50 States/50 Levels of Quality Care

Some of the leading states set new benchmarks for 20 of the 35 indicators with trends. These patterns indicated that public policies at the state and local levels could make a difference, according to the report. Vermont, Maine, and Massachusetts, for example, have enacted comprehensive reforms to expand coverage.

And Minnesota proved to be a leader in bringing together public- and private sector stakeholders in collaborative initiatives to improve the overall value of healthcare, Nuzum said. This is an approach that appears to be gaining ground in other states.

Other highlights of the report:

• The quality of hospital care for heart attack, heart failure, pneumonia, and the prevention of surgical complications improved sharply, as all states gained ground and the variation across states narrowed. The improvement takes into account the impact of national efforts by Medicare to measure and benchmark performance.
• Key indicators of nursing home and home healthcare quality improved in nearly all states, with declines in rates of pressure ulcers, physical restraints, and pain for nursing home residents and improved mobility for home care patients.
• Ambulatory care quality indicators, including preventive care, changed little or declined in half the states, with wide gaps persisting across states.
• In many states, symptoms of poor care coordination and continued inefficiency in the use of resources are evident in the increasing rates of hospital readmissions.
• And, in most states, increases in hospital admissions have occurred and readmissions from nursing homes, as well as hospital admissions for home healthcare patients. These indicators point to a lack of incentives for effective transitional care and care management, the report noted.

"There's been a lot of talk of international models. We think there is a lot of value to that. But at the same time, we know we're in a kind of uniquely American situation here with the way that our system is constructed," Nuzum said. "And some really innovative creative things are happening at the state level."