Texas Health Care Quality & Efficiency

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Inefficiencies Drive Up Health Care Costs

On the Commonwealth Fund’s State Scorecard “avoidable health costs” dimension – a measure that speaks to efficiency within the health care system – Texas ranked 48th overall. Texas came up amongst three other states (Maryland, Nevada and Louisiana) with the highest proportion of Medicare patients readmitted to the hospital within 30 days, a finding that the study shows “could be a key indicator of underlying care patterns that increase costs.”[1] In fact, total annual Medicare costs in the five states with the highest 30-day readmissions (Texas included) have average Medicare costs 38 percent higher than those states with the lowest readmission rates.[2] Texas also reappeared amongst the states with the highest rates of admission and readmission among nursing home residents.[3]

 

The last dimension measured by the Commonwealth Fund’s State Scorecard was “healthy lives” which refers to measures of mortality and disease prevalence. Here, the state received an average ranking (24th) and was above the state median on all but one dimension – mortality amenable to health care.[4] To see the full state scorecard for Texas or any other state, visit www.commonwealthfund.org/statescorecard, and use the interactive map to view scorecard results for each state. In addition the chart below from the Commonwealth Fund's Scorecard on Texas presents a unique look at how Texas would have fared if it performed as the top state for each of the dimensions. Because Texas has such a large population and such a high uninsured rate, Texas statistics skew those for the country as a whole. If Texas’ performance were to improve to the level of the best-performing state, according to the Commonwealth Fund State Scorecard, 2,680,422 adults and 965,127 children would have health insurance,[5] bringing down the country’s overall uninsured rate by one percentage point.

 

Estimated Impact of Improving Texas' Performance

Source: “State Scorecard: Texas.” The Commonwealth Foundation. 30 July 2007 <http://www.commonwealthfund.org/statescorecard/statescorecard_show.htm?doc_id=496088>.

 

The table shows the estimated impact if this state's performance improved to the rate of the best-performing state for 11 Scorecard indicators. These examples illustrate only a few important opportunities for improvement in a state. Because some indicators affect the same individuals, these numbers should not be added.

Indicator

If TEXAS's performance improved to the level of the best-performing state for this indicator, then:

Insured Adults

2,680,422

more adults (ages 18-64) would be covered by health insurance (public or private), and therefore would be more likely to receive health care when needed.

Insured Children

965,127

more children (ages 0-17) would be covered by health insurance (public or private), and therefore would be more likely to receive health care when needed.

Adult Preventive Care

877,920

more adults (ages 50 and older) would receive recommended preventive care, such as colon cancer screenings, mammograms, pap smears, and flu shots at appropriate ages.

Diabetes Care

385,903

more adults (ages 18 and older) with diabetes would receive three recommended services (eye exam, foot exam, and hemoglobin A1c test) to help prevent or delay disease complications.

Childhood Vaccinations

83,012

more children (ages 19-35 months) would be up-to-date on all recommended doses of five key vaccines.

Adults with a Usual Source of Care

2,763,107

more adults (ages 18 and older) would have a usual source of care to help ensure that care is coordinated and accessible when needed.

Children with a Medical Home

1,309,645

more children (ages 0-17) would have a medical home to help ensure that care is coordinated and accessible when needed.

Preventable Hospital Admissions

84,322

fewer preventable hospitalizations for ambulatory care sensitive conditions would occur among Medicare beneficiaries (age 65 and older) and

$437,484,000

dollars would be saved from the reduction in hospitalizations.

Hospital Readmissions

19,855

fewer hospital readmissions would occur among Medicare beneficiaries (age 65 and older) and

$250,304,000

dollars would be saved from the reduction in readmissions.

Hospitalization of Nursing Home Residents

10,770

fewer long-stay nursing home residents would be hospitalized and

$106,821,000

dollars would be saved from the reduction in hospitalizations.

Mortality Amenable to Health Care

7,505

fewer premature deaths (before age 75) might occur from causes that are potentially treatable or preventable with timely and appropriate health care.

NOTES: Estimates of improvements in state performance were calculated as follows: for each indicator, the difference between the best-performing state's rate and the subject state's rate was multiplied by the applicable subpopulation of individuals in the subject state. (For the readmissions indicator, the difference in rates was multiplied by the applicable number of Medicare hospitalizations in the subject state.) Medicare cost-savings from reduced hospitalizations were calculated using the average cost of the applicable hospitalizations in the subject state. Calculations do not account for potentially interactive effects of indicators (e.g., insurance coverage increases the likelihood of having a usual source of care and receiving preventive care).



24 %



14 %



15 %


[1] Ibid.

[2] “Aiming Higher: Results from a State Scorecard on Health System Performance,” The Commonwealth Fund Commission on a High Performance Health System, June 2007: p.34, 23 June 2007 <http://www.commonwealthfund.org/usr_doc/StateScorecard.pdf?section=4039>.

[3] Ibid.

[4] “State Scorecard: Texas,” The Commonwealth Foundation.

[5] Ibid.

 

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