CT drops five notches in our state’s health system performance ranking

Connecticut ranks 11^th among states according to the Commonwealth Fund’s 2025 Scorecard on State Health System Performance report. While we’re still ahead of 39 states, we fell from 6^th place in the 2023 report. The problems touch the cost of care, no surprise, but also utilization/access and quality. The cost of care gets a lot of policy attention in Connecticut while access and quality are largely ignored. We have a lot of work to do.

The Commonwealth Fund’s report uses 62 meaningful measures that cross populations, costs of care, and utilization of services. As a multi-year report, it helps point out where we are moving in the right direction and where we have stalled or moved backward. The specificity of the measures helps identify the problems, compared to other states’ performance, which drives better solutions.

Connecticut’s worst performance was in the Avoidable Use & Costs metrics – we are 48^th in the nation. In good news, we scored in the top quartile of states in Access & Affordability (9^th), Prevention & Treatment (5^th), Healthy Lives (2^nd – we always do well here), and Racial Health Equity (11^th).

There is lots of room for improvement. We are below the US average for:

• Adults with substance use disorder who did not get treatment (37^th)
• Drug overdose deaths per population (32^nd )
• Hospital patient experience ratings (44^th)
• Nursing home residents with an antipsychotic medication (30^th)
• Home health patients getting better at taking their medications by mouth (34^th)
• Potentially avoidable ED visits, for both seniors on Medicare (47^th) and adults 18-64 years old with employer coverage (38^th)
• Admissions for ambulatory care-sensitive conditions (could’ve been prevented with adequate primary care) for seniors on Medicare (31^st)
• Hospital readmissions for both seniors on Medicare (45^th ) and adults 18 to 64 years with employer coverage (42^nd )
• Skilled nursing facility patients with a hospital readmission (45^th )
• Employer-sponsored coverage cost per enrollee (46^th )
• Medicare spending per beneficiary (43^rd )

Areas with wider disparities between high and low-income Connecticut residents than in most states:

• Adults who went without care due to cost in the past year (16 percentage points difference between high- and low-income CT residents) CT has had no improvement on this measure since 2019
• Adults without a usual source of care (18 percentage point gap)
• Underinsured – adults with high out-of-pocket medical costs relative to income (28 percentage point gap) CT has had no improvement on this measure since 2019
• Adults without a dental visit in the past year (27 percentage point gap)
• Adults with appropriate cancer screenings (12 percentage point gap)
• Adults with appropriate flu and pneumonia vaccines (19 percentage point gap)
• Adults who are obese (12 percentage point gap)
• Potentially avoidable ED visits for seniors on Medicare (41^st largest gap by income among states)
• Hospital admissions for primary-care sensitive for seniors in Medicare (38^th largest gap by income among states)
• Hospital readmissions for seniors on Medicare (42^nd largest gap by income among states)

Since 2019 Connecticut has made no progress on:

• Deaths due to healthcare-treatable or preventable causes
• Infant mortality
• Firearm deaths
• Drug overdose deaths – we actually got worse on this measure
• Adults missing care due to cost in the past year
• Adults under age 65 with high out-of-pocket costs relative to household income
• Adults with diabetes and employer-sponsored coverage without a hemoglobin A1c test during the year
• Hospital patient experience ratings – we also got worse on this measure
• Potentially avoidable ED visits for adults under age 65 – we also got worse on this measure
• Total Medicare cost per enrollee – this also got worse

Since 2019, we improved on:

• Central line-associated bloodstream infections
• Potentially avoidable ED visits for seniors
• Preventable hospital admissions for primary care-sensitive conditions for both seniors and adults under age 65

A Clue? — Given that we improved on potentially avoidable ED visits for state residents over 65 and got worse on the same measure for adults under age 65, the solution may be linked to payment policies.