Directors Corner | October 2021 | A Scorecard for Statewide Health System Performance

In the poignant 1971 movie Fiddler on the Roof about life in a Jewish community of a pre-revolutionary Russian village, there is a scene where Reb Tevye intervenes between two men arguing heatedly over a goat (or perhaps a mule). Tevya tries to mediate.  After the first guy makes his case, Tevye pronounces with absolute certainty, “You’re right!”  And after the second man make his case, Tevye exclaims with equal conviction, “You’re right!”  A perplexed by-stander then intervenes, “Wait!” Pointing to each man he says in turn, “He’s right AND he’s right?  They can’t both be right.”  Tevye considers that for a second, shrugs, and then acknowledges to the by-stander, “You’re right!”

And so it is with US healthcare as well – both nationally and here in Colorado: healthcare is so inevitably complex and so multi-variable that any two of us can make completely contradictory statements about it and both may actually be true.  Context, as usual, is everything.

Providing context on health system performance here in Colorado at our recent 2021 annual forum is why we so appreciated the presentation from Sara Collins, PhD from The Commonwealth Fund on “Health Care Coverage and Access.”  Using data from the Commonwealth Fund’s 2020 Scorecard on State Health System Performance, Dr. Collins addressed the question, “How Did Colorado Stack Up?”   While the overall answer is “pretty darn well,” any specific answer depends on the specific question.

The Commonwealth Fund’s “Scorecard” should be of interest to every Colorado policy maker, legislator, State administrator, health plan, and health plan sponsor.  With 49 indicators organized into 4 dimensions , the 2020 Scorecard is based on most recent state-level, pre-pandemic data including federal surveys,  vital statistics, administrative claims.   Of specific interest to Colorado, the Scorecard includes our…

  • Rankings (and changes from baseline) for Access and Affordability, Prevention and Treatment, Avoidable Use and Cost, Healthy Lives, and Income Disparity.
  • “Top ranked” and “most improved” indicators.
  • “Bottom ranked” indicators and indicators that worsened the most in our State.

Among key findings and takeaways that Dr. Collins shared were these:

  • Colorado does better than average on insurance coverage but ranks behind many other Medicaid-expansion states.
  • Racial and ethnic disparities in uninsured rates are somewhat narrower in Colorado than in other states.
  • Performance on affordability in Colorado is mixed.
  • Avoidable hospital use is relatively low in Colorado. Yet spending is not as low as might be expected based on hospital utilization.
  • Price increases are driving total spending growth here.

You can find Dr. Collins’ full presentation on our website by clicking here.

Mazel tov!