Transforming The U.S. Health System:What Needs To Be Done & Your RoleStephen C. Schoenbaum, MD, MPHExecutive Vice President for Programswww.cmwf.org

Mountainside HospitalFebruary 8, 2007

What Well CoverIntroduction to The Commonwealth Fund and The Commission on a High Performance Health SystemGoals for a high performance health systemWhere we stand nowKeys to transforming the health systemWhat you can do

The Commonwealth FundEstablished in 1918, The Commonwealth Fund (www.cmwf.org) is a private national foundation that aims to promote a high performing health care system by supporting independent research on health care issues and making grants to improve health care practice and policy.

The Commonwealth Fund Commission on a High Performance Health SystemObjective:Move the U.S. toward a higher-performing health care system that achieves better access, improved quality, and greater efficiency, with particular focus on the most vulnerable due to income, gaps in insurance coverage, race and ethnicity, health, or age

Chairman: James J. Mongan, M.D.President and CEO Partners HealthCare System, Inc.

Goals for a High Performance Health SystemEFFICIENCYCAPACITY FOR SYSTEM AND WORKFORCE INNOVATION AND IMPROVEMENTLONG, HEALTHY, AND PRODUCTIVE LIVES

Scores: Dimensions of a High Performance Health SystemSOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006

Mortality Amenable to Health CareDeaths per 100,000 population*PercentilesInternational Variation, 1998State Variation, 2002Mortality from causes considered amenable to health care is deaths before age 75 that are potentially preventable with timely and appropriate medical care.LONG, HEALTHY & PRODUCTIVE LIVES

U.S. Adults Receive Half of Recommended Care; Quality Varies Significantly by Medical ConditionSource: E. McGlynn et al. 2003. "The Quality of Health Care Delivered to Adults in the United States," The New England Journal of Medicine 248(26): 26352645.Percent of recommended care received

Patients Reporting Any Error by Numberof Doctors Seen in Past Two YearsPercent2005 Commonwealth Fund International Health Policy Survey

Number of States with High Proportion of Uninsured Adults Ages 1864 Is Growing

Data: Two-year averages 19992000 and 20042005 from the Census Bureaus March 2000, 2001 and 2005, 2006 Current Population Surveys. Estimates by the Employee Benefit Research Institute.Source: The Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006ACCESS: UNIVERSAL PARTICIPATION

Quality and Costs of Care for Medicare Patients Hospitalized for Heart Attacks, Colon Cancer and Hip Fractures, by Hospital Referral Regions, 2000-2002Median Relative Resource Use = $25,995* Indexed to risk-adjusted 1 year survival rate (median = 0.70).** Risk-adjusted spending on hospital and physician services using standardized national prices.Data: E. Fisher and D. Staiger, Dartmouth College analysis of data from a 20% national sample of Medicare beneficiaries.Source: The Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006EFFICIENCY

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hrr

Relative Resource Use**

Quality of Care* (1 Year Survival Index, Median = 70%)

comb_LVC

NamehrrPERFORMANCEcost_amicost_ccacost_hipcost_combinationmortality_amiN_amimortality_ccaN_ccamortaloty_hipN_hipmortality_combinationN_combination

AL-Birmingham14272623005924398266130.3300925990.235443430.2936118590.30564801

AL-Dothan22215713229621526229110.325574360.16711620.270733030.28834801

AL-Huntsville52275662413224396260790.311845990.18609980.273744960.28621193

AL-Mobile64302102702423324272110.315356720.192871240.274515640.288031360

AL-Montgomery73288622951222208266460.342944530.17701770.314263260.31579856

AL-Tuscaloosa94219992440923519232550.302982280.27763490.200351790.26144456

AK-Anchorage101240501650118231215190.390412510.21582450.235391780.31618474

AZ-Mesa114250572755824342246200.323294170.28699820.296373760.31026875

AZ-Phoenix123314202813321694271970.3405815120.207782960.3091513780.317033186

AZ-Sun City143251962353627615257650.306013280.14819760.28313260.28451730

AZ-Tucson153288402426523356262840.336286890.248361210.265496110.299961421

AR-Fort Smith163248213474127009267070.351184520.33912610.270933400.31669853

AR-Jonesboro184245112944423973253260.380044010.21597550.328772610.34453717

AR-Little Rock194275512544726517274750.3385317890.229522590.282513140.307113362

AR-Springdale213248263144623594253470.33415550.27987650.268764000.302741020

AR-Texarkana225302792647025036285580.321064340.16123460.322732820.3066762

CA-Orange County233301823220926518280520.3505510730.220161860.271169540.308752213

CA-Bakersfield254247243167224717257870.362724310.21293840.291514260.31979941

CA-Chico312296491611021441257720.3173030.13523400.302833010.29886644

CA-Contra Costa County333335733032826010295040.354733080.15906590.282393150.30848682

CA-Fresno433274752873021183253110.350156630.22201940.2744740.310011231

CA-Los Angeles563321373481929519307210.311334300.183796410.2525226410.277726712

CA-Modesto583264582857921694251400.349364250.17558750.286244020.3093902

CA-Napa623289254345323386282690.317491850.15346460.342032090.31655440

CA-Alameda County652257702173826065246020.307814890.20511930.237484090.27235991

CA-Palm Springs/Rancho Mira693305063182829180299570.273772230.18751500.251692290.25984502

CA-Redding732231292174720399223680.328282780.23354700.244713330.28225681

CA-Sacramento773264202627423493252530.3118910310.126661740.282989610.286592166

CA-Salinas782312592896521972270430.279732110.1711380.260591810.26359430

CA-San Bernardino793234673056724763244320.357197740.280391250.3385930.341381492

CA-San Diego804287502862525352270640.3361213450.202731820.2748210370.300652564

CA-San Francisco812296903062923238264080.289837030.197451300.253594910.270031324

CA-San Jose822243442027322794227430.342565110.13622820.264914390.29421032

CA-San Luis Obispo833241922264920926232770.335531550.18026480.307992010.31091404

CA-San Mateo County852258222786830736277220.304263270.2158620.259943290.28036718

CA-Santa Barbara863224672122722591222750.331621700.21314460.24032730.27965489

CA-Santa Cruz872278212864421738246000.328781310.15795240.202751340.25975289

CA-Santa Rosa893211212332019676204030.371642120.22931520.240662170.30488481

CA-Stockton913263783217624894261110.353483010.16941390.316742000.32613540

CA-Ventura964249063006525686252070.299513960.13442620.315633510.29522809

CO-Boulder1013444623593321929314080.27624710.24907190.302141010.29602191

CO-Colorado Springs1022255992704824963256530.312093670.23726860.252623930.2818846

CO-Denver1032291282450723060259870.315479340.20731620.270948570.28891953

CO-Fort Collins1043340862093422767263990.278081910.18167400.292552120.28186443

CO-Grand Junction1051215202115719519211610.25121510.18138390.243861480.24653338

CO-Greeley1062246462452921483238650.295562530.03291370.284962140.27038504

CO-Pueblo1073245371924922945234830.238971010.07504270.296941180.25452246

CT-Bridgeport1092285403499722403259660.347214940.210551000.23063970.289991

CT-Hartford1102303182293722719263380.3101217000.206172830.2430212810.275693264

CT-New Haven1113288483132426358274730.3103216150.169382810.2586211650.278493061

DE-Wilmington1124303013281227437287880.349788300.213361330.259234940.305551457

DC-Washington1134293043194225551276170.3326518820.184553440.2636212390.29273465

FL-Bradenton1153266142441026440259730.324095330.14431910.248073420.2784966

FL-Clearwater1164314573060126374289600.303656680.230371250.301755800.298891373

FL-Fort Lauderdale1183308942882527904290520.3170925510.17274290.28723540.294385334

FL-Fort Myers1193254213202625461258130.3243916540.166582570.2833210750.294152986

FL-Gainesville1203255272233525563256490.330455500.23698810.297723730.307691004

FL-Hudson1224291052857226863279880.335996800.203161020.29455170.306451299

FL-Jacksonville1234284323465825757278260.355110270.196391800.302748430.321132050

FL-Lakeland1243253203121626268264770.360583250.23557660.343732760.34259667

FL-Miami1274304613116130497300860.3697718010.206292560.2695412490.316133306

FL-Ocala1293278972677125128272730.312029400.140791620.313325780.293751680

FL-Orlando1304290853171724832277580.3220537550.214996040.3086123940.30656753

FL-Ormond Beach1312253872414225566253680.297993380.18462790.291883380.28805755

FL-Panama City1333250352187821928236190.311811400.17422360.276741960.28591372

FL-Pensacola1344290212537924704270610.327628150.261311240.284615930.304511532

FL-Sarasota1373283262701125316266460.327319300.158661530.272047030.291291786

FL-St. Petersburg1395314062579525149279960.339263680.18651900.290474220.30649880

FL-Tallahassee1403247622242222247240470.335035350.21965910.300664420.309831068

FL-Tampa1414280512997027462278370.331467800.21911340.288076030.304081517

GA-Albany1422204012552320185210400.32291460.24285210.308971140.309281

GA-Atlanta1443256122600623349247590.3395833730.220644920.3071628650.316936730

GA-Augusta1453251492586321734238870.332984880.22226840.31254280.315961000

GA-Columbus1463233192972522735237160.360542950.2197520.326752250.33436572

GA-Macon1473271582893623375261160.367266090.1811040.291365440.320171257

GA-Rome1483281512184623450264220.355963340.21804600.269082810.30988675

GA-Savannah1493240112966828338269690.31155670.194871260.33855010.314811194

HI-Honolulu1503230092101724994230530.366245960.186771090.233383380.303621043

ID-Boise1511207382344121383219750.324034520.194800.268464030.28979935

ID-Idaho Falls1523261663171323154257070.29542990.16652240.27186990.27262222

IL-Aurora1543231762910716287207130.301711040.0808190.299211010.28498224

IL-Blue Island1555317253334731085308520.3248910050.218231750.286546270.301681807

IL-Chicago1565320582823930271303690.3350718600.269322770.28769700.309883107

IL-Elgin1585322873870527652305610.316194550.25359730.276933700.29564898

IL-Evanston1613290433373126242274400.312319920.156561650.263288230.280961980

IL-Hinsdale1634287094182433057306370.297112600.25857540.277252750.29146589

IL-Joliet1644268242865223361253430.320235350.23261060.283744200.299261061

IL-Melrose Park1663307253845524299279900.3096611430.187162200.277448730.288322236

IL-Peoria1702235883089224526253930.314526910.241461620.280396700.29711523

IL-Rockford1711275292635324329263920.310128140.179161510.283895960.288791561

IL-Springfield1721271743283826367278440.3055514220.181872260.2829710160.286272664

IL-Urbana1732245512632123484250690.354355020.16997760.279943510.31101929

IL-Bloomington1753229894172223881251840.301891420.31367310.275321440.2969317

IN-Evansville1793238932682323948248560.369468600.163941550.295047220.321841737

IN-Fort Wayne1802249731978823547242670.297329720.226121650.247056750.272861812

IN-Gary1813265392529526123259840.291385200.165561130.311883300.28426963

IN-Indianapolis1832272902776223430260000.3241327860.211484320.295422140.303125432

IN-Lafayette1843286913359724189275330.334912350.22665210.282811080.30358364

IN-Muncie1851311743223425124290410.338082120.12113390.232711430.27704394

IN-Munster1863271352212427729264930.343113760.23975660.297852660.31608708

IN-South Bend1872260133137720740247420.320827270.183151520.262195660.285951445

IN-Terre Haute1883261662338421212245440.411113250.19325360.301731800.35504541

IA-Cedar Rapids1901258972762523806254060.284953060.17018690.283222640.27612639

IA-Davenport1912278302608624291265880.316337930.131971110.272335050.284481409

IA-Des Moines1921254022633621875246310.3161212370.198032490.2778810230.290962509

IA-Dubuque1932216312784824635241430.289621240.25545280.142011030.22899255

IA-Iowa City1941260632145221069243120.286393470.15597620.273232990.27172708

IA-Mason City1951270991943420232248520.24811820.21948370.305111790.27863398

IA-Sioux City1962204072747320114223330.29882630.22402660.286992910.2915620

IA-Waterloo1972313632846323873283770.283862260.24276440.292011990.28656469

KS-Topeka2001284742457523744264990.304153570.21641870.283834210.29165865

KS-Wichita2012284413440024226276930.3230314050.196922830.2716113420.291323030

KY-Covington2033282702294825800267430.309143380.25885470.349642780.32265663

KY-Lexington2045284523324126068286330.3462317440.23392340.302711620.31943140

KY-Louisville2055287263039426805282620.3425118820.198343290.2753914370.303473648

KY-Owensboro2073256265568623204260370.391461920.31638220.252251390.32874353

KY-Paducah2083253122998425679267820.303986130.15754960.314924610.295211170

LA-Alexandria2093296243064827444293860.357133070.22221490.257912280.30543584

LA-Baton Rouge2104287302799529733292170.327316140.23498910.260284520.291921157

LA-Houma2123268792581431552288760.286142740.18966290.333961700.29248473

LA-Lafayette2134237232994228654268170.372215370.20282950.276563780.319821010

LA-Lake Charles2143288411786029106286880.304612520.23544420.269091920.28354486

LA-Metairie2165264043944724956271380.348173460.20902450.263652580.30229649

LA-Monroe2173295163604929362299700.315954280.09969440.221572290.26326701

LA-New Orleans2185269312723128951274040.360734150.27099620.300623530.32738830

LA-Shreveport2193276742920026815278840.314687240.159031310.212286020.259651457

LA-Slidell2205283406783826132311360.336821680.1403180.276841040.29688290

ME-Bangor2213250962134823475247820.341687680.19138880.268423670.30291223

ME-Portland2221249002906922564247820.3264813950.192552200.2950810080.303292623

MD-Baltimore2234307782845025515280970.3263428690.20024390.2833517500.298725058

MD-Salisbury2253334622334722834301650.307036290.23498980.306883450.29941072

MD-Takoma Park2263317673583220980274110.328815450.214171080.282173980.301021051

MA-Boston2273318442991225593287450.3232442450.190587170.2665427080.29087670

MA-Springfield2302283522235822074254330.322338780.168371170.286955510.295961546

MA-Worcester2313339812814926786306290.314435750.14763730.278993430.28879991

MI-Ann Arbor2324288302597625458268310.3596915510.266031960.286469550.323892702

MI-Dearborn2334323152757729470302640.363988490.22826790.272584390.320281367

MI-Detroit2345300942937930259292070.3321722310.197853690.291811180.302633718

MI-Flint2353249783012721677238880.340686580.19657900.272613630.302121111

MI-Grand Rapids2361270982783920252245460.3183810740.224061900.272718180.293822082

MI-Kalamazoo2383252802671023930250960.317687860.227011360.261095260.287751448

MI-Lansing2392257423094421873250240.323576980.246990.257894630.292321260

MI-Marquette2401227084430719066230830.28383310.1677370.232672170.25338585

MI-Muskegon2421249092591322743242820.288433660.22023580.236762530.26108677

MI-Petoskey2432262061974921624248750.312712480.25069360.292841660.29967450

MI-Pontiac2444260483167323822247990.342194760.26651600.310152730.32037809

MI-Royal Oak2453316973127123476273970.338227850.227331040.295095930.312291482

MI-Saginaw2461267332877624585265040.320199900.199271610.271545990.290551750

MI-St. Joseph2481271862683018606242880.337171750.22392360.255551250.29579336

MI-Traverse City2491253693207416674232610.306243670.218650.2692090.28352641

MN-Duluth2501283762401320826256550.294615120.169650.210683510.2505928

MN-Minneapolis2511261743138322642254120.2863423560.193083800.2741617170.273954453

MN-Rochester2531273172604222277257210.291494930.15043850.276863750.27461953

MN-St. Cloud2541213884478321627229870.235782080.31606360.241481400.2463384

MN-St. Paul2561257942639425349251480.30126650.19126960.293254510.287991212

MS-Gulfport2574341882976628871315200.396521750.27734300.25663980.33653303

MS-Hattiesburg2582228583924225233249090.321232980.14527450.253992000.27723543

MS-Jackson2593254102970327048268710.333079920.184721850.262947140.290981891

MS-Meridian2603259623712725735278260.3781860.06287420.237121570.28897385

MS-Oxford2612257351644623693255080.374711730.41238170.228451410.31053331

MS-Tupelo2622309993032624034288610.280844340.16531740.241273400.25449848

MO-Cape Girardeau2632298292792625002284910.307263190.10707620.331593210.30323702

MO-Columbia2642266202861023573264130.333868860.168471540.299066490.305981689

MO-Joplin2674261833110924420264830.330976020.18925910.298154010.304841094

MO-Kansas City2683276413341825210270520.2951420480.232353360.2740216870.282134071

MO-Springfield2703253213138522557253720.3231410920.242761600.329547910.317522043

MO-St. Louis2734284323010425629273810.3276635950.221865720.3050326840.309856851

MT-Billings2741223912574222858238890.283464390.2094880.259224180.26907945

MT-Great Falls2751287381994220542244280.248041080.23604310.208351030.23728242

MT-Missoula2762234642208219257224640.268023180.17766500.288243030.27143671

NE-Lincoln2772328823285220785269390.321633830.196051270.290845720.300241082

NE-Omaha2782263523123721969253290.2949110990.216222350.2601110640.276042398

NV-Las Vegas2794313644012523955285660.362555590.263051130.298694840.328761156

NV-Reno2803250532486823482247180.360034200.25182740.363183890.35526883

NH-Lebanon2811227002347121327230480.320145290.17974680.265153190.28878916

NH-Manchester2821275363192521125253270.313867570.259491510.276156570.296461565

NJ-Camden2835300753014528429287550.3341834390.164895690.2937522310.303156239

NJ-Hackensack2843351333450629923321350.3376213150.204542410.273919530.302052509

NJ-Morristown2853288953260824975269660.294678690.190311570.284267220.283621748

NJ-New Brunswick2885315973358428967297460.338959170.18511720.273686260.300871715

NJ-Newark2895315003279927409293040.3438313330.205051750.301818540.314792362

NJ-Paterson2915271852485829397270580.393773130.18328580.263222560.32098627

NJ-Ridgewood2923307592103931584290000.290234000.19409880.287883250.28329813

NM-Albuquerque2932267142666021883251630.335538710.224731330.243927890.286541793

NY-Albany2952259603022524124256940.3340220180.165723480.2586516060.291093972

NY-Binghamton2961232792875622422234900.347976120.16719910.248933830.296051086

NY-Bronx2974330312629124760292310.358347630.21521180.28213740.317461255

NY-Buffalo2993259342460220006235950.3528215450.239412050.268669670.311162717

NY-Elmira3001247913471225560261530.318514630.21201740.258143530.284890

NY-East Long Island3014317963115626903289330.3521439860.186266630.2885528020.31377451

NY-Manhattan3033302742975124689273970.3399527520.216684570.244821010.290645310

NY-Rochester3042268032697721591248230.324169310.202261520.277917520.296391835

NY-Syracuse3071279512651521949257920.341212960.20312080.269288980.302162402

NY-White Plains3083329773042224147283250.320719730.170061730.277478090.290931955

NC-Asheville3092254343180721657249900.328498840.210941200.283747920.301171796

NC-Charlotte3113248212458223402246090.3140318600.201893080.2725716440.287623812

NC-Durham3123266412384721173246590.3277514450.254072380.292810370.306412720

NC-Greensboro3132243622145020191227320.306455270.15312800.26054760.274141083

NC-Greenville3143238222857223094245920.344558210.198391260.291155460.311181493

NC-Hickory3152258012415319027233500.351973260.21819430.262342790.30404648

NC-Raleigh3182253862676523697248440.3433216130.195492220.282339830.307042818

NC-Wilmington3193252872728424401256000.328883760.32541570.273752780.3063711

NC-Winston-Salem3203231432493523515239290.3556510650.156871400.289319420.312892147

ND-Bismarck3212306032088827179293780.26742590.19994330.229131950.2449487

ND-Fargo/Moorhead MN3221280602590118394247440.29536890.255721290.213645060.26131324

ND-Grand Forks3233225914997519746237560.243731660.17944330.207731210.22618320

ND-Minot3241264102195824460260080.332191800.25278270.182991400.26409347

OH-Akron3252285672807228618281340.323676760.19231140.309164800.306031270

OH-Canton3262286392408021474256830.305796690.264491290.284835140.295591312

OH-Cincinnati3273267682994826372267670.3347712730.225732620.2720211330.300232668

OH-Cleveland3283314303026626872291980.3001722300.203533680.2743615750.2824173

OH-Columbus3293291442984525438281420.3479131200.237364690.3157418910.325465480

OH-Dayton3303253382531922355244280.3151212610.222551990.288869040.296512364

OH-Elyria3313327572041723946275930.302122030.13952560.273291790.27613438

OH-Kettering3323239573698424781251930.371353290.29361530.291153210.33241703

OH-Toledo3343285103008625151273910.338911590.181511630.282948230.303812145

OH-Youngstown3353304332500925539279700.317059030.251791480.271366030.292771654

OK-Lawton3362218482216424516238030.331952690.21544260.294172210.30404516

OK-Oklahoma City3394275353560224612273200.3382618900.170752930.2997115330.308693716

OK-Tulsa3403253432492226712261720.3365315330.204871620.3180910710.317862766

OR-Bend3412205521703720502210600.331691310.20179240.308641220.31538277

OR-Eugene3422267332619720432243620.345894490.18891710.276273710.30438891

OR-Medford3433246592474618171227030.293174630.25505970.32913390.30373899

OR-Portland3443260332781818873232570.3257611660.184092060.279759360.296332308

OR-Salem3452248622423316879211770.344161170.19983260.370031410.34944284

PA-Allentown3463279492544825167267050.3164315380.204152220.286469780.294522738

PA-Altoona3474282862823223851271180.370454520.21304700.294472780.32755800

PA-Danville3502228292702221938234950.362257630.21413970.291764440.32331304

PA-Erie3513269032560325009266900.3335410380.18921560.278287110.30031905

PA-Harrisburg3522264213116924499262840.3600214190.211371760.258438030.312362398

PA-Johnstown3542332483732725322312630.342533130.09212400.215481880.27568541

PA-Lancaster3552266772580524990259450.32837370.20541430.266815310.294111411

PA-Philadelphia3564320703279127771296490.3310329090.204455550.2944124410.305945905

PA-Pittsburgh3573317682954325593291420.3250734670.202795550.282325050.29736527

PA-Reading3583260922828325200258290.355817450.185391240.292194900.31671359

PA-Sayre3592318332458624255295770.365982840.1873430.306221900.32774517

PA-Scranton3604251963571323386254400.329965530.174941000.267643800.290211033

PA-Wilkes-Barre3624280672500924585263060.361834940.16625680.301262940.32115856

PA-York3633227172884921347229580.362295180.144021070.286733540.3141979

RI-Providence3642307633323724876281850.3417711210.224621590.262737020.303031982

SC-Charleston3654241542981726266257090.358337040.185731360.282115800.31171420

SC-Columbia3663234282714222900238180.3425211740.191712010.337138030.325582178

SC-Florence3673255112348122884248250.315425110.15055580.265832250.28114794

SC-Greenville3683245172412222502239420.360119090.233721360.295167600.323071805

SC-Spartanburg3691211342981423353230940.322434400.1323740.29193370.29423851

SD-Rapid City3701214422847021445224860.216681700.10066220.245381780.22148370

SD-Sioux Falls3712266273003722805261440.283299110.189111770.259898670.267611955

TN-Chattanooga3733257502872125284260880.30686460.185231000.275325860.284151332

TN-Jackson3743244823906126670268960.353245930.21784570.304423600.322861010

TN-Johnson City3753306443111925667292660.36462680.20957370.268222550.30858560

TN-Kingsport3763228273245224110244450.364136740.17246650.335834940.337341233

TN-Knoxville3773251253075426146265240.3145417980.229231960.2950613260.298333320

TN-Memphis3794291962917324539276010.3639915730.227182690.2836411470.319852989

TN-Nashville3804248472797925513259630.3388622920.223813480.297718860.312794526

TX-Abilene3823247643941225596267870.3443610.18371600.309463380.31671759

TX-Amarillo3834251072537221104238680.339414100.20826590.278844110.30183880

TX-Austin3853296552936925311278370.336137380.165531130.248377040.284771555

TX-Beaumont3864286882826723177267480.349735280.24741850.318713910.330021004

TX-Bryan3882248144823324679267090.322031580.24616350.222791580.27418351

TX-Corpus Christi3903266873088925891270240.306174320.1807720.225293420.26319846

TX-Dallas3915257622904326291262710.3539726050.226524290.2800423540.312515388

TX-El Paso3933264772872526652267080.334356340.235211220.262645470.29581303

TX-Fort Worth3943258582998924759256090.350612060.227351590.2864710270.314162392

TX-Harlingen3964274432704521041250940.338725470.25589570.232052660.29165870

TX-Houston3975321172899928334302280.3385433730.207055410.2720724930.301136407

TX-Longview3993268592758226995273730.35212390.15323370.240231880.29038464

TX-Lubbock4003272712854022693258590.348466100.148981120.271047030.296661425

TX-McAllen4023247584053332822270950.296253530.24767440.233612300.26625627

TX-Odessa4063223551994721504217840.324673570.27797420.250762600.28742659

TX-San Angelo4112302181825324974275440.33941650.16167290.238841650.28153359

TX-San Antonio4124279432936325895274340.3423114000.249832190.2665313120.301522931

TX-Temple4132263542054828903277310.283111780.18938270.281971510.27306356

TX-Tyler4165234013102526906260870.37687050.214411160.29535450.329471366

TX-Victoria4173267953596925347271790.331942110.01562320.21111500.25887393

TX-Waco4182277262950720982252990.314413600.2655700.313252940.3096724

TX-Wichita Falls4203304452301923140268550.285532470.17729570.252262690.26341573

UT-Ogden4213277311818718334229560.2862020.21153350.336991900.30365427

UT-Provo4222265412707824090255200.326292170.28017250.351642010.33472443

UT-Salt Lake City4232246252706021689236290.33829340.25481730.307678950.320392002

VT-Burlington4243260612948022618258060.298347020.215351480.264385070.278971357

VA-Arlington4262252693093223400242170.337578360.178961690.308778100.313881815

VA-Charlottesville4272242882320722262240960.283916760.2098990.295454790.282331254

VA-Lynchburg4281255222152323539246940.334892940.10198570.305162790.30304630

VA-Newport News4292242653240522050237440.346985230.25307940.269734180.308441035

VA-Norfolk4302247713163623095244230.3427110270.213251830.273417470.304351957

VA-Richmond4313264262809523841254360.328113890.214252680.2923611570.304432814

VA-Roanoke4321250262591124509252950.3321910280.151491380.274237340.293451900

VA-Winchester4352305342982324262288480.322014210.19587630.321443210.31259805

WA-Everett4373257463748020196242560.322983000.11086480.279732790.29034627

WA-Olympia4382247331923420412229220.343732680.21319470.287662410.31156556

WA-Seattle4392238813177422496236310.341714150.16712400.290812570.307022912

WA-Spokane4401257712634820049240000.320611820.176342560.2692710010.287622439

WA-Tacoma4413275942594026986268510.375353970.17477770.268993610.31342835

WA-Yakima4421249982880918324227010.289582480.15627470.338442160.30088511

WV-Charleston4433252612567924138253560.3226213120.235521740.279878820.297152368

WV-Huntington4444250022137527125252930.298676630.24393830.298413670.289731113

WV-Morgantown4454245982420624282253420.327675060.19703790.321863410.31133926

WI-Appleton4461334774548820046285330.2992740.18334490.272272640.28018587

WI-Green Bay4471243162389521258234080.292085850.205431050.212344430.253161133

WI-La Crosse4481253092781818984238580.269333080.191690.237082580.25277635

WI-Madison4491234192440323771238870.314628430.146181890.262427180.278751750

WI-Marshfield4501263922784523109260240.277814340.1745780.263283410.26391853

WI-Milwaukee4513269832994524603259800.3024923430.191314800.2796518660.284414689

WI-Neenah4521256313681121003247590.350912190.12492490.278451760.30286444

WI-Wausau4562270102844523220261570.230752070.21527480.215981810.22815436

WY-Casper4572279252656123740267220.305421500.18832310.242121360.26884317

comb_LVC

00.297815

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0

hrr

Annual Relative Resource Use

1-Year Mortality Rate

comb_LVC (2)

Namehrrcost_combinationIndexing to Medianmortality_combinationIndexing to MedianInverse mortalityIndexing to MedianN_combination

AL-Birmingham1266130.30561.030.69440.994801

AL-Dothan2229110.288340.970.711661.01801

AL-Huntsville5260790.28620.960.71381.021193

AL-Mobile6272110.288030.970.711971.011360

AL-Montgomery7266460.315791.060.684210.97856

AL-Tuscaloosa9232550.261440.880.738561.05456

AK-Anchorage10215190.316181.060.683820.97474

AZ-Mesa11246200.310261.040.689740.98875

AZ-Phoenix12271970.317031.060.682970.973186

AZ-Sun City14257650.284510.960.715491.02730

AZ-Tucson15262840.299961.010.700041.001421

AR-Fort Smith16267070.316691.060.683310.97853

AR-Jonesboro18253260.344531.160.655470.93717

AR-Little Rock19274750.307111.030.692890.993362

AR-Springdale21253470.302741.020.697260.991020

AR-Texarkana22285580.30661.030.69340.99762

CA-Orange County23280520.308751.040.691250.982213

CA-Bakersfield25257870.319791.070.680210.97941

CA-Chico31257720.298861.000.701141.00644

CA-Contra Costa County33295040.308481.040.691520.98682

CA-Fresno43253110.310011.040.689990.981231

CA-Los Angeles56307210.277720.930.722281.036712

CA-Modesto58251400.30931.040.69070.98902

CA-Napa62282690.316551.060.683450.97440

CA-Alameda County65246020.272350.910.727651.04991

CA-Palm Springs/Rancho Mira69299570.259840.870.740161.05502

CA-Redding73223680.282250.950.717751.02681

CA-Sacramento77252530.286590.960.713411.022166

CA-Salinas78270430.263590.890.736411.05430

CA-San Bernardino79244320.341381.150.658620.941492

CA-San Diego80270640.300651.010.699351.002564

CA-San Francisco81264080.270030.910.729971.041324

CA-San Jose82227430.29420.990.70581.011032

CA-San Luis Obispo83232770.310911.040.689090.98404

CA-San Mateo County85277220.280360.940.719641.02718

CA-Santa Barbara86222750.279650.940.720351.03489

CA-Santa Cruz87246000.259750.870.740251.05289

CA-Santa Rosa89204030.304881.020.695120.99481

CA-Stockton91261110.326131.100.673870.96540

CA-Ventura96252070.295220.990.704781.00809

CO-Boulder101314080.296020.990.703981.00191

CO-Colorado Springs102256530.28180.950.71821.02846

CO-Denver103259870.28890.970.71111.011953

CO-Fort Collins104263990.281860.950.718141.02443

CO-Grand Junction105211610.246530.830.753471.07338

CO-Greeley106238650.270380.910.729621.04504

CO-Pueblo107234830.254520.850.745481.06246

CT-Bridgeport109259660.2890.970.7111.01991

CT-Hartford110263380.275690.930.724311.033264

CT-New Haven111274730.278490.940.721511.033061

DE-Wilmington112287880.305551.030.694450.991457

DC-Washington113276170.29270.980.70731.013465

FL-Bradenton115259730.27840.930.72161.03966

FL-Clearwater116289600.298891.000.701111.001373

FL-Fort Lauderdale118290520.294380.990.705621.005334

FL-Fort Myers119258130.294150.990.705851.012986

FL-Gainesville120256490.307691.030.692310.991004

FL-Hudson122279880.306451.030.693550.991299

FL-Jacksonville123278260.321131.080.678870.972050

FL-Lakeland124264770.342591.150.657410.94667

FL-Miami127300860.316131.060.683870.973306

FL-Ocala129272730.293750.990.706251.011680

FL-Orlando130277580.30651.030.69350.996753

FL-Ormond Beach131253680.288050.970.711951.01755

FL-Panama City133236190.285910.960.714091.02372

FL-Pensacola134270610.304511.020.695490.991532

FL-Sarasota137266460.291290.980.708711.011786

FL-St. Petersburg139279960.306491.030.693510.99880

FL-Tallahassee140240470.309831.040.690170.981068

FL-Tampa141278370.304081.020.695920.991517

GA-Albany142210400.3091.040.6910.98281

GA-Atlanta144247590.316931.060.683070.976730

GA-Augusta145238870.315961.060.684040.971000

GA-Columbus146237160.334361.120.665640.95572

GA-Macon147261160.320171.080.679830.971257

GA-Rome148264220.309881.040.690120.98675

GA-Savannah149269690.314811.060.685190.981194

HI-Honolulu150230530.303621.020.696380.991043

ID-Boise151219750.289790.970.710211.01935

ID-Idaho Falls152257070.272620.920.727381.04222

IL-Aurora154207130.284980.960.715021.02224

IL-Blue Island155308520.301681.010.698320.991807

IL-Chicago156303690.309881.040.690120.983107

IL-Elgin158305610.295640.990.704361.00898

IL-Evanston161274400.280960.940.719041.021980

IL-Hinsdale163306370.291460.980.708541.01589

IL-Joliet164253430.299261.000.700741.001061

IL-Melrose Park166279900.288320.970.711681.012236

IL-Peoria170253930.29711.000.70291.001523

IL-Rockford171263920.288790.970.711211.011561

IL-Springfield172278440.286270.960.713731.022664

IL-Urbana173250690.311011.040.688990.98929

IL-Bloomington175251840.29691.000.70311.00317

IN-Evansville179248560.321841.080.678160.971737

IN-Fort Wayne180242670.272860.920.727141.041812

IN-Gary181259840.284260.950.715741.02963

IN-Indianapolis183260000.303121.020.696880.995432

IN-Lafayette184275330.303581.020.696420.99364

IN-Muncie185290410.277040.930.722961.03394

IN-Munster186264930.316081.060.683920.97708

IN-South Bend187247420.285950.960.714051.021445

IN-Terre Haute188245440.355041.190.644960.92541

IA-Cedar Rapids190254060.276120.930.723881.03639

IA-Davenport191265880.284480.960.715521.021409

IA-Des Moines192246310.290960.980.709041.012509

IA-Dubuque193241430.228990.770.771011.10255

IA-Iowa City194243120.271720.910.728281.04708

IA-Mason City195248520.278630.940.721371.03398

IA-Sioux City196223330.29150.980.70851.01620

IA-Waterloo197283770.286560.960.713441.02469

KS-Topeka200264990.291650.980.708351.01865

KS-Wichita201276930.291320.980.708681.013030

KY-Covington203267430.322651.080.677350.96663

KY-Lexington204286330.31941.070.68060.973140

KY-Louisville205282620.303471.020.696530.993648

KY-Owensboro207260370.328741.100.671260.96353

KY-Paducah208267820.295210.990.704791.001170

LA-Alexandria209293860.305431.030.694570.99584

LA-Baton Rouge210292170.291920.980.708081.011157

LA-Houma212288760.292480.980.707521.01473

LA-Lafayette213268170.319821.070.680180.971010

LA-Lake Charles214286880.283540.950.716461.02486

LA-Metairie216271380.302291.020.697710.99649

LA-Monroe217299700.263260.880.736741.05701

LA-New Orleans218274040.327381.100.672620.96830

LA-Shreveport219278840.259650.870.740351.051457

LA-Slidell220311360.296881.000.703121.00290

ME-Bangor221247820.30291.020.69710.991223

ME-Portland222247820.303291.020.696710.992623

MD-Baltimore223280970.298721.000.701281.005058

MD-Salisbury225301650.29941.010.70061.001072

MD-Takoma Park226274110.301021.010.698981.001051

MA-Boston227287450.29080.980.70921.017670

MA-Springfield230254330.295960.990.704041.001546

MA-Worcester231306290.288790.970.711211.01991

MI-Ann Arbor232268310.323891.090.676110.962702

MI-Dearborn233302640.320281.080.679720.971367

MI-Detroit234292070.302631.020.697370.993718

MI-Flint235238880.302121.010.697880.991111

MI-Grand Rapids236245460.293820.990.706181.012082

MI-Kalamazoo238250960.287750.970.712251.011448

MI-Lansing239250240.292320.980.707681.011260

MI-Marquette240230830.253380.850.746621.06585

MI-Muskegon242242820.261080.880.738921.05677

MI-Petoskey243248750.299671.010.700331.00450

MI-Pontiac244247990.320371.080.679630.97809

MI-Royal Oak245273970.312291.050.687710.981482

MI-Saginaw246265040.290550.980.709451.011750

MI-St. Joseph248242880.295790.990.704211.00336

MI-Traverse City249232610.283520.950.716481.02641

MN-Duluth250256550.25050.840.74951.07928

MN-Minneapolis251254120.273950.920.726051.034453

MN-Rochester253257210.274610.920.725391.03953

MN-St. Cloud254229870.24630.830.75371.07384

MN-St. Paul256251480.287990.970.712011.011212

MS-Gulfport257315200.336531.130.663470.94303

MS-Hattiesburg258249090.277230.930.722771.03543

MS-Jackson259268710.290980.980.709021.011891

MS-Meridian260278260.288970.970.711031.01385

MS-Oxford261255080.310531.040.689470.98331

MS-Tupelo262288610.254490.850.745511.06848

MO-Cape Girardeau263284910.303231.020.696770.99702

MO-Columbia264264130.305981.030.694020.991689

MO-Joplin267264830.304841.020.695160.991094

MO-Kansas City268270520.282130.950.717871.024071

MO-Springfield270253720.317521.070.682480.972043

MO-St. Louis273273810.309851.040.690150.986851

MT-Billings274238890.269070.900.730931.04945

MT-Great Falls275244280.237280.800.762721.09242

MT-Missoula276224640.271430.910.728571.04671

NE-Lincoln277269390.300241.010.699761.001082

NE-Omaha278253290.276040.930.723961.032398

NV-Las Vegas279285660.328761.100.671240.961156

NV-Reno280247180.355261.190.644740.92883

NH-Lebanon281230480.288780.970.711221.01916

NH-Manchester282253270.296461.000.703541.001565

NJ-Camden283287550.303151.020.696850.996239

NJ-Hackensack284321350.302051.010.697950.992509

NJ-Morristown285269660.283620.950.716381.021748

NJ-New Brunswick288297460.300871.010.699131.001715

NJ-Newark289293040.314791.060.685210.982362

NJ-Paterson291270580.320981.080.679020.97627

NJ-Ridgewood292290000.283290.950.716711.02813

NM-Albuquerque293251630.286540.960.713461.021793

NY-Albany295256940.291090.980.708911.013972

NY-Binghamton296234900.296050.990.703951.001086

NY-Bronx297292310.317461.070.682540.971255

NY-Buffalo299235950.311161.040.688840.982717

NY-Elmira300261530.2840.950.7161.02890

NY-East Long Island301289330.31371.050.68630.987451

NY-Manhattan303273970.290640.980.709361.015310

NY-Rochester304248230.296391.000.703611.001835

NY-Syracuse307257920.302161.010.697840.992402

NY-White Plains308283250.290930.980.709071.011955

NC-Asheville309249900.301171.010.698831.001796

NC-Charlotte311246090.287620.970.712381.013812

NC-Durham312246590.306411.030.693590.992720

NC-Greensboro313227320.274140.920.725861.031083

NC-Greenville314245920.311181.040.688820.981493

NC-Hickory315233500.304041.020.695960.99648

NC-Raleigh318248440.307041.030.692960.992818

NC-Wilmington319256000.30631.030.69370.99711

NC-Winston-Salem320239290.312891.050.687110.982147

ND-Bismarck321293780.24490.820.75511.08487

ND-Fargo/Moorhead MN322247440.26130.880.73871.051324

ND-Grand Forks323237560.226180.760.773821.10320

ND-Minot324260080.264090.890.735911.05347

OH-Akron325281340.306031.030.693970.991270

OH-Canton326256830.295590.990.704411.001312

OH-Cincinnati327267670.300231.010.699771.002668

OH-Cleveland328291980.2820.950.7181.024173

OH-Columbus329281420.325461.090.674540.965480

OH-Dayton330244280.296511.000.703491.002364

OH-Elyria331275930.276130.930.723871.03438

OH-Kettering332251930.332411.120.667590.95703

OH-Toledo334273910.303811.020.696190.992145

OH-Youngstown335279700.292770.980.707231.011654

OK-Lawton336238030.304041.020.695960.99516

OK-Oklahoma City339273200.308691.040.691310.983716

OK-Tulsa340261720.317861.070.682140.972766

OR-Bend341210600.315381.060.684620.97277

OR-Eugene342243620.304381.020.695620.99891

OR-Medford343227030.303731.020.696270.99899

OR-Portland344232570.296331.000.703671.002308

OR-Salem345211770.349441.170.650560.93284

PA-Allentown346267050.294520.990.705481.002738

PA-Altoona347271180.327551.100.672450.96800

PA-Danville350234950.32331.090.67670.961304

PA-Erie351266900.30031.010.69971.001905

PA-Harrisburg352262840.312361.050.687640.982398

PA-Johnstown354312630.275680.930.724321.03541

PA-Lancaster355259450.294110.990.705891.011411

PA-Philadelphia356296490.305941.030.694060.995905

PA-Pittsburgh357291420.29731.000.70271.006527

PA-Reading358258290.31671.060.68330.971359

PA-Sayre359295770.327741.100.672260.96517

PA-Scranton360254400.290210.970.709791.011033

PA-Wilkes-Barre362263060.321151.080.678850.97856

PA-York363229580.31411.050.68590.98979

RI-Providence364281850.303031.020.696970.991982

SC-Charleston365257090.31171.050.68830.981420

SC-Columbia366238180.325581.090.674420.962178

SC-Florence367248250.281140.940.718861.02794

SC-Greenville368239420.323071.080.676930.961805

SC-Spartanburg369230940.294230.990.705771.01851

SD-Rapid City370224860.221480.740.778521.11370

SD-Sioux Falls371261440.267610.900.732391.041955

TN-Chattanooga373260880.284150.950.715851.021332

TN-Jackson374268960.322861.080.677140.961010

TN-Johnson City375292660.308581.040.691420.98560

TN-Kingsport376244450.337341.130.662660.941233

TN-Knoxville377265240.298331.000.701671.003320

TN-Memphis379276010.319851.070.680150.972989

TN-Nashville380259630.312791.050.687210.984526

TX-Abilene382267870.316711.060.683290.97759

TX-Amarillo383238680.301831.010.698170.99880

TX-Austin385278370.284770.960.715231.021555

TX-Beaumont386267480.330021.110.669980.951004

TX-Bryan388267090.274180.920.725821.03351

TX-Corpus Christi390270240.263190.880.736811.05846

TX-Dallas391262710.312511.050.687490.985388

TX-El Paso393267080.29580.990.70421.001303

TX-Fort Worth394256090.314161.050.685840.982392

TX-Harlingen396250940.291650.980.708351.01870

TX-Houston397302280.301131.010.698871.006407

TX-Longview399273730.290380.980.709621.01464

TX-Lubbock400258590.296661.000.703341.001425

TX-McAllen402270950.266250.890.733751.04627

TX-Odessa406217840.287420.970.712581.01659

TX-San Angelo411275440.281530.950.718471.02359

TX-San Antonio412274340.301521.010.698480.992931

TX-Temple413277310.273060.920.726941.04356

TX-Tyler416260870.329471.110.670530.951366

TX-Victoria417271790.258870.870.741131.06393

TX-Waco418252990.30961.040.69040.98724

TX-Wichita Falls420268550.263410.880.736591.05573

UT-Ogden421229560.303651.020.696350.99427

UT-Provo422255200.334721.120.665280.95443

UT-Salt Lake City423236290.320391.080.679610.972002

VT-Burlington424258060.278970.940.721031.031357

VA-Arlington426242170.313881.050.686120.981815

VA-Charlottesville427240960.282330.950.717671.021254

VA-Lynchburg428246940.303041.020.696960.99630

VA-Newport News429237440.308441.040.691560.981035

VA-Norfolk430244230.304351.020.695650.991957

VA-Richmond431254360.304431.020.695570.992814

VA-Roanoke432252950.293450.990.706551.011900

VA-Winchester435288480.312591.050.687410.98805

WA-Everett437242560.290340.970.709661.01627

WA-Olympia438229220.311561.050.688440.98556

WA-Seattle439236310.307021.030.692980.992912

WA-Spokane440240000.287620.970.712381.012439

WA-Tacoma441268510.313421.050.686580.98835

WA-Yakima442227010.300881.010.699121.00511

WV-Charleston443253560.297151.000.702851.002368

WV-Huntington444252930.289730.970.710271.011113

WV-Morgantown445253420.311331.050.688670.98926

WI-Appleton446285330.280180.940.719821.03587

WI-Green Bay447234080.253160.850.746841.061133

WI-La Crosse448238580.252770.850.747231.06635

WI-Madison449238870.278750.940.721251.031750

WI-Marshfield450260240.263910.890.736091.05853

WI-Milwaukee451259800.284410.950.715591.024689

WI-Neenah452247590.302861.020.697140.99444

WI-Wausau456261570.228150.770.771851.10436

WY-Casper457267220.268840.900.731161.04317

MEDIAN=25,994MEDIAN=0.300.70

10th %ile

90th %tile

comb_LVC (2)

01

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

hrr

Relative Resource Use

Quality of Care (1 Year Mortality Index, Median = 30%)

01

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

hrr

Relative Resource Use**

Quality of Care* (1 Year Survival Index, Median = 70%)

Variation in Annual Total Cost and Quality for Chronic Disease Patients Quality of Care* and Medicare Spending for Beneficiaries with Three Chronic Conditions, by Hospital Referral RegionBest Practice CurveMedian Amount Spent per Patient per HRR = $28,694Greenville, NCNewark, NJSaginaw, MIManhattan, NYOrange County, CAEast Long Island, NYFt. Lauderdale, FLCamden, NJNew Brunswick, NJHackensack, NJ

International Comparison of Spending on Health, 19802004Data: OECD Health Data 2005 and 2006.Average spending on health per capita ($US PPP)Total expenditures on health as percent of GDPSource: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006EFFICIENCY*

Percentage of National Health Expenditures Spent on Health Administration and Insurance, 2003Net costs of health administration and health insurance as percent of national health expendituresabc*Source: The Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006EFFICIENCY

The Discourse Has ChangedFROM:Americans have the best health care system in the worldPresident Bush, State of the Union Speech, 2004

TO:We need to do betterWe spend more on health care than any other countryWe need more value for what we are spending

We Know The ProblemsNow We Need Solutions

Keys to Transforming the U.S. Health Care SystemGuarantee affordable health insurance coverageImplement major quality and safety improvementsWork toward a more organized delivery system that emphasizes primary and preventive care and is patient-centeredIncrease transparency and reporting on quality and costsExpand the use of interoperable information technologyReward performance on quality and efficiency Encourage public-private collaboration to achieve simplification, more effective change

Guarantee Affordable Health Insurance Coverage1. Guarantee Affordable Health Insurance Coverage

What Are the Most Important Health Care Issuesfor Presidential and Congressional Action?Source: C. Schoen, S.K. How, I. Weinbaum, J.E. Craig, Jr., and K. Davis, Public Views on Shaping the Future of the U.S. Health System, The Commonwealth Fund, August 2006.

Percent listing issue as first or second priority:TotalLess than $50,000$50,000 $74,999$75,000 or moreEnsure that all Americans have adequate, reliable health insurance52565250Control the rising cost of medical care37354239Lower the cost of prescription drugs31312733Ensure that Medicare remains financially sound in the longterm29293230Improve the quality of nursing homes and long-term care14161513Reform the medical malpractice system14101218Reduce the complexity of insurance12121010

Why Do We Need Universal Coverage?Wastecost-shiftingineffective care (poorer adherence)duplicationback-end vs. front-end careSocietal benefit

Its Not Just Altruism

The Action Now Lies In StatesSingle payer isnt likelyCommon elements Expand public programs (cover more poor people)Require individual participationRequire employer participation

Massachusetts Health Plan

MassHealth expansion for children up to 300% Federal Poverty Level; adults up to 100% FPLIndividual mandate, with affordability provision; subsidies between 100% and 300% of povertyEmployer mandatory offer, employee mandatory take-upEmployer assessment ($295 if employer doesnt provide health insurance)Connector to organize affordable insurance offerings through a group poolSource: John Holahan, The Basics of Massachusetts Health Reform, Presentation to United Hospital Fund, April 2006.

California Governors ProposalIndividual mandatePremium subsidies for adults below 250% federal poverty levelEmployer offer health insurance or pay 4% of wages into poolProvider fee assessment (2% of physician revenues to 4% of hospital revenues)Insurance market regulationGuaranteed issue Community rating with age bands 85 percent minimum medical loss ratio

Effective May, 2006: New law in New Jersey allowing persons up to age 30 to be covered under their parents insurance

Implement Major Quality and Safety Improvements2. Implement Major Quality and Safety Improvements1. Guarantee Affordable Health Insurance Coverage

Allegheny General HospitalRichard Shannon, MD

Highmark Quality Blue Year 4MRSA

Chart2

1071624

11024

21025

10012

20013

10034

13105

Presbyterian CTICU

Shadyside MICU

McKeesport Med-Surg

St. Margaret Med-Surg Teach

Totals

FY 2006 Hosp. Acq. MRSA Cases

UPMC FY 2006 (Oct. - March) Hospital Acquired MRSA Case Trending

CLABS_RATE

HOSPITAL1/1/03-12/31/03FY 2003FY 2004FY 2005FY 2006 (Thru Mar)7/1/04-6/30/05

Presbyterian CTICU36.0%3.60.71.10.5

Shadyside MICU24.6%4.72.72.01.3

McKeesport Med-Surg51.8%0.01.81.30.0

St. Margaret Med-Surg Teach27.8%2.20.30.70.4

Totals3.41.11.30.7

Number of Infections

HOSPITAL1/1/03-12/31/03CY 2003CY 2004CY 2005CY 2006 (Thru Mar)

Presbyterian CTICU36.0%18660

Shadyside MICU24.6%11960

McKeesport Med-Surg51.8%1100

St. Margaret Med-Surg Teach27.8%1300

Totals3119120

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CLABS_RATE

Presbyterian CTICU

Shadyside MICU

McKeesport Med-Surg

St. Margaret Med-Surg Teach

Totals

Central / Femoral Line Rates(per 1000 Line-Days)

UPMC Central / Femoral Line Rate Trending

Trendline for "Totals"

MRSA

Presbyterian CTICU

Shadyside MICU

McKeesport Med-Surg

St. Margaret Med-Surg Teach

Totals

Number of Central / Femoral Line Infections

UPMC Central / Femoral Line Infections

Trendline for "Totals"

VAPS

HOSPITAL1/1/03-12/31/03BaselineOCT. 2005NOV. 2005DEC. 2005JAN. 2006FEB. 2006MAR. 20067/1/04-6/30/05

Presbyterian CTICU36.0%2.61.53.11.53.21.81.7

Shadyside MICU24.6%2.01.61.70.00.00.06.4

McKeesport Med-Surg51.8%3.30.00.00.00.00.04.0

St. Margaret Med-Surg Teach27.8%5.75.66.23.05.38.50.0

Totals2.82.22.81.11.82.43.4

Number of Infections

HOSPITAL1/1/03-12/31/03BaselineOCT. 2005NOV. 2005DEC. 2005JAN. 2006FEB. 2006MAR. 2006

Presbyterian CTICU36.0%10121211

Shadyside MICU24.6%7110003

McKeesport Med-Surg51.8%1000001

St. Margaret Med-Surg Teach27.8%6221130

Totals24452345

Number of Patient-Days

HOSPITALBaselineOCT. 2005NOV. 2005DEC. 2005JAN. 2006FEB. 2006MAR. 2006

Presbyterian CTICU3,800652646649625568585

Shadyside MICU3,500607577597609519472

McKeesport Med-Surg300244256249288251252

St. Margaret Med-Surg Teach1,050356322328189353149

Totals8,6501,8591,8011,8231,7111,6911,458

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VAPS

Presbyterian CTICU

Shadyside MICU

McKeesport Med-Surg

St. Margaret Med-Surg Teach

Totals

FY 2006 Hosp. Acq. MRSA Cases(per 1000 Pat-Days)

UPMC FY 2006 (Oct. - March) Hospital Acquired MRSA Rate Trending

CLABS_NUM

Presbyterian CTICU

Shadyside MICU

McKeesport Med-Surg

St. Margaret Med-Surg Teach

Totals

FY 2006 Hosp. Acq. MRSA Cases

UPMC FY 2006 (Oct. - March) Hospital Acquired MRSA Case Trending

HOSPITAL1/1/03-12/31/03BaselineOCT. 2005NOV. 2005DEC. 2005JAN. 2006FEB. 2006MAR. 20067/1/04-6/30/05

Presbyterian 4G36.0%6.74.59.89.35.16.35.2

Shadyside CTICU24.6%3.20.04.10.00.00.06.9

McKeesport Med-Surg51.8%7.40.00.00.00.020.80.0

St. Margaret Med-Surg Teach27.8%0.20.00.06.00.00.09.4

Totals1.81.33.84.11.64.65.9

Number of Infections

HOSPITAL1/1/03-12/31/03BaselineOCT. 2005NOV. 2005DEC. 2005JAN. 2006FEB. 2006MAR. 2006

Presbyterian 4G36.0%3122111

Shadyside CTICU24.6%10010002

McKeesport Med-Surg51.8%1000020

St. Margaret Med-Surg Teach27.8%1001001

Totals15133134

Number of Vent-Days

HOSPITALBaselineOCT. 2005NOV. 2005DEC. 2005JAN. 2006FEB. 2006MAR. 2006

Presbyterian 4G447222204215197158194

Shadyside CTICU3173265244230208159289

McKeesport Med-Surg135651331201189686

St. Margaret Med-Surg Teach4461236201167104245106

Totals8216788782732627658675

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00000

00000

00000

00000

00000

00000

Presbyterian 4G

Shadyside CTICU

McKeesport Med-Surg

St. Margaret Med-Surg Teach

Totals

FY 2006 VAP Rate(per 1000 Vent-Days)

UPMC FY 2006 (Oct. - March) VAP Rate Trending

00000

00000

00000

00000

00000

00000

00000

Presbyterian 4G

Shadyside CTICU

McKeesport Med-Surg

St. Margaret Med-Surg Teach

Totals

FY 2006 VAP Cases

UPMC FY 2006 (Oct. - March) VAP Case Trending

HOSPITAL1/1/03-12/31/03CY 2003CY 2004CY 2005CY 2006 (Thru Mar)7/1/04-6/30/05

Presbyterian CTICU36.0%18.06.06.00.0

Shadyside MICU24.6%11.09.06.00.0

McKeesport Med-Surg51.8%1.01.00.00.0

St. Margaret Med-Surg Teach27.8%1.03.00.00.0

Totals31.019.012.00.0

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&CUPP Diabetic Statin and Ace / Arb Trending

&LMichaux&R&D

00000

00000

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Presbyterian CTICU

Shadyside MICU

McKeesport Med-Surg

St. Margaret Med-Surg Teach

Totals

Central / Femoral Line Infections

UPMC Central / Femoral Line Rate Trending

Institute for Healthcare Improvement 100K Lives Campaign: Success Story

Patient-Centered Hospital Care: Staff Managed Pain, Responded When Needed Help, and Explained Medicines, 2005Percent of patients reporting always******

Reid Hospital; Richmond, Indiana

* Countries age-standardized death rates, ages 074; includes ischemic heart diseaseDATA: International: WHO mortality database from Nolte and McKee 2003; U.S. 2002 state estimates: K. Hempstead, Rutgers University using Nolte/ McKee methodology. Methods in technical appendix to Scorecard Chartpack.SOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006Telephoned random sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiencesReceived written consent use info from previous two years of medical records to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive careOver 46 million uninsured last year* Based on percent of beneficiaries with three conditions (diabetes, chronic obstructive pulmonary disease, and congestive heart failure) who had a doctors visit four weeks after hospitalization, a doctors visit every six months, annual cholesterol test, annual flu shot, annual eye exam, annual HbA1C test, and annual nephrology test. Source: G. Anderson and R. Herbert for the Commonwealth Fund, Medicare SAF 5% 2001 data.a 2002 b 1999 c 2001* Includes claims administration, underwriting, marketing, profits, and other administrative costs; based on premiums minus claims expenses for private insurance.Data: OECD Health Data 2005.

Source: Institute for Healthcare Improvement web site: www.ihi.org, accessed 10.25.2006

*Patients pain was well controlled and hospital staff did everything to help with pain**Patient got help as soon as wanted after patient pressed call button and in getting to the bathroom/using bedpan***Hospital staff told patient what medicine was for and described possible side effects in a way that patient could understandSOURCE: CAHPS Hospital Survey results for 254 hospitals submitting data in 2005. National CAHPS Benchmarking Database