 5 3 Minnesota Mississippi 8 5 Missouri 6 Montana Nebraska 6 5 Nevada 2 8 New Hampshire 4 4 New Jersey New Mexico 5 New York 4 3 North Carolina 6 5 North Dakota 8 8 Ohio 5 4 Oklahoma 8 Oregon 4 Pennsylvania 5 4 Rhode Island South Carolina 4 South Dakota 8 8 Tennessee 6 4 Texas Utah 8 Vermont 6 8 Virginia 6 5 Washington 3 West Virginia Wisconsin Wyoming Change 4 3 States Improved States Worsened Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Indicates that estimates are not available. Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Indicates that estimates are not available. commonwealthfund.org March

10 APPENDIX D1. Prevention & Treatment: Dimension and Indicator Ranking Overall performance Top quartile Second quartile Third quartile Bottom quartile Data not available Adults with a usual source of care Adults with recommended cancer screening Adults with recommended vaccines Children with a medical home Child medical and dental visit Children received needed mental health care Children ages 35 months with all recommended vaccines Medicare beneficiaries received a high-risk drug 1 Vermont Massachusetts Rhode Island New Hampshire Connecticut Iowa Maine Minnesota Wisconsin Delaware Pennsylvania South Dakota North Dakota Colorado Hawaii Maryland Michigan Nebraska District of Columbia Kansas New Jersey Ohio Illinois New York North Carolina Virginia Washington West Virginia Idaho Kentucky Utah Missouri Wyoming Indiana California Montana Oregon Oklahoma Tennessee Arkansas South Carolina Alabama Louisiana Florida Georgia Texas Arizona New Mexico Alaska Mississippi Nevada Medicare beneficiaries received a contraindicated drug Medicare patients experience communication with pro Hospital - Notes: SIR = Standardized Infection Ratio. commonwealthfund.org March

11 APPENDIX D1. Prevention & Treatment: Dimension and Indicator Ranking (continued) icator Ranking Overall performance Top quartile Second quartile Third quartile Bottom quartile Data not available ental visit hildren received needed mental health care Children ages 35 months with all recommended vaccines Medicare beneficiaries received a high-risk drug Medicare beneficiaries received a contraindicated drug Vermont Massachusetts Rhode 1 Island New 2Hampshire Connecticut Iowa Maine Minnesota Wisconsin Delaware Pennsylvania South 1 Dakota North 1 Dakota Colorado Hawaii Maryland Michigan Nebraska District of 2 Columbia Kansas New Jersey Ohio Illinois New York North 4 Carolina Virginia Washington West 3 Virginia Idaho Kentucky Utah Missouri Wyoming Indiana California Montana Oregon Oklahoma Tennessee Arkansas South 4 Carolina Alabama Louisiana Florida Georgia Texas Arizona New 3 Mexico Alaska Mississippi Nevada Notes: SIR = Standardized Infection Ratio. Notes: () SIR is Standardized Infection Ratio Hospital -day mortality Medicare patients experienced good communication with provider Central Line-associated Blood Stream Infection (CLABSI), SIR Hospital discharge instructions for home recovery Hospitalized adults received patientcentered care Home health patients better at walking or moving around High-risk nursing home residents with pressure sores Home health patients whose wounds healed after an operation Nursing home residents with an antipsychotic medication commonwealthfund.org March

12 APPENDIX D2. Prevention & Treatment: Dimension Ranking and Indicator Rates Adults with a usual source of care Adults with age- and gender-appropriate cancer screenings Adults with ageappropriate vaccines Children with a medical home Children with a medical and dental preventive care visit in the past year Children who received needed mental health care in the past year Children ages 35 months with all recommended vaccines Medicare benefic received a high drug / / / United States 6% 8% 6% 68% 36% 38% 54% 68% 61% 0% 2% Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Change 33 States Improved 6 States Worsened 0 2 Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Indicates that estimates are not available. Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Indicates that estimates are not available. commonwealthfund.org March

13 APPENDIX D2. Prevention & Treatment: Dimension Ranking and Indicator Rates (continued) n d l re st Children ages 35 months with all recommended vaccines Medicare beneficiaries received Adults a with high-risk a usual source drugof care Medicare Adults with beneficiaries age- and gender-appropriate received a Medicare patients experienced good communication Adults with age-witappropriate Children with a medical Hospital -day provider vaccines contraindicated cancer screenings drug homemortality 2 0/ - 06/ 0% United States 2% % % % % 6% 6%.2%.5% % 8% 68% Alabama Alaska 64 Arizona 65 Arkansas 5 California 6 Colorado 6 Connecticut 8 Delaware District of Columbia Florida 0 Georgia 0 Hawaii 6 Idaho 0 Illinois 6 Indiana 6 Iowa 8 Kansas 6 Kentucky 3 Louisiana 6 Maine 68 Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New 5 Hampshire New 3 Jersey New 66 Mexico New 2 York North 2 Carolina North 2 Dakota Ohio Oklahoma Oregon Pennsylvania Rhode 82 Island South 6 Carolina South 4 Dakota Tennessee Texas Utah Vermont Virginia Washington West 66 Virginia Wisconsin Wyoming Change States Improved States Worsened Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Indicates that estimates are not available. Children who received Central lineassociated needed bloodstream mental Children ages 35 infections health care (CLABSI), months Hospital with all discharge Medicare Hospita benefic in Standardized the past recommended instructions for home received receive a high Infection year Ratio vaccines recovery drug cente 0/ - 06/ Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Indicates that estimates are not available. commonwealthfund.org March

14 APPENDIX D2. Prevention & Treatment: Dimension Ranking and Indicator Rates (continued) - BSI), d io Hospital discharge instructions for home recovery Home health patients Hospitalized adults Adults who with get age- better and at Children Home health patients with High-risk a nursing Adults received with patient-centered usual gender-appropriate walking or moving Adults whose with wounds age- healed medical home residents with of care source cancer screenings around appropriate after an vaccines operation homepressure sores.50 United 86% States8% 68% 68% 61% 66% 8% 0% 6% 6% % %.1.65 Alabama 85 Alaska Arizona Arkansas 83 California 84 Colorado Connecticut Delaware District 8 of Columbia Florida Georgia 84 Hawaii Idaho88 Illinois 86 Indiana Iowa Kansas 86 Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New 88 Hampshire New 82 Jersey New 84 Mexico New 84 York North 8Carolina North 82Dakota Ohio Oklahoma Oregon Pennsylvania Rhode 86Island South 86Carolina South 8Dakota Tennessee Texas Utah Vermont Virginia Washington West 85 Virginia Wisconsin Wyoming (Q2-Q4) (Q2-Q4) Change States Improved States Worsened Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Indicates that estimates are not available. Children who received needed mental Nursing home Children ages 35 health residents care with an months with all in the antipsychotic past recommended year medication vaccines (Q2-Q4) (Q2-Q4) Medicare benefic received a high drug Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Indicates that estimates are not available. commonwealthfund.org March

15 APPENDIX E1. Avoidable Hospital Use & Cost: Dimension and Indicator Ranking Overall performance Top quartile Second quartile Third quartile Bottom quartile Data not available Hospital admissions for pediatric asthma (per 0,000 children) Medicare admissions for ambulatory care sensitive conditions, ages 65 4 Medicare admissions for ambulatory care sensitive conditions, age 5 and older Medicare -day readmissions Short-stay nursing home residents with a readmission within days Long-stay nursing home residents with a hospital admission Home health patients with a hospital admission Medicare avoidable emergency department visits Employer-sponsored insurance spending per enrollee 1 Hawaii Idaho Oregon Utah Montana Washington Arizona Colorado New Mexico Minnesota South Dakota Alaska Vermont California Nebraska North Dakota Wisconsin Iowa Nevada Maine Rhode Island North Carolina Georgia South Carolina Virginia Wyoming New Hampshire Delaware Maryland Kansas Pennsylvania District of Columbia Missouri New York Ohio Indiana Tennessee Texas Connecticut Massachusetts Alabama Arkansas Illinois Michigan Florida New Jersey Oklahoma Louisiana West Virginia Kentucky Mississippi Medicare spending per beneficiary commonwealthfund.org March

16 APPENDIX E2. Avoidable Hospital Use & Cost: Dimension Ranking and Indicator Rates Hospital admissions for pediatric asthma, per 0,000 children Medicare admissions for ambulatory care sensitive conditions, ages 65 4 Medicare admissions for ambulatory care sensitive conditions, age 5 and older Medicare -day hospital readmissions, per 1,000 beneficiaries Short-stay nursing home residents with a -day readmission to the hospital Long-sta home resid hospital United States % % Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico 5 56 New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island 2 66 South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 2 32 Change 4 34 States Improved 4 34 States Worsened Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Spending estimates exclude prescription drug costs and are adjusted fo estimates are not available. Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Spending estimates exclude prescription drug costs and are adjusted for regional wage differences; Medicare estimates reflect only the age 65+ fee-for-service Medicare population. Indicates that estimates are not available. commonwealthfund.org March

17 cator Rates APPENDIX E2. Avoidable Hospital Use & Cost: Dimension Ranking and Indicator Rates (continued) ns, ies Short-stay nursing home residents with a -day readmission to the hospital Medicare admissions Medicare admissions Potentially for ambulatory avoidable Total reimbursements Short-stay nursing Long-stay Hospital admissions nursing for Home health for ambulatory patients ED visits care sensitive among per enrollee Medicare (ages -day Total home Medicare residents (Parts with A a home pediatric residents asthma, with a per with care sensitive a hospital Medicare conditions, beneficiaries, age 5 and 64) hospital with readmissions, employersponsored per 1,000 insurance beneficiaries per the enrollee & -day B) reimbursements readmission to hospital 0,000 admission children conditions, admission ages 65 4 per 1,000 beneficiaries older hospital Long-sta home resid hospital % United States % % % 8 5 $4,48 $4,56 $8,854 $8,8 Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware ,634,33 4, 3,0 4,52 4,45 5, 4,43 3,6,82 4,2 3,2 4,6 4,68 5,6 4,388,344 5,3,8 8,6 8,3,460 8,36 8,5,2 6,1, 8,652 8,346,4,0 8,53 District of Columbia 8 5 3,56 3,6 8,88 8,633 Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland ,45 4,61 3,0 3,02 4,48 4,8 3,8 3,65 4,0 3,852 4,1 3,603 4,5 3,3 3,5 3,34 4,64 4,46 4,035 4,052 4,3 3,84 4,333 3,638,5 8,43 5,408,8,,045,46 8,586,,868,606 8,42,434 8,665 5,52,365,8 8,1,638 8,6,05,6,6 8,2 Massachusetts 5 4,43 4,5,041 8,82 Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada ,852 4,450 3,5 4,002 4,21 4,3 4,048 3,83 4,60 3,4 3,33 4,333 4,5 4,0,565,5,046 8,68 6,585 8,062 8,3,551,4,885 8,35 6,62 8,2 8,404 New Hampshire 2 0 5,1 5,,6,686 New Jersey New Mexico New York ,50 3,6 5,05 4,8 3, 5,0,556 6,1 8,,560 6,38 8,5 North Carolina 5 4,346 4,1 8,8 8,21 North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island ,6 4,5 4, 4,46 4,3 3,86 4,438 4,333 4,0 4,43 4,5 3,2,52,42,2 6,0, 8,55,,3, 6,5,2 8,6 South Carolina ,52 8,45 South Dakota ,41 4,,4,4 Tennessee ,03 3 3,6 2,,0 Texas , 34 5,0 2,5 20,2 Utah ,2 4,343 8,0,80 Vermont ,8 4,8 6,8 6,88 Virginia , ,2 32 8,000, Washington ,5 4,35,6,5 West Virginia , , ,63 8,5 Wisconsin ,68 5,85,6,640 Wyoming 2 5 5, 32 5,46 6,8 6,866 Change States Improved States Worsened clude prescription Notes: drug Denotes costs a and change are adjusted of at least for 0.5 regional standard wage deviations. differences; Denotes Medicare a estimates change of reflect 1.0 standard only the deviation age 65+ or Medicare more. Spending fee-for-service estimates population. exclude prescription Indicates drug that costs and are adjusted fo estimates are not available. Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Spending estimates exclude prescription drug costs and are adjusted for regional wage differences; Medicare estimates reflect only the age 65+ fee-for-service Medicare population. Indicates that estimates are not available. commonwealthfund.org March

18 APPENDIX F1. Healthy Lives: Dimension and Indicator Ranking Overall performance Top quartile Second quartile Third quartile Bottom quartile Data not available Mortality amenable to health care (deaths per 0,000 population) Years of potential life lost before age 5 Colorectal cancer deaths (per 0,000 population) Breast cancer deaths (per 0,000 female population) Suicide deaths (per 0,000 population) Infant mortality (per 1,000 live births) Adults with poor health-related quality of life Adults who smoke Adults who are obese Children who are overweight or obese 1 Connecticut Minnesota Massachusetts Utah California Colorado Hawaii Vermont New Jersey Washington New York Rhode Island New Hampshire Idaho Iowa Oregon Wisconsin Nebraska Wyoming Florida Maryland North Dakota Virginia Arizona Illinois Texas Maine Pennsylvania Montana Delaware Kansas South Dakota District of Columbia Alaska New Mexico Nevada North Carolina Michigan Ohio Georgia Missouri Indiana South Carolina Tennessee Alabama Kentucky Oklahoma Arkansas Louisiana Mississippi West Virginia Adults who have lost six or more teeth commonwealthfund.org March

19 APPENDIX F2. Healthy Lives: Dimension Ranking and Indicator Rates Mortality amenable to health care Years of potential life lost before age 5 Breast cancer deaths per 0,000 female population Colorectal cancer deaths per 0,000 population Suicide deaths per 0,000 population - - United States ,4 6, Alabama. 1.,3, Alaska ,4, Arizona ,60 6, Arkansas , 8, California ,8 5, Colorado ,538 5, Connecticut ,6 4, Delaware ,4 6, District of Columbia ,8, Florida ,556 6, Georgia ,66, Hawaii ,445 5, Idaho ,80 6, Illinois ,1 6, Indiana ,342, Iowa ,4 5, Kansas..0 6,643 6, Kentucky ,86 8, Louisiana ,52, Maine ,8 6, Maryland ,4 6, Massachusetts ,82 5, Michigan ,, Minnesota , 4, Mississippi ,6, Missouri ,48, Montana ,63 6, Nebraska ,01 5, Nevada ,658 6, New Hampshire ,0 5, New Jersey ,3 5, New Mexico ,8 8, New York , 5, North Carolina ,02, North Dakota ,43 6, Ohio ,2, Oklahoma ,, Oregon , 5, Pennsylvania , 6, Rhode Island ,54 5, South Carolina.4.8,62 8, South Dakota ,83 6, Tennessee ,464 8, Texas ,45 6, Utah , 5, Vermont ,2 5, Virginia ,65 5, Washington ,3 5, West Virginia ,44, Wisconsin ,66 5, Wyoming ,046, Change States Improved States Worsened Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. Notes: Denotes a change of at least 0.5 standard deviations. Denotes a change of 1.0 standard deviation or more. commonwealthfund.org March