Commonwealth Fund Report Shows Healthcare Gains, But Gaps Persist

Lilo H. Stainton | May 30, 2018 | Health Care
New Jersey finishes in middle of the pack nationally, with room to improve in several key areas, like preventative care and hospital readmissions for elderly

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New Jersey remains in the middle of the national pack when it comes to its healthcare system, according to a new national report, but it can do more to improve preventative care, reduce the number of elderly patients readmitted to the hospital within a month, and control the cost of medical treatment, among other things.

The Commonwealth Fund’s 2018 state healthcare scorecard ranked the Garden State 25th in its review of healthcare performance in the 50 states and Washington, D.C., a decline of two places from last year’s standing. But New Jersey lags behind its neighbors, with all other states in the Northeast scoring higher, including Massachusetts at number 2 and Vermont at number 4.

New Jersey did well on providing access to care, ranking 14th overall; fifth, when it came to covering kids; and third in the amount of money paid by employee-based insurance plans. It came in 19th for promoting healthy lives in general, and seventh for its low infant-mortality rate. (The data accounts for the total infant mortality rate and not racial disparities; black babies are more than three times more likely to die here than white ones, a growing focus for state and healthcare officials.)

Where New Jersey falters

But the Garden State ranked closer to the bottom, 36th, when it came to avoiding hospital use and costs, with per-person Medicare reimbursements nearly twice the national average, according to the report. It came in 47th for providing patient-centered care and 50th for its failure to properly discharge hospital patients with aftercare instructions.

The findings suggest that the Garden State’s expansion of Medicaid under the federal Affordable Care Act, which took effect in 2014 and has helped an additional 800,000 residents obtain coverage, has had a positive impact — a trend that was the focus of Commonwealth’s 2017 report. But its status as state with significant regulation; high costs for real estate, staff and, other needs; and a plethora of clinical options, may also shape these outcomes.

Commonwealth’s findings also raise questions about New Jersey’s success with preventative care, including for mental illness. The state ranked 35th for the number of diabetics that take annual blood screenings and 42nd for connecting youngsters with proper mental health care. (New Jersey will soon become one of a handful of states in which Medicaid funds can be used to pay for diabetes prevention programs; Medicare will roll out similar coverage in July.)

The 2018 scorecard, released earlier this month, involves a review of various data from 2013 through 2016 to assess all states and D.C. on their performance on nearly four-dozen measures to determine access to care, the quality and efficiency involved, the health outcomes, and disparities related to income. Overall, the study found that states are improving more than declining on these metrics, “a reversal of sorts from the first decade of the century, when stagnating or worsening performance was the norm,” the study notes.

Disquieting trends

But the research also pointed to some disturbing trends, the authors said. For one, it found a rising number of preventable deaths and a 50 percent increase since 2005 in “deaths of despair” — suicides or overdoses related to drugs or alcohol. (While New Jersey is a center for the opioid epidemic, and more than 2,000 lost their lives to drugs or alcohol in 2016, the state actually ranked 11th nationwide for these deaths in the 2018 survey.)

Researchers also noted that, while access and care have improved in recent years, there are growing questions about the value of New Jersey’s healthcare spending nationwide. America spends more than other wealthy countries, they said, but does not see better outcomes as a result.

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As examples, the study noted that 29 percent of patients with job-based insurance diagnosed with a lower-back problem were referred for unnecessary imaging studies, a costly diagnostic procedure that didn’t benefit their care. One-third of patients with insurance coverage were not participating in routine cancer screenings, a low-cost protocol that can improve outcomes and reduce the need for more expensive treatments.

In addition, obesity rates continue to rise — increasing the likelihood for kidney disease and other complications — treatment for mental illness remains hard to find, and too many patients still seek routine care in emergency rooms, the research found. The authors suggest this may reflect a lack of quality primary-care providers that are accessible and affordable.

“This scorecard shows us that all states have the opportunity to improve, including those at the top. Moving forward, we should continue to evaluate states’ progress and support effective policies that are making it easier for people to get and afford the health care they need,” said Commonwealth Fund president Dr. David Blumenthal.

Two areas in which nearly half the states have shown gains are improving nursing-home care, with residents becoming more mobile in recent years, and reducing hospital readmissions for elderly patients — a trend researchers said reflects the growing use of federal penalties to encourage hospitals to reduce their return rates.

But the 2018 report suggests New Jersey is still struggling with these issues on several fronts. The state ranked 42nd for its number of Medicare hospital readmissions within 30 days, 43rd for readmissions among residents of long-term nursing homes, and 46th for the number of short-term nursing home patients that returned to inpatient care in a month or less.