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Joel C. Cantor, Rutgers

The performance of Tennessee’s health system won’t get a standing ovation.

That’s according to the Commonwealth Fund Commission, which in June released a state-by-state scorecard assessing access, quality, avoidable hospital use and costs, equity and healthy lives. Tennessee ranked 40th.

“There’s tremendous room to improve. Every state has different situations and different resources, so the way they can improve might be different,” explained Joel C. Cantor, one of the authors of “Aiming Higher: Results from a State Scorecard on Health System Performance.” A professor of public policy at Rutgers in New Jersey, Cantor is also the director of the university’s Center for State Health Policy.

The report comes on the heels of the “National Scorecard on U.S. Health System Performance,” published in 2006 by the Commonwealth Fund, a private foundation that supports independent research on healthcare and promotes improved healthcare access, quality and efficiency, particularly for society’s most vulnerable. “The state scorecard is a first shot at trying to take a comprehensive view of health-system performance, but it has more gaps in measures (than the national study) simply because of data availability. So it’s slightly less comprehensive,” Cantor said. For the statewide assessments, researchers compiled data for 32 different indicators and then sorted them into the five “dimensions.”

“Much of the information comes right out of official government reports, for example, Medicare claims data. Some comes from data that hospitals report to the government. Other measures come out of surveys,” Cantor said.

Summary information from the report was distributed to state governors’ offices, Congressional delegations and the Commonwealth Fund’s extensive distribution networks. “Of course, when you put out something of this scope, you worry about how people will receive it,” he acknowledged. “Even in states that have done fairly poorly, we have heard people on the ground delivering healthcare in those places say, ‘Yeah. This seems right to us.’ So it passes the sniff test, if you will, the reality check.”

Tennessee ranked 26th in access, 26th in quality, 42nd in avoidable hospital use and costs, 27th in equity and 42nd in healthy lives, a category that examined death rates and preventable mortality. Tennessee ranked 47th in infant mortality.

Only 40 percent of Tennessee adults age 50 and older receive recommended screenings and preventive care, according to the study. “That is sort of shockingly low. These are things that everybody should get in that age range,” Cantor said. “But the truth is, the best state only had 50 percent. So, there is room for everybody to improve on that measure.”

Then Cantor continued, “On other measures, there’s a bigger gap between where Tennessee comes out and the best states. We think that Tennessee can look to other states that provide examples.”

Tennessee’s rate is nearly 10,000 admissions for every 100,000 seniors in the category of number of hospitalizations in the Medicare population for conditions like diabetes that shouldn’t lead to hospitalization at all if they are treated well on an ambulatory basis. The best state has 4,000 admissions. “So it’s more than twice the rate of the best state. On that particular indicator, Tennessee ranks 47th,” Cantor said. “So it’s worth asking, ‘How are we doing in terms of providing good, comprehensive management of chronic illnesses in the ambulatory setting and the doctor’s office? How well are we able to prevent people from having those acute episodes that lead to hospitalization?’ That’s an area where Tennessee is doing worse than the nation, and it’s even low for the region.”

Cantor said he has followed Tennessee’s trials and tribulations with TennCare, which was founded with the aim of some insurance for all. “I’m sure you know better than I that TennCare didn’t achieve all it had hoped, and the funding just wasn’t there to sustain it,” Cantor said. “You do pretty well in covering kids — 90 percent is good — but that ranks you only 31st, because there are many states that do much better. The best state does 95 percent of the children. It’s not a huge gap, but you want to insure all kids. That’s generally the goal in most places.”

Tennessee does worse for adults, with about 81 percent covered while the best state almost reaches 90 percent. “I know TennCare was intended to do that, but it didn’t quite get there,” he said.

Cantor said he hopes that state decision makers “will take a hard look at the data and look to their neighbors around the nation for examples of how to improve.” He added, “States can learn from each other. Our aim is for the scorecard to help states set priorities.”



September 2007

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