2024 Health Value Dashboard Frequently Asked Questions (FAQ)

General questions

1. What is the Health Value Dashboard?

The Health Policy Institute of Ohio Health Value Dashboard is a tool to track Ohio’s progress toward health value — a composite measure of Ohio’s performance on population health outcomes and healthcare spending. The Dashboard examines Ohio’s rank and trend performance relative to other states across seven categories, referred to as “domains:” population health, healthcare spending, access to care, healthcare system, public health and prevention, social and economic environment and physical environment. In addition, through a series of equity profiles, the Dashboard highlights gaps in outcomes between groups for some of Ohio’s most systematically disadvantaged populations.

The Dashboard is based on the Pathway to Improved Health Value conceptual framework (below), created in 2013 with input from HPIO’s Health Value Dashboard Advisory Group. The framework defines health value and outlines the systems and environments that affect health. The Dashboard includes measures of these various systems and environments, including access to care, healthcare system performance, public health and prevention, social and economic environment and physical environment.

The 2024 Health Value Dashboard is the sixth edition of this publication. HPIO released previous editions in 2014, 2017, 2019, 2021 and 2023. This edition of the Dashboard is being released only one year after the last edition. HPIO has decided to publish the Dashboard in even years to better align with the development of the biennial state operating budget, with future releases on a biennial basis.

Pathwaydiagram
 

2. Why does HPIO produce the Dashboard?

Improving health and addressing healthcare spending growth are concerns shared by state policymakers and others. We also know that many Ohioans face barriers to being healthy. Collecting and sharing publicly available data on health, spending and the drivers of health provides an important starting place to understand Ohio’s performance relative to other states. The Dashboard also highlights evidence-informed policies that can be implemented at the state and local levels to address Ohio’s health challenges and move the state toward achieving health equity.


3. How was the Dashboard initially developed?

In 2013-2014, HPIO convened the Health Value Dashboard Advisory Group to advise HPIO on the development of the Pathway to Improved Health Value conceptual framework upon which the Dashboard is based. Since 2013, HPIO has convened the group to inform selection and updating of metrics and advise on the layout, methodology and equity components. The Advisory Group includes stakeholders from a wide array of sectors and public and private organizations across Ohio. HPIO’s Equity Advisory Group has provided feedback on the equity profiles and equity components in the Dashboard.

Since 2017, HPIO has contracted with researchers at the Voinovich School of Leadership and Public Affairs at Ohio University to assist in analysis and ranking.


4. How does the 2024 Dashboard compare to the 2023 Dashboard?

Most metrics in the ranked domains of the 2024 edition (96.4%) are the same or similar to the 2023 edition. Of the 112 metrics in the 2024 Dashboard, 108 are the same or similar to the 2023 Dashboard, one is revised, and three are new or replacements for existing metrics. Seventy-six metrics (67.9%) were updated with new data between the 2023 and 2024 Dashboard.

The 2024 Dashboard:

  • Maintains consistency in methodology for ranking and trend
  • Adds new equity profile content, including a profile for Asian Ohioans
  • Adds two new metrics related to civic engagement, which are included in the social and economic environment domain

5. How is the Dashboard different from other scorecards and rankings that are out there?

Unlike other scorecards, the HPIO Dashboard places a heavy emphasis on the sustainability of healthcare spending, a critical component of any policy discussion on improving health, but one that often is not included on state rankings. In fact, as far as we know, the Health Policy Institute of Ohio was the first in the nation to develop a state ranking of “health value,” placing equal emphasis on population health outcomes and healthcare spending. The Dashboard also provides a more comprehensive look at other factors that impact population health outcomes and healthcare spending. It addresses the wide range of factors, such as a state’s social, economic and physical environment, that contribute to health value. 

Still, Ohio’s rank on health outcomes is similar across scorecards:

Rankingshvd24

The emphasis on health equity through the equity profiles and data appendix is another distinguishing element of the Dashboard. The 2024 Dashboard disaggregates data for 42 metrics by race/ethnicity, disability status, educational attainment and/or income, and sexual orientation and gender identity and uses disparity ratios to assess the extent of disparities and inequities in Ohio for systematically disadvantaged groups. In addition, on some measures, the Dashboard provides estimates of the potential impact of eliminating disparities. These estimates are expressed as the number of people potentially impacted. For example, if the disparity in those unable to see a doctor due to cost that exists between Ohioans with disabilities and those without disabilities was eliminated, 174,923 Ohioans with disabilities would not have to go without health care due to cost.

 

Questions about correlations, metrics and methodology

6. How are age, poverty and other factors correlated with a state’s rank on health value, population health and healthcare spending?

HPIO ran a series of correlation analyses to determine the strength of relationships between specific factors and health value rank, population health rank and healthcare spending rank (displayed in the table below). HPIO generally considers a correlation with a correlation coefficient (r) of 0.75 or higher to be strong, 0.5 - 0.75 to be moderate and below 0.5 to be weak. However, even a strong correlation does not suggest a causal relationship.

The correlation between the percent of a state’s population age 65 and older and ranks for health value, population health and healthcare spending were not significant. This means that states with a higher percentage of adults ages 65 and older do not necessarily have worse health value, worse health outcomes or higher healthcare spending (measured on a per-person basis).

Child and adult poverty, however, did strongly correlate with population health rank, indicating that poverty plays a role in driving health outcomes. Adult smoking was also strongly correlated with population health and health value. Consistent with every past edition of the Health Value Dashboard, this finding highlights the importance of reducing tobacco use to improve health value.

2024dashboardfaqgraphicsagepovertysmokingcorralation
 

7. Which domains most strongly correlate with population health and healthcare spending ranks?

The public health and prevention domain was most strongly correlated with population health, with healthcare system and social and economic environment also strongly correlated with population health. Physical environment was moderately correlated with population health. None of the domains had a significant correlation with healthcare spending rank.

2024dashboarddomaincorrelation
 

8. How many metrics are in the Dashboard and where does the data come from?

  • There are 112 metrics in the domain profiles of the 2024 DashboardOf these, 107 are ranked. Metrics with more than 10 missing states were not ranked. Some metrics were also not ranked because the data could not be compared across states or desired direction could not be identified.
  • There are 42 metrics in the equity profiles and/or equity appendix. HPIO disaggregated these metrics by race and ethnicity, educational attainment, income, sexual orientation, gender identity and/or disability status depending on data availability. Thirty-one metrics were disaggregated by race and ethnicity, 17 by education and/or income, 13 by disability status and 13 by sexual orientation and/or gender identity.
  • All Dashboard data comes from public sources. Most of the data used in the Dashboard was obtained without a data request. Some data was obtained from state agencies. The 2024 Dashboard includes data from 77 unique sources. See the data appendices for additional source information.

9. Where can I find information about metrics (e.g., sources, years, descriptions)?

See the data appendices for information about individual metrics in the ranked domains and equity profiles.


10. Where can I find more information about the methodologies/methods used in the Dashboard?

See the Dashboard process and methodology document for more information, including:

  • Information about the Health Policy Institute of Ohio and the history of the Health Value Dashboard
  • Metric selection process
  • Data gaps and limitations
  • Ranking and trend methodology
  • Methodology for assessing health disparities and inequities

11. How do I interpret disparity ratios?

Disparity ratios displayed in the 2024 Dashboard equity profiles were calculated by dividing the outcome (e.g., rate or percent) of comparison groups (i.e., groups that consistently experience worse outcomes and are systematically disadvantaged) by the outcome of the reference group (i.e., the group that most consistently experiences the best outcomes and is systematically advantaged). For example, the unemployment rate for Black Ohioans (comparison group) is 10.2%. The unemployment rate for white Ohioans (reference group) is 4.1%. The Black-white disparity ratio for unemployment is 2.5. This means that the unemployment rate for Black Ohioans is 2.5 times higher than the unemployment rate for white Ohioans.


Questions about the COVID-19 pandemic

12. How did the pandemic affect data availability and quality?

HPIO compiled the most recently available data for the Dashboard. In most cases (84% of metrics), the most-recent data presented in the domain profiles is from 2020 or later, meaning that it captured the time period since the COVID-19 pandemic was declared in early 2020. However, some data was only available for 2019 or earlier. The table below describes the number of metrics in the Dashboard, by recency of data and by domain:

Faq12covid

* Data for one metric (mortality amenable to healthcare) uses pooled data from 2019-2020.

** Data for four metrics (preschool enrollment, some college, income inequality and children in single-parent households) uses pooled data for 2017-2021. Data for one metric (high school graduation) uses pooled data from the 2019-2020 school year.

*** Data for one metric (outdoor air pollution) uses pooled data from 2019-2021. Data for one metric (severe housing problems) uses pooled data from 2016-2020.

The COVID-19 pandemic had a significant impact on data collection, reporting and quality, resulting in some metrics not being updated with more recent data. HPIO took steps to thoroughly screen and report only the highest quality publicly available measures, reporting data from pre-pandemic years when the estimates from more recent years were unstable or contained fluctuations in reporting. For more information, see the Dashboard process and methodology.


13. What changes to the Dashboard did HPIO make in response to the pandemic?

HPIO added two metrics specific to COVID-19 beginning in the 2023 edition:

  • COVID-19 mortality. Number of deaths from COVID-19 per 100,000 population since January 21, 2020 (data current as of November 4, 2023). Added to the population health domain.
  • COVID-19 vaccinations. Percent of the total population that has received the primary series of the COVID-19 vaccination (as of October 23, 2023). Added to the public health and prevention domain.

In addition, page 21 of the 2024 Dashboard describes the impact of COVID-19 on health value.


Questions about 2024 Dashboard findings

14. Where does Ohio rank?

  • Ohio ranks 44 out of 50 states and the District of Columbia (D.C.) on health value— a combination of population health and healthcare spending metrics. This means that Ohioans are living less healthy lives and spending more on health care than people in most other states.
  • Ohio ranks in the bottom quartile on 30.8% of ranked metrics and in the top quartile on only 8.4% of ranked metrics.

15. How is Ohio’s health value rank determined?

  • Health value is calculated by equally weighting population health and healthcare spending metrics. The diagram below shows Ohio’s rank on the value factor domains (population health and healthcare spending), which are combined to calculate Ohio’s rank on health value.
  • The Dashboard also includes ranks for the contributing factor domains (access to care, healthcare system, public health and prevention, social and economic environment and physical environment). The diagram below shows Ohio’s rank on these domains.
  • The contributing factor domain ranks are not included in the calculation of the health value rank. Rather, the contributing factor domain ranks provide information about how Ohio performs compared to other states on a wide range of factors that are relevant to health outcomes and healthcare spending.
2024dashboardfaqgraphicshowrankdetermined
 

16. Did Ohio improve?

  • Ohio’s health value rank is 44 in the 2024 edition. Ohio’s rank in the 2023 edition was also 44. Because the metrics that go into the health value rank have changed slightly in each edition, and because not all data could be updated between the 2023 and 2024 editions, caution should be taken when comparing Ohio’s health value rank across editions.
  • Looking at trends over time relative to other states across all metrics in the Dashboard, Ohio saw more improvement than worsening. Ohio improved on 24% and worsened on 19% of metrics where trend was assessed. (This is similar to the pattern for the U.S. overall.)
  • As shown in the graphic below, the physical environment domain had the highest proportion of metrics that improved, while the access to care domain had the highest proportion of metrics that worsened.
  • Due to the lag in data availability, the 2024 Dashboard does not reflect changes in access to care due to the unwinding of the Medicaid continuous enrollment provision. The effects of this unwinding are not yet known.
2024dashboardfaqgraphicsmetricchanges
 

17. What are the regional differences across states?

There are some notable regional patterns in rankings:

  • The pattern for population health and health value rank is similar, with bottom quartile states clustered in the South and Midwest, plus Maine. States with the best population health are located in the Northeast and West.
  • All states in the bottom quartile for spending (indicating higher spending) are in the northern half of the country, while states in the top quartile for spending (indicating lower spending) are primarily in the west and southeast.
  • Missouri and West Virginia are the only states ranked in the bottom quartile for both population health and healthcare spending.
  • Four states are in the top quartile for both population health and healthcare spending: Hawaii, Utah, California and Maryland.
2024dashboardfaqgraphicshexmaps
 

18. Which states had the most improvement?

The four states that improved on the highest percent of metrics from baseline to most recent year were: Vermont (28.2%), New Jersey (28.2%), District of Columbia (27.7%) and Kentucky (27.6%)


19. How does HPIO calculate trend?

Trends are measured by looking at state performance over the three most recent years of available data, not by comparing ranks from one edition of the Dashboard to the next. HPIO’s trend methodology compares a state’s absolute change on a metric from baseline to most recent year to the standard deviation of all state’s values for the three most recent years. This methodology is consistent with the approach used in the Commonwealth Fund’s Scorecard on State Health System Performance. For more information, see the methodology.


20. Which metrics had the largest disparity ratios across the equity profiles?

The following metrics had the largest disparity ratios in the equity profiles:

Top five metrics with the largest gaps in outcomes

2024dashboardfaqgraphicsdisparitytable
 

Questions about strategies to improve health value

21. How can we improve health value in Ohio?

The 2024 Dashboard highlights four key policy priorities to improve health value, including several specific strategies with strong evidence of effectiveness for state policymakers. Research evidence indicates that these policies and programs are likely to decrease disparities, improve outcomes and, in some cases, have demonstrated to be cost effective or cost saving. Page 24 of the 2024 Dashboard has a list of the strategies, and the question below has additional details.


22. How did HPIO prioritize the strategies highlighted in the 2024 Dashboard?

There are many effective strategies to improve health and control healthcare spending. The example strategies in the 2024 Dashboard are not an exhaustive list. HPIO used the following criteria to prioritize an actionable and relevant set of strategies to elevate in the 2024 Dashboard:

  • Relevance. Strategies relevant to the four policy priorities to improve Ohio’s performance on health value, as identified in the 2024 Dashboard (mental well-being, tobacco and cannabis prevention, healthcare affordability, and creating opportunities to thrive).
  • Strength of evidence. The Dashboard elevates strategies with strong evidence of effectiveness as rated in evidence registries, such as What Works for Health and other topic-specific sources.
  • Equity. There is evidence that the policy reduces disparities or inequities or creates structural change to advance equity, including strategies elevated in HPIO publications and state plans with a focus on eliminating disparities, such as the Social Drivers of Infant Mortality: Recommendations for Action and Accountability in Ohio. HPIO referred to the disparity ratings in What Works for Health to identify programs and policies most likely to achieve equity.
  • Momentum and alignment. Strategies with momentum in Ohio’s legislature, priorities of Gov. DeWine’s administration and initiatives with strong advocacy efforts underway.
  • Policy and structural change. Policy, structural and systemic changes that can be acted on by state and/or local policymakers were generally prioritized over specific programs or services.
  • Clarity. Strategies that are easily explained and defined.
  • Potential impact. Strategies that are being considered in the current policy landscape in Ohio but have not been fully implemented and would benefit from additional attention from an independent organization such as HPIO.
  • New perspectives. Rather than repeat many of the same approaches from past editions of the Dashboard, priority was given to highlighting strategies not addressed in previous editions.