State Spotlight Iowa
When AHRQ began publishing national reports on health care quality and disparities 10 years ago, the reports were well received. But almost immediately, Ernie Moy, M.D., began hearing, "What's happening in my State?"
"We understood," says Moy, one of the main authors of AHRQ's annual National Healthcare Quality Report and National Healthcare Disparities Report. "So, we started collecting data more aggressively and in 2005 came out with our first State Snapshots."
Every State and the District of Columbia could compare their own health care statistics with the Nation as a whole. "But then States wanted to know how they compared with their neighbors. Wisconsin wanted to know if they beat Minnesota," says Moy. "And vice versa. It's been an evolutionary process."
As AHRQ collects more specific, sophisticated data, the State Snapshots reflect the new measures. Each State has an online dashboard, complete with a needle gauge ranging from very weak to very strong, which summarizes more than 100 quality measures and provides tables and graphs with specific measures. These performance measures for each State and the District of Columbia include overall health care quality, types of care, settings of care, common clinical conditions, and special areas, such as diabetes, asthma, disparities, and Healthy People 2020.
Beginning with this issue, Research Activities will publish a bimonthly column on how individual States use the information from their AHRQ State Snapshots.
Health in the Hawkeye State
The first State we're featuring is Iowa, known for its county fairs and presidential caucuses. It has a population of about 3.1 million who live in 99 counties, which were developed in the 1800s to ensure all residents could reach their county seat within a day by horse and buggy. Crops cover about 60 percent of this Midwestern State, recognized as a major supplier of food for the world.
On the online AHRQ State Snapshots dashboard, Iowa earned a strong rating and ranked fifth in overall health care quality compared to other States. Minnesota achieved the highest ranking, followed by Wisconsin, Maine, and Massachusetts.
"Compared with most of the country, our overall quality of care is high," says Paul M. Pietzsch, president of the Health Policy Corporation of Iowa, the State's business group on health. "Overall, our geographic and financial access to care is better than most.We have a lower percentage of uninsured people than many States. But there is wide variation by type of care, setting of care, and care by clinical area."
Although Pietzsch takes pride in his State's progress, he says, "We need to leap forward to improve quality and drive down costs. Even though Iowa is doing better than average, it's still not good enough. Average or even above average is not our goal. Iowa and all States have room for improvement."
Pietzsch pulled statistics from AHRQ's State Snapshots, the Institute of Medicine, the Dartmouth Atlas of Health Care, and a dozen other organizations to create the Chartbook of the Quality and Financial Performance of the Health Industry in the Greater Iowa Area, which was released in March 2013.
"The thing we're trying to do with the chart book is increase transparency in public reporting on cost and quality. We think it's essential to drive a health care market towards improvement," says Pietzsch. "With transparency comes clarity and accountability. In health care, we believe there's a need for transparency — maybe more than any other industry."
Pietzsch points out that the book covers the greater Iowa area. "We didn't just put a fence around Iowa. That's not how it works. We looked at the market area. People who live in southwest Iowa may go to Omaha for care. Others may go to Illinois, and patients in Des Moines may go to the Mayo Clinic in Rochester (Minnesota)."
To illustrate the dynamics of the market area, Pietzsch told an anecdote about a hospital in Des Moines that competed with the Mayo Clinic for patients. "A few years ago, they gave bumper stickers to their employees that said, ‘Hold the Mayo.'"
In putting together the book, Pietzsch found that the lack of information on cost was larger than he expected. "We knew there was a void, but we didn't know how much of a void there was," Pietzsch says. "Consumers and patients are seeking more information on how much they would need to pay for health care and that's only going to grow."
Pietzsch's ultimate goal for the book is to help improve the quality, cost, and affordability of health care for Iowans.
Iowa Medicaid focus on medical homes
"This has been a State that keeps its eye on health care," says Jason Kessler, M.D., FAAP., Iowa Medicaid Medical Director. And AHRQ's State Snapshots data helps with that. "Compared to the rest of the nation, our quality of health care is pretty high. I think that really speaks to the quality of providers in this State. We've got some top notch institutions for medical education that produce quality clinicians."
As part of his position, Kessler meets with clinicians throughout the State. "I'm really interested to see the changes going on in Iowa," he says. "Our ability to change and respond depends on what comes up, but I like to think we can take advantage of opportunities."
These opportunities include patient-centered medical homes (PCMHs). In 2012, Iowa Medicaid launched medical homes for their members with chronic conditions.
"This program benefits providers by offering new opportunities to track, coach, and engage patients. The program benefits patients by offering enhanced services and access to care using the PCMH model," says Kessler. "We are already hearing stories about how health homes are improving the lives and health care of our members. By the time the program is 1-year-old this summer, we hope to have some data showing cost savings and by 2 years we should have some meaningful quality data."
Iowa is now starting a health home for people with serious and persistent mental illness. "I really am a big believer in the medical home model as a way to provide more coordinated, person-centered care," says Kessler. "We have some good experience in this area."
Kessler also keeps in touch with providers through his monthly column called "Medical Director's Minute" about clinical news and policies. "Typically it is about 250 words each month, which should take the average person one minute to read," says Kessler. "In Iowa, we're certainly trying to keep up with the changes in health care and promote quality."
Editor's note: AHRQ's 2011 State Snapshots (2012 will be out soon) are at http://statesnapshots.ahrq.gov/snaps11.