The report findings point to the need to strengthen primary care to ensure timely access, reduce reliance on emergency rooms, and improve care for those with chronic disease. The scorecard finding that those living in low-income communities often fare worse points to the need for targeted efforts focused on "hot spots," or communities with very high rates of hospital or emergency room use, to act early, prevent complications and improve population health.

More gaps
The report, "Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations," and an online interactive map rank states on 30 indicators covering issues such as access to affordable health care, preventive care and quality, potentially avoidable hospital use and health outcomes. The report also examines how well the top-performing state in each category does for its high-income residents and sets that as a benchmark in order to assess the potential if all states could do as well.

The report finds substantial variation in health care and health outcomes for low-income people – a two- to five-fold difference. While there was room for every state to improve, states in the Upper Midwest, Northeast, and Hawaii performed best, while Southern and South Central states often lagged.

[See also: Blumenthal on EHR study: Road to digitalization is challenging.]

Some findings of wide geographic disparities and gaps in care include:

• The percentage of uninsured low-income adults ranged from a low of 12 percent in Massachusetts to a high of 55 percent in Texas.
• Only 32 percent of low-income adults ages 50 or older received recommended preventive care, such as cancer screenings and vaccines, ranging from 26 percent or less in Idaho, Oklahoma and California, to 42 percent in Massachusetts, the top-ranked state for this indicator.
• In eight states, 40 percent or more of Medicare beneficiaries received medications considered high-risk for the elderly – rates more than double that of states with safer prescribing.
• Asthma-related hospitalizations among children from low-income communities in New York were eight times higher than in Oregon, the state with the lowest rate. (477 per 100,000 in New York, compared to 56 per 100,000 in Oregon.)
• At least one of four low-income adults under 65 in West Virginia, Tennessee, Alabama, Mississippi and Kentucky lost six or more teeth due to decay or disease, compared to less than 10 percent in Connecticut, Hawaii and Utah, the states with the lowest rates.