Embedded Files
Facility Based Service Trends
Facility Based Service Trends
ER Visit Trends
ER Visit Trends
Top states: DC, LA, CT, MS, WV
High ER utilization is often a sign of deeper system issues, limited access to outpatient care, poor after-hours coverage, or lower patient engagement, all areas that value-based care models are built to address.
DC and Louisiana have consistently high ER rates, pointing to long-standing fragmentation or structural barriers. These aren't just clinical gaps; they likely reflect broader social and systemic challenges.
Mississippi and West Virginia follow a similar pattern: high ER and low E&M use. That combination suggests reactive care environments, where patients turn to the ER because proactive outpatient systems either don't exist or aren't trusted.
Connecticut is notable for appearing on both the E&M and ER charts, meaning patients are getting in to see providers and still ending up in the ER at high rates. That points more toward breakdowns in coordination, follow-up, or navigation rather than basic access.
For these states, there’s a clear opportunity to reduce avoidable ER visits by scaling virtual care, expanding urgent care capacity, and tightening post-discharge follow-up, especially in systems still operating under fee-for-service incentives.
Skilled Nursing Facility Covered Stays
Skilled Nursing Facility Covered Stays
Top States: CT, NJ, MA, OH, RI
SNF utilization is declining across the board, a trend sharply accelerated by the pandemic and notably not rebounding. From a value-based care perspective, this raises a critical question: Are states actively replacing institutional post-acute care with something better, or just scaling it back without a safety net?
Connecticut and New Jersey still sit above the national average, though the decline is steady. That suggests a slower shift, possibly due to entrenched referral patterns, capacity dependencies, or delayed scaling of home-based alternatives like SNF-at-home or transitional care models.
Massachusetts and Rhode Island are showing a more deliberate, controlled decline. These are likely intentional system shifts, stronger discharge planning, better coordination with home health, and alignment with ACO goals around reducing unnecessary institutional stays.
Ohio holds relatively flat, not an outlier in either direction. It reflects a stable, balanced system that hasn’t over-relied on SNFs but also hasn’t aggressively pushed for substitution either.
The goal isn’t just lower SNF use, it’s better post-acute recovery. The real wins come when states invest in coordinated, home-based rehab models that reduce readmissions and improve the patient experience without compromising outcomes.
Inpatient Covered Stays
Inpatient Covered Stays
Top States: DC, FL, IL, LA, MA
This is one of the clearest indicators of value-based care in motion: a sharp drop in inpatient stays around 2020, followed by varying levels of sustainment across states.
D.C. and Florida started with some of the highest inpatient rates and, while both have improved, they continue to trend above the national benchmark. That persistence suggests underdeveloped alternatives like SNF-at-home, hospital-at-home, or limited transitional care infrastructure, all critical levers for reducing inpatient reliance under VBC.
In contrast, Illinois, Louisiana, and Massachusetts show more significant reductions, trending closer to what value-based models are designed to achieve, avoiding inpatient stays through earlier intervention, care coordination, and managed risk.
Massachusetts stands out. Its progress likely reflects broader statewide alignment through ACO adoption, policy support for integrated delivery, and well-established transitional care protocols.
The states that succeed here will be the ones that scale post-acute alternatives, transitional care, home health, and SNF substitution. Without that, we’re not reducing system pressure, we’re just shifting it.
Home Healthcare Episodes
Home Healthcare Episodes
Top States: OK, TX, LA, MS, NV
Home health utilization surged after 2019, particularly in Oklahoma and Texas, likely driven by pandemic-era policy shifts, increased reimbursement flexibility, and a broader push for in-home alternatives. But what matters more than the spike is the sustained high usage that followed.
Oklahoma is a clear outlier. Its sharp rise may reflect provider expansion or policy alignment, but without outcomes data, it’s hard to say whether that spike is translating into actual value or just volume.
Texas and Mississippi show a more consistent upward trend, which could indicate maturing home-based ecosystems and greater patient comfort with receiving care at home, both promising signs for long-term value-based care.
Nevada reappears here (alongside E&M), reinforcing the idea that it’s investing broadly in outpatient and home-based infrastructure. That kind of alignment across services signals strong VBC potential.
Louisiana, on the other hand, is holding steady, not falling behind, but not scaling either. That may reflect limitations in provider availability, home health capacity, or barriers to patient eligibility and uptake.
Home health at this scale only creates value if it leads to fewer readmissions, better recovery, and lower total cost of care. Without that follow-through, we’re just shifting dollars, not improving outcomes. Tracking post-acute outcomes alongside this trend is essential.
Primary Care
Primary Care
Federally Qualified Healthcare Center/Rural Health Clinic
Federally Qualified Healthcare Center/Rural Health Clinic
Top states: VT, ME, KS, MO, WV
FQHCs and RHCs are essential to delivering primary care in rural and underserved areas. High utilization at this level signals a stronger reliance on community-based care, the kind of infrastructure value-based care is designed to support.
Vermont and Maine are clear examples of what aligned systems look like: consistent growth in FQHC visits, steady performance, and a clear focus on access and prevention.
West Virginia is more complex. FQHC use is high, but so is ER utilization, pointing to deeper challenges. The infrastructure for access exists, but coordination, continuity, or wraparound support might be falling short, especially for high-need populations.
Kansas and Missouri show stable performance, but without the same upward momentum. That could reflect a plateau, either in investment, policy direction, or provider adoption of more advanced VBC models.
FQHC-heavy states are ahead of the curve, but unless those services are integrated with downstream care and care management, the value won’t fully materialize. High FQHC use and high ER use should be a red flag, a sign that the pieces are there, but the system still isn’t working as one.
Evaluation & Management Events
Evaluation & Management Events
Top states: NJ, FL, NY, CT, NV
Higher outpatient E&M utilization typically reflects stronger engagement with primary care, a foundational element of value-based care. These services play a critical role in early detection, chronic condition management, and reducing avoidable hospitalizations.
New Jersey and Florida consistently lead, likely due to a combination of mature ACO participation and high Medicare Advantage penetration, both of which incentivize proactive, longitudinal care.
Nevada shows steady growth, which may point to ongoing investments in primary care infrastructure and stronger care coordination models.
Connecticut and New York remain stable but appear on both the E&M and ER charts, suggesting that while access exists, there may be gaps in continuity or follow-through that limit system efficiency.
States performing well on E&M are often those with more VBC-aligned infrastructure. For others, there's an opportunity to scale care management programs and improve care navigation to strengthen system performance.
End of Life Care
End of Life Care
Hospice Covered Stays
Hospice Covered Stays
Top States: AL, UT, FL, OK, TX
Hospice use is a powerful proxy for how well healthcare systems support patients at the end of life holistically. In a value-based care lens, the goal is timely, coordinated transitions that align with patient preferences, reduce unnecessary hospitalizations, and improve the experience for both patients and caregivers.
Alabama leads and continues to grow, which is worth noting. It’s one of the few states consistently outperforming the national average, a sign of strong provider education, clearer referral patterns, and possibly cultural norms that support earlier hospice adoption.
Utah and Florida are stable but high, a sign of maturity in palliative infrastructure. The consistency reflects well-established practices, but it also raises a question: Are patients entering hospice early enough to meaningfully benefit, or is late referral still the norm?
Oklahoma and Texas show encouraging upward trends, especially from 2017 onward. That kind of growth could be driven by policy changes, network expansion, or rising physician awareness, all signals of a system starting to evolve toward more supportive end-of-life models.
The national average is improving, but still lags well behind the leaders. That delta is telling: in many parts of the country, patients may still be dying in hospitals or ICUs when they could have experienced a more supportive, lower-cost, and values-aligned transition elsewhere.
Top-performing states are aligning late-life care with VBC goals. Others should be asking hard questions about what’s standing in the way, whether that’s cultural hesitation, gaps in provider training, weak discharge planning, or lack of access to home-based palliative options.
Page updated
Google Sites
Report abuse