California again ranked in the bottom half of states in health system performance, but improved to 31st from its previous ranking of 40th in 2007, according to the Commonwealth Fund “State Health Care Scorecard.”

Focused on identifying opportunities to improve, the Scorecard assesses states’ performance on health care relative to achievable benchmarks for 38 indicators of access, quality, costs and health outcomes. The number one ranked state was Vermont, while Mississippi ranked last. California’s ranking was immediately behind New Jersey and immediately in front of Oregon.

According to the Scorecard, if California improved to the level of the best-performing state, more than half a billion dollars could be saved in health care spending. Specifically, the following improvements would have to occur for California to reach Vermont’s current level of health care:

• Insured Adults: 3.9 million more adults ages 18-64 — or 15 percent of California’s adult population — would be covered by health insurance (public or private), and therefore more likely to receive health care when needed.
• Insured Children: 698,671 more children (ages 0-17) would be covered by health insurance (public or private), and therefore more likely to receive health care when needed.
• Adult Preventive Care: 1.4 million more adults (ages 50 and older) would receive recommended preventive care, such as colon cancer screenings, mammograms, pap smears and flu shots at appropriate ages.
• Diabetes Care: 399,875 more adults (ages 18 and older) with diabetes would receive three recommended services (eye exam, foot exam and hemoglobin A1c test) to help prevent or delay disease complications.
• Childhood Vaccinations: 111,706 more children (ages 19-35 months) would be up-to-date on all recommended doses of five key vaccines.
• Adults with a Usual Source of Care: 4.5 million more adults (ages 18 and older) would have a usual source of care to help ensure that care is coordinated and accessible when needed.
• Children with a Medical Home: 1.8 million more children (ages 0-17) would have a medical home (or Patient-Centered Medical Home, an approach to providing comprehensive primary care) to help ensure that care is coordinated and accessible when needed.
• Preventable Hospital Admissions: 31,877 fewer preventable hospitalizations for ambulatory care sensitive conditions would occur among Medicare beneficiaries (age 65 and older) and $286 million would be saved from the reduction in hospitalizations.
• Hospital Readmissions: 10,195 fewer hospital readmissions would occur among Medicare beneficiaries (age 65 and older) and $181 million dollars would be saved from the reduction in readmissions.
• Hospitalization of Nursing Home Residents: 7,115 fewer long-stay nursing home residents would be hospitalized and $87 million would be saved from the reduction in hospitalizations.
• Mortality Amenable to Health Care: 4,874 fewer premature deaths (before age 75) might occur from causes that are potentially treatable or preventable with timely and appropriate health care.

The Commonwealth Fund is a privately funded foundation that promotes access, quality and efficiency in American health care, with particular attention to uninsured, low-income, minority, young and elderly Americans. The Commonwealth Fund carries out its mission by supporting research and providing grants in health care practice and policy.