The state scorecard released this week by the Commonwealth Fund (CF) ranks Iowa second in the country across key dimensions of health system performance.  Vermont was the highest ranking state, followed by Iowa and Hawaii, which tied for second.  Six of the 13 top-ranked states are located in the Upper Midwest.

 The new report, “Aiming Higher: Results from the 2009 State Scorecard on Health System Performance,” is a follow-up to CF’s 2007 state scorecard report; it ranks states on 38 indicators in the areas of access, quality, avoidable hospital use and costs, healthy lives and equity.  Iowa fell within the top quartile of states for 21 of the 38 measures.  Compared with 2007 results, Iowa improved 5 percent or more in 14 measures, worsened in seven measures and remained unchanged in 14 measures.

Poorly coordinated care and inefficient use of resources continue to undermine care and drive up costs in many state health care systems, according to the report.  States with higher medical costs tend to have higher rates of readmissions to the hospital and potentially preventable hospital admissions for chronic conditions like asthma and diabetes.

The report finds that Iowa and other Upper Midwestern states are all providing high quality care at lower cost.  “Their examples suggest that better coordinated care and more efficient use of resources could improve the quality of care people receive while keeping cost in check,” a CF statement concluded.

The scorecard points to substantial opportunities to improve.  If all states could reach the level achieved by the top-performing states like Iowa:

•  Nearly 78,000 fewer adults and children would die prematurely every year from conditions that could have been prevented with timely and effective health care.
•  Nine million more adults age 50 and older would receive recommended preventive care, and almost 800,000 more children would receive key vaccinations.
• Five billion dollars could be saved annually by avoiding preventable hospital admissions and readmissions for vulnerable elderly and disabled residents.
•  Twenty-nine million more people would have health insurance, cutting the number of uninsured by more than half.

“The differences we see among the states translate to real lives and dollars,” said CF President Karen Davis. “If we can enact health reforms that give all states the opportunity to do as well as the best states we will save lives, improve quality and cut costs.  And, the good news is that these aren’t pie-in-the-sky goals – we know they are attainable because we see it happening in the states at the top of the pack.”

The authors concluded that federal action is needed to raise the floor on performance levels across all states and create a supportive climate for state innovation.  If the health care system continues on its current course of rising costs and declining health insurance coverage, states will have an increasingly difficult time going it alone on providing access to affordable, quality health care.