The Commonwealth Fund’s 2016 Scorecard on Local Health System Performance is out, and it gives interesting perspective on the state of healthcare in the U.S. Wisconsin and the Upper Midwest scored well overall, while most Southern states did not. Milwaukee’s ranking dropped 17 spots from the 2012, the year the first edition of the Scorecard was released, yet it still compares favorably to other major cities.

The latest Scorecard measured changes in the country’s 306 regional health care markets from 2011 through 2014. Each health care market is defined as a hospital referral region (HRR). HRRs are widely used in health services research and policy analysis to represent areas with at least one hospital in which complex surgeries are performed. The Scorecard evaluated HRRs on 36 measures in four categories: access, prevention and treatment, avoidable hospital use and cost, and healthy lives.


According to the Scorecard, the top performing regions are Hawaii, the Upper Midwest, New England, and the San Francisco Bay area. Honolulu earned the top spot overall and the Bay area took three of the top seven spots. San Francisco and San Jose tied for seventh, while San Mateo County came in third.

Four of Minnesota’s five HRRs scored in the top ten nationally – St. Paul (2), Rochester (4), St. Cloud (6), and Minneapolis (9). The only Minnesota HRR to fall outside the top ten, Duluth, still ranked in the top quintile at 44.

Appleton, WI (5) and Dubuque, IA (10) rounded out the top ten. Although Wisconsin did not rank as highly as Minnesota, seven of its eight HRRs still scored in the top quintile. Appleton earned the highest ranking in the state, followed by Madison (13), La Crosse (15), Green Bay (19), Neenah (34), Wausau (38), and Marshfield (49). Wisconsin’s lowest ranked HRR, Milwaukee, came in at 75th placing it in the second quintile of HRRs.

The lowest scoring region in the Scorecard is the South. Ninety percent of the HRRs in the lowest performing quintile are in the South, and five of the six lowest performing HRRs are in Mississippi. The only non-southern HRRs in the bottom quintile are Dearborn, MI (255), Terre Haute, IN (266), Cape Girardeau, MO (281), Joplin, MO (282), Gary, IN (292), and Munster, IN (296). Overall, health care performance improved in 302 of 306 HRRs, but progress was uneven across the country.

Reasons for optimism in Milwaukee

At least one writer has used the latest Scorecard results to unfairly portray Milwaukee’s health system performance in a negative light. The truth is that although Milwaukee certainly has room for continued improvement, the area’s health system is performing better than it was four years ago and compares quite favorably to most other major metro areas. As UW-Madison’s health policy program director explained in a quote buried in the July 14 Journal Sentinel piece, Milwaukee’s actual performance improved between Scorecards but its ranking dropped because other HRRs made even greater improvements.

For example, the rate of uninsured adults in Milwaukee dropped from 14% to 11%, yet Milwaukee’s rank in this metric fell from 45th to 55th. In comparison the rate of uninsured adults in Rockford, IL plunged from 18% to 11%, enough to move the city’s ranking in this metric from 113th into a tie with Milwaukee at 55th. Accordingly, Milwaukee’s overall drop in the rankings should be understood not as a step backward for this community but rather a reflection of the successes other communities have had in improving their own health system performance.

Moreover, the Scorecard noted that socioeconomic factors play significant roles in health system performance. Specifically, “areas with a disproportionate share of low-income residents tend to exhibit worse health system performance than areas with relatively fewer low-income residents.” What’s more, large cities have outsize influence in driving health system performance, as the country’s 54 largest metro areas are home to 45% of the nation’s population and many of the nation’s most well-known hospitals and health systems. As is the case overall, the performance of large cities varies widely due to disparities in residents’ ability to access affordable care, in the quality of care received, and in health outcomes.

Milwaukee’s performance looks even better when compared against other large metropolitan areas (see below). Among the country’s 53 largest metro areas, Milwaukee came in 12th. In the Midwest, Milwaukee ranked 3rd among large cities, behind only St. Paul and Minneapolis. The next highest ranked Midwest metro areas were the Chicago suburbs of Melrose Park and Evanston which ranked 98th and 111th, respectively. Milwaukee’s health system certainly has room for improvement but its achievements deserve to be recognized, not downplayed.

Metro Area Overall Rank
St. Paul, MN 2
San Mateo County, CA 3
San Francisco, CA 7
Minneapolis, MN 9
Seattle, WA 16
Alameda County, CA 21
Boston, MA 26
Arlington, VA 29
Denver, CO 50
Orange County, CA 61
Portland, OR 62
Milwaukee, WI 75
Washington, DC 79
San Diego, CA 80
Camden, NJ 93
Baltimore, MD 95
Melrose Park, IL 98
Philadelphia, PA 111
Evanston, IL 111
Manhattan, NY 131
Pittsburgh, PA 139
Clearwater, FL 158
Los Angeles, CA 161
Raleigh, NC 164
Charlotte, NC 168
Kansas City, MO 172
Phoenix, AZ 180
Ft. Lauderdale, FL 182
Cleveland, OH 186
Atlanta, GA 189
St. Louis, MO 190
Cincinnati, OH 196
Durham, NC 200
Bronx, NY 201
Little Rock, AR 211
Blue Island, IL 217
Chicago, IL 218
San Antonio, TX 219
St. Petersburg, FL 221
Louisville, KY 233
Dallas, TX 236
New Orleans, LA 237
Detroit, MI 239
Las Vegas, NV 241
Birmingham, AL 242
Nashville, TN 245
Fort Worth, TX 251
Orlando, FL 252
Houston, TX 252
Tampa, FL 260
Miami, FL 261
Memphis, TN 278
Jackson, MS 301

Source: The Commonwealth Fund, Scorecard on Local Health System Performance 2016 Report and Methods.