Each of the factors associated with mortality amenable to health care
merits attention in the context of a comprehensive, systemic approach
to improving the way care is organized and delivered, starting with
access. In addition, each state and health system within it should
consider immediately how it might improve its performance, improve
the health and productivity of the population, and potentially reduce
mortality. Although across the US states, there is a wide range of
performance on a variety of health care and health-system indicators,
not just amenable mortality,6 and although there are several state-level
‘market, politicial, and cultural characteristics that can help or hinder
health system improvement’, a study of high and low performers by
Silow-Carroll and Moody15 suggests that all states, ‘regardless of
starting point’, can work to improve and that there are common lessons
that can be applied. These include developing incentives for consumers,
providers, and health plans; ‘framing health in terms of economic
development to gain public and political support’; and engaging
purchasers and payers to adopt methods of value-based purchasing.
Perhaps most importantly, Silow-Carroll and Moody emphasize ‘bringing
stakeholders together to develop goals and build trust’. States, even
poor states, can convene stakeholders and encourage joint action. Prior
measurements of health indicators across states over time have demonstrated
that when improvement goals are set, improvement actually
occurs.6 Accordingly, we encourage states, regardless of their individual
demographic characteristics, and the nation as a whole to adopt goals
of improving the health-system indicators associated with amenable
mortality.