Commonwealth Foundation State Scorecard

As the temperatures across North Dakota cool down, across the nation, concerns about health care are heating up.  While solutions to challenges facing health care depend on one’s vantage point, consumers, payers, providers and policymakers tend to share the same set of concerns; variability in care quality, challenges in holding down health care costs, and maintaining affordable access to health insurance.  Rather than pursuing solutions to these thorny problems from the perspective of just one stakeholder group, the Commonwealth Fund has convened 18 individuals representing all of the sectors, to propose strategies that could produce a high performance health system. These strategies are designed to influence activity at the bedside, in the board room, and in the nation’s capitol. 

Mary Wakefield, Ph.D., R.N., and director, Center for Rural Health, is a member of the Commission on Creating a High Performing Health System.

The focus of our dialogue pivots off of four goals: achieve high quality safe care, access to care, efficient and high value care, and  build in capacity for systems to improve.  The latter involves both organizational and workforce capacity for innovation.  As part of this effort, information has been compiled  on what is done well in and across the nation and where and what improvements need to occur.   What becomes readily apparent is that some places are doing very well on measures of these four goals while others are not.          

While there is ample opportunity for us to learn from other states, we can also take some pride in the fact that on many measures, North Dakota does quite well. In fact, our state is in the top quartile on the Commonwealth Fund’s State Performance Scorecard.   

Recognizing that there is much to be learned from rural America that can help to reframe health care, I invited the Commonwealth Fund representatives to North Dakota earlier this year.  They heard firsthand from some of our payers and  providers about how we achieve high marks on a number of important measures. For example, North Dakota has a higher than average proportion of primary care providers.  Research is clear that states and nations with more primary care tend to do better managing chronic illness, holding down spending and using fewer hospital beds. 

We also see homegrown virtual networks built across health care sectors, clinicians and communities.  Such networks harness efficiencies and cooperation that can support quality, access, efficiency and certainly innovation.

Through the scorecard we can also see the gaps that need to be bridged in North Dakota. To do so, we can look to and learn from the states and other countries that do better than we do on some measures.  

In the meantime, the important work of the Commonwealth Fund is finding its way into briefings on Capitol Hill, articles in the health trade press, speeches at national meetings, and informing health proposals of presidential candidates.   The Fund’s work will continue to be informed by what was learned not only in places like Denver and Los Angeles, but also by what was learned in North Dakota. Efforts will continue around the complex but essential business of improving health and health care, because whether its North Dakota, or across the nation, doing less than the best isn’t quite good enough.

-Mary Wakefield