by Bryan Thompson, KHI News Service
A review of health system performance nationwide shows some improvement in Kansas — but not much.
The report, released Thursday by the nonprofit Commonwealth Fund, covers three dozen indicators of access, quality, cost and health outcomes.
Most of the data used for the report is from 2011 to 2014, which is the first year the Affordable Care Act provided subsidized health insurance through the online marketplace for citizens who were not insured through an employer.
The report concludes that the ACA is largely responsible for many of the health system improvements as more people gained insurance and were able to obtain and better afford needed health care.
“Largely because of the ACA’s coverage expansions, the percentage of working-age adults without health insurance fell in nearly all local areas — dropping by four percentage points or more in 189 local areas between 2012 and 2014,” the report said. “In addition, 155 local areas saw substantial reductions in 30-day readmission rates for Medicare beneficiaries, coinciding with the ACA’s penalties for hospitals that have high readmission rates.”
Like the rest of the country, Kansas saw more measures improving than declining — but most of the state’s measures showed little or no change.
Doug McCarthy, co-author of the report, said Kansas is doing better than average in providing patient-centered care in hospitals, preventing pressure sores in nursing home residents and limiting readmission to hospitals from nursing homes. He sees room for improvement in access to care.
McCarthy said the researchers found that states where Medicaid eligibility was expanded had greater improvement in access to care than states without expansion, including Kansas and Missouri.
“In fact, we looked at communities where there’s a large proportion of individuals who are living on a low income, and those areas in particular did much better — about twice as much improvement there — as similar kinds of communities with a large low-income population in states that didn’t expand Medicaid,” he said.
But improving access to care goes beyond making sure people have insurance, McCarthy said.
“You have, I think, 50,000 more individuals covered through the marketplace in Kansas,” he said. “There’s still a lot of opportunity for local areas to help those individuals get connected to a primary care medical home and ensure they know how to navigate the health system, especially if they have cultural or linguistic barriers.”
The Kansas suicide rate worsened, McCarthy said, and its obesity and infant mortality rates remain worse than the national average.
The Kansas City region, including parts of Kansas and Missouri, had no indicators where health system performance worsened. That region had improved insurance rates for both children and adults. It also improved on several health care quality indicators for people with Medicare.
Overall, the Kansas City region ranked 172nd out of the 306 “hospital referral regions” the report compared. The Topeka region, which includes most of northeast Kansas outside the Kansas City area, ranked 124th. Almost all of the rest of Kansas is included in the Wichita region, which was 184th overall.
The 2016 report is a follow-up to a similar report issued in 2012. Statistics on each of the indicators from both time periods were compared to determine whether performance had improved, worsened or stayed about the same.
Report highlights include:
• The 2016 scorecard finds substantial differences among local health care systems, with those in Hawaii, the Upper Midwest, New England and the San Francisco area generally performing better than those in the South and West.
• Overall, health care systems in communities with large low-income populations generally do not perform as well as those in wealthier communities. People in poor communities are more likely to go without needed medical care because of the cost, receive a high-risk prescription drug and die early from treatable causes.
“Many communities are showing signs of getting healthier, and that is encouraging,” said Commonwealth Fund President David Blumenthal. “It shows that with the right policies and actions we can make our health care system work for all of us.”
The report calls on the nation to invest more to address social determinants of health — including income, nutrition and environmental conditions — and improve access to mental and behavioral health services.
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