Right Track? Nation’s Worst? What’s the Diff?

Tennessee state house speaker Beth Harwell picked an odd week to write an op-ed (in this morning’s Tennessean) declaring that “Tennessee is on the right track” — unless she equates “on the right track” with “among the nation’s worst.” Because “among the nation’s worst” is precisely and appropriately how Tennessean reporter Shelley DuBois sums up the state’s standing in a new Commonwealth Fund report comparing states on dozens of measures of health care access, quality, costs and outcomes.

The report titled Aiming Higher (full text pdf here), which covers the period 2007-2012, finds widespread gains among states in areas that were getting a lot of policy attention, such as child immunizations and hospital readmissions, but on the down side rising costs and declines in access to care. In comparisons of states, Tennessee comes out rather badly. Skimming through the report’s various charts and graphs (pdf), this is easy to see.

Exhibit 12: Percent of adults who went without care because of cost, Tennessee ranks 10th from the bottom, unchanged from 2007.

Exhibit 16: Mortality amenable to heath care, Tennessee is in the bottom 10 for both black and white residents (they do that one by race).

Exhibit 8: Tennessee has the 16th highest rate of Medicare 30-day readmissions.

Exhibit 3: An overall state scorecard summary of health system performance across five dimensions (access and affordability; prevention and treatment; avoidable hospital use and cost; health lives; equity) ranks Tennessee’s 40th, in the bottom quartile.

Two bright spots: Exhibit 6 shows Tennessee ranks 11th in percent of children receiving all recommended vaccine doses, and Exhibit 11 shows Tennessee in top third of states in percent of children with insurance.

Perhaps these weak results mask improvement, making it possible to couch them in Harwell’s “on the right track” optimism. Is that plausible? Not so much. The CF report captures trends in Tennessee on 34 indicators, and finds improvement on 12 of them, worsening on 10, and no change on the rest — pretty much a wash. With the state’s ongoing stubborn refusal to entertain Medicaid expansion, it’s hard to look at the data here and predict upward movement in Tennessee’s health care quality and outcomes anytime soon.

“Right track” indeed.

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.