Nishi Singhal, Program Officer, Primary Care, Texas Health Institute

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The Commonwealth Fund Scorecard on State Health System Performance annually assesses how well the health care system is working in every state with 56 performance indicators. For the 2022 Scorecard, a new question was added to the assessment: “How well has each state responded to and managed the COVID-19 pandemic?” The scorecard mostly reflects data from 2020; however, the COVID-19 measures incorporate data through the first quarter of 2022.

Diving into Texas’s scorecard, we can see that Texas is not meeting the needs of its residents in regards to health care and wellness.

Highlights of how Texas ranks to other states shows an unenviable picture.

• Overall national rank: 48 of 51
• Access and affordability: 51 of 51
• COVID-19: 44 of 51

The scorecard measures access and affordability using rates of insurance coverage for children and adults, cost-related barriers to receiving care, and rates of medical debt. Without Medicaid expansion, with many counties that lack a primary care team, and a patient population that requires an extensive range of care services, Texas’s ranking may not come to many as a surprise.

The COVID-19 measures include indicators such as state progress in vaccinating residents and COVID-related hospitalization rates. As Texas Health Institute’s 2020 brief, COVID-19 in Texas: Uncovering Racial Inequities and Advancing Health Equity in Response and Recovery, uncovered, “The COVID-19 pandemic has laid bare the profound racial inequities that exist across Texas. Hispanic and Black residents, in particular, have faced the brunt of COVID-19 infection, hospitalizations, and deaths, as well as its economic fallout.” The report highlights the staggering percentage of Hispanic and Black COVID-19 cases and deaths.

Some indicators have improved in Texas since the previous report:

• Nursing home residents on antipsychotic medication
• Potentially avoidable emergency department visits, age 65 and older
• Preventable hospitalizations, age 65 and older

The indicators that worsened included:

• Home health patients with improved mobility
• Preventable hospitalizations, ages 18 to 64
• Adults with any mental illness reporting unmet need

We have many opportunities to strengthen Texas’ care delivery system and to improve the accessibility of health care. The Texas Primary Care Consortium (TPCC) is creating a coordinated advocacy roadmap to prioritize primary care during the 88th Texas Legislative Session (2023). We aim to establish state-led leadership to strengthen and optimize the primary care system. The roadmap centers four fundamental priorities:

• Access to primary care: Given the state’s chronic challenges with access to care, all policy priorities will be assessed for their impact on improving access to care.
• Cost-effectiveness: Priority will be given to ‘efforts’ that are designed to be cost-effective or efforts that could potentially generate costs savings.
• Intended beneficiaries: Each policy priority will be reviewed and assessed for its intended beneficiaries.
• Realistic: Each policy priority will be assessed for its ability to galvanize support not just within the primary care system but both sides of the Texas legislature.

Additionally, TPCC will host our annual summit in-person in Austin on September 8 and 9. This summit will honor the past ten years of convening health champions but most importantly, continue in the shared pursuit of improving the health of Texans through accessible, equitable, and coordinated person-centered primary care. Below is a highlight of sessions that are continuing to educate on ways to improve the health of Texas:

• Community-Driven Model of Caring for Underserved Texans: Learn how a rural clinic in East Texas has effectively served its community with a high burden of chronic illness.
• Making the Inequalities Visible: Understanding What Drives Health Outcomes in the Transgender and Gender-Diverse Community: See the impact of discrimination and resilience on health and social determinants of health in the transgender or gender diverse population.
• Reducing 30-Day Readmissions by Patient-Centered Care Teams: Understand how employing a whole-person approach to care coordination—including assessing for and addressing social determinants of health, medication adherence, and psychosocial barriers to carrying out a patient-centered care plan—lower readmission rates.

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Contact

Nishi Singhal

nsinghal@texashealthinstitute.org