Access to health care services and the affordability of health insurance are crucial to overall health but vary widely across the United States. MoneyGeek analyzed a host of statistics, from health outcomes — such as preventable deaths and rates of certain diseases or risk factors — to health access and cost — such as how many people are uninsured and have low-cost health insurance options available — to find the best and worst states for health care in 2023.
The Best and Worst States for Health Care
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Deb Gordon
CEO, Umbra Health Advocacy
Deb Gordon, the co-founder and CEO of Umbra Health Advocacy, has held executive roles in health insurance and health care technology services. She authored a book titled “The Health Care Consumer’s Manifesto,” based on her research as a senior fellow at Harvard Kennedy School’s Mossavar-Rahmani Center for Business and Government. Her works have been published on JAMA Network Open, Harvard Business Review blog, USA Today and RealClear Politics, among others. Gordon is an Aspen Institute Health Innovators Fellow and an Eisenhower Fellow. She was a 2011 Boston Business Journal 40 Under 40 honoree and a volunteer at MIT’s Delta V start-up accelerator, the Fierce Healthcare Innovation Awards. She earned her bioethics degree from Brown University and her MBA with distinction from Harvard Business School.
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Megan Hull
Web Content Editor
A word nerd at heart, Megan is committed to creating quality content that fills in knowledge gaps and improves people’s lives. Previously, she worked at one of the nation’s largest behavioral health care providers and has written content for medical practices across the country. She went to school at the University of Central Florida, where she studied English with a focus in technical communications and literature. Megan geeks out on psychology, cooking and secondhand finds.
MoneyGeek is dedicated to providing trustworthy information to help you make informed financial decisions. Each article is edited, fact-checked and reviewed by industry professionals to ensure quality and accuracy.
Editorial Policy and StandardsUpdated: June 26, 2024
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Eduardo Grunvald
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Dr. Grunvald is board-certified in internal medicine and obesity medicine. He is the medical director of the Center for Advanced Weight Management within the UCSD (University of California San Diego) Bariatric and Metabolic Institute. Dr. Grunvald and his associates manage patients with combinations of lifestyle interventions, anti-obesity pharmacotherapy, and metabolic bariatric surgery. As a clinical professor, Dr. Grunvald is very involved in teaching at the medical school on metabolism, weight regulation, and treatment of obesity and weight-related medical conditions. He has served on a national committee developing competencies for obesity education in medical schools and has authored guidelines on using medications for weight management. His research interests include obesity medicine education, bariatric surgery outcomes and weight-related complications. He has served as principal investigator for clinical trials on anti-obesity drug development. Dr. Grunvald completed his residency training at UC San Diego School of Medicine. He earned his medical degree at the University of Washington School of Medicine.
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Executive Director, Deloitte Center for Health Solutions
Jay Bhatt, D.O., MPH, MPA is a physician executive, internist, geriatrician and public health innovator. As executive director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI), Dr. Bhatt directs the research, insights and eminence agenda across the life sciences and health care industry while driving high-impact collaborations to advance health equity. He is a prominent thought leader around the issues of health equity, health care transformation, public health and innovation. Passionate about patient care, Dr. Bhatt will continue practicing medicine at local community health centers in Chicago and Cook County while serving in his leadership role at Deloitte.
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Cyrena Gawuga
Director of Research, Preparedness & Treatment Equity Coalition
Cyrena Gawuga is director of research at the Preparedness and Treatment Equity Coalition (PTEC). As director of research, Cyrena facilitates the design and implementation of activities and initiatives that further PTEC’s mission to increase the use of data metrics to reduce health inequity in the healthcare system, particularly for Black, Latinx and Native American communities. Before joining PTEC, Cyrena completed a Ph.D. in Molecular Pharmacology and Physiology at Brown University, focused on the influence of adverse childhood experiences on inflammation and health outcomes in adulthood. Subsequently, she earned an MSW in Macro Social Work at Boston University. She also was research associate on a PCORI-funded community-based participatory research program at Boston University School of Social Work.
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Rima Cohen
Special Advisor, Centers for Medicare & Medicaid Services
Rima Cohen has spent more than three decades developing and implementing health care policies and programs that touch millions of Americans. In Washington, D.C., they were the senior health advisor to the Democratic Leader of the U.S. Senate for nearly 10 years, a counselor to the HHS Secretary in the Obama Administration during the implementation of the Affordable Care Act and the founder and executive director of the Aspen Institute's Health Innovators Fellowship. Rima spent more than a decade in New York, working for Mayor Michael Bloomberg and directing an initiative that expanded health insurance to more than 500,000 New Yorkers. They are currently a senior advisor at the Centers for Medicare & Medicare Services, where they help to advance the administration's Medicare priorities in areas such as health equity and value-based care.
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Tracey Brigman, Ed.D., M.S., RDN, LD
Clinical Associate Professor and Director at FACS Education Program at the University of Georgia
Tracey Brigman is a registered and licensed dietitian. She received her B.S. degree in Dietetics from Indiana University of Pennsylvania, her M.S. degree in Foods and Nutrition from the University of Georgia and her Ed.D. in Learning, Leadership, and Organizational Development from the University of Georgia.
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Tinglong Dai, Ph.D.
Bernard T. Ferrari, Professor of Business at the Johns Hopkins Carey Business School
Tinglong Dai is the Bernard T. Ferrari Professor in Operations Management and Business Analytics at the Johns Hopkins Carey Business School. He serves on the leadership team of the Hopkins Business of Health Initiative and the executive committee of the Institute for Data-Intensive Engineering and Science. As a renowned expert in health care analytics, human-AI interaction, and global supply chains, Professor Dai has been quoted hundreds of times in the media, including Associated Press, Bloomberg, CNN, Fortune, New York Times, NPR, USA Today, Wall Street Journal and Washington Post. It has appeared on national and international TV, such as CNBC, PBS NewsHour and Sky News.
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Allie Peckham, MSW, Ph.D.
Assistant Professor at Arizona State University
Dr. Peckham leads actionable research to guide enhanced care quality, care coordination and integration of health and social care services for older adults and complex populations (i.e., older adults living with dementia or co-morbid conditions, those living with a serious mental illness (SMI), and unpaid caregivers). She relies on co-design and integrated knowledge translational approaches where people with lived experience (patients, caregivers, care providers, decision-makers) are actively involved in her research.
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Reena Kelly, Ph.D., MHA
Assistant Professor, Department of Population Health & Leadership, School of Health Sciences at the University of New Haven
Dr. Reena Kelly has worked in the health care industry in the clinical, administrative and research fields for nearly 20 years. She started her career in private clinical practice as a dental surgeon for nearly a decade before transitioning to the area of health care administration and management. Dr. Kelly has a Master’s in Health Administration (MHA) and a graduate certificate in Public Health from the University of Missouri-Columbia and her Ph.D. in health services administration from the University of Alabama at Birmingham. Her work has been published in several peer-reviewed academic journals, and her research and teaching interests lie in the area of strategic management and organizational behavior in health care organizations.
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Raymond March, Ph.D.
Assistant Professor of Economics at North Dakota State University
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Chunhuei Chi, Sc.D., MPH
Professor of Health Management and Policy, Professor in Global Health at Oregon State University
Chunhuei's expertise includes health systems financing and strengthening, universal health care systems, governance in health systems and global health, equity in health care financial burden and access to health care, and comparative health systems and policy responses to the COVID-19 pandemic.
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Dr. Brandon Di Paolo Harrison
Assistant Professor of Accounting at Austin Peay State University
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Deb Gordon
CEO, Umbra Health Advocacy
Deb Gordon, the co-founder and CEO of Umbra Health Advocacy, has held executive roles in health insurance and health care technology services. She authored a book titled “The Health Care Consumer’s Manifesto,” based on her research as a senior fellow at Harvard Kennedy School’s Mossavar-Rahmani Center for Business and Government. Her works have been published on JAMA Network Open, Harvard Business Review blog, USA Today and RealClear Politics, among others. Gordon is an Aspen Institute Health Innovators Fellow and an Eisenhower Fellow. She was a 2011 Boston Business Journal 40 Under 40 honoree and a volunteer at MIT’s Delta V start-up accelerator, the Fierce Healthcare Innovation Awards. She earned her bioethics degree from Brown University and her MBA with distinction from Harvard Business School.
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Megan Hull
Web Content Editor
A word nerd at heart, Megan is committed to creating quality content that fills in knowledge gaps and improves people’s lives. Previously, she worked at one of the nation’s largest behavioral health care providers and has written content for medical practices across the country. She went to school at the University of Central Florida, where she studied English with a focus in technical communications and literature. Megan geeks out on psychology, cooking and secondhand finds.
MoneyGeek is dedicated to providing trustworthy information to help you make informed financial decisions. Each article is edited, fact-checked and reviewed by industry professionals to ensure quality and accuracy.
Editorial Policy and StandardsUpdated: June 26, 2024
Advertising & Editorial Disclosure
Hawaii is the top state for health care in the U.S. It has the best health outcomes in the country, with low preventable death (630 per 100,000 people), diabetes mortality and obesity rates. However, the state ranks fairly low for accessibility (No. 30).
Rhode Island is the second-best state for health care. Its residents enjoy convenient access to medical services, securing the No. 2 spot for accessibility.
West Virginia has the worst health care in the nation. Though West Virginia ranks No. 3 for accessibility, it has the worst health outcomes of any state, with the highest rate of preventable deaths (1,229 deaths per 100,000 residents) and diabetes mortalities. It also has the second-highest average private health insurance premiums ($11,472 per year) in the U.S.
Utah has the nation’s lowest overall health care costs but ranks No. 39 for accessibility. The state has the second-fewest primary care providers for every 100,000 residents.
New York is the most expensive state for health care. The state has the highest annual private health care premiums in the country (averaging almost $18,400), and government spending on health care is $7,820 per capita.
Virginia has the lowest annual private health insurance premiums of any state ($5,172, on average). The national average annual cost across all states in the U.S. is $7,549.
Massachusetts ranks No. 4 for overall health care. However, the state also has the highest rate of government health care spending in the U.S. at $9,320 per person. That’s nearly $3,600 more than the national average and nearly 12% of the state’s GDP.
States With the Best (and Worst) Health Care
![Best US States for Health Care](https://res.cloudinary.com/moneygeek/image/upload/c_scale,q_auto:eco,f_auto,fl_lossy,w_300/v1695919109/Top_States_in_the_US_For_Healthcare_6b0a987f28.png)
The states with the best health care in the United States are those where people are generally healthier, have access to health care services and are less likely to be uninsured. The best states for health care are found all across the country, from Hawaii to Rhode Island. That said, six of the top 10 states on our list are located in the Northeast.
States that fare worse on our health care rankings tend to have higher costs for less access and higher rates of medical conditions like diabetes and obesity. The worst states for health care are concentrated regionally, with eight of the 10 clustered in the South and Southeast.
The Top 10 States for Health Care
State | Score | Region | |
---|---|---|---|
1. | Hawaii | 73.0 | West |
2. | Rhode Island | 68.0 | Northeast |
3. | Iowa | 67.7 | Midwest |
4. | Massachusetts | 67.4 | Northeast |
5. | Minnesota | 67.0 | Midwest |
6. | New Hampshire | 66.9 | Northeast |
7. | Colorado | 66.8 | West |
8. | Vermont | 66.6 | Northeast |
9. | Connecticut | 64.5 | Northeast |
10. | New Jersey | 63.6 | Northeast |
The 10 Worst States for Health Care
State | Score | Region | |
---|---|---|---|
1. | West Virginia | 35.4 | South |
2. | Mississippi | 42.1 | South |
3. | Alaska | 44.2 | West |
4. | Louisiana | 44.4 | South |
5. | Oklahoma | 44.6 | South |
6. | New Mexico | 45.2 | West |
7. | Tennessee | 45.6 | South |
8. | Arkansas | 46.6 | South |
9. | Kentucky | 47.4 | South |
10. | Alabama | 48.0 | South |
Additional Findings: Outcome, Cost and Access Data Rankings
To evaluate health care in the United States, MoneyGeek looked at three categories of data that together create a comprehensive view of the overall quality of health care in each location. Those categories include:
Health outcomes, including indicators such as rates of disease and risk factors like obesity and smoking, preventable deaths and infant mortality. These measures help answer the question: How healthy are the people who live here?
Cost, including factors like how much the state spends on health care and the average cost of private health insurance. These measures help answer the question: How expensive is health care in this state?
Access, including data on the number of primary care providers and hospital beds available, how many people are uninsured and how many people needed care but had difficulty getting it. These indicators help answer the question: How easy is it to get the health care you need in this state?
Within these three categories, we broke down the best and the worst states across a wide range of health care outcome, cost and access data points. Below is a summary of those findings, along with the best and worst states for each data point.
Deep Blue States Across the US Have the Healthiest Residents
1. Hawaii
2. Vermont
3. Massachusetts
4. California
5. New Jersey
1. West Virginia
2. Mississippi
3. Louisiana
4. Kentucky
5. Arkansas
Southern States Have Highest Diabetes Mortality Rates
1. Connecticut: 15.9
2. Massachusetts: 17.3
3. New Jersey: 17.6
4. Hawaii: 17.7
5. Vermont: 17.9
1. West Virginia: 47.6
2. Mississippi: 42.1
3. Arkansas: 39.3
4. Louisiana: 35.7
5. Oklahoma: 35.1
West Virginia’s Preventable Death Rate Is Nearly Double Hawaii’s
1. Hawaii: 630
2. New York: 713
3. Massachusetts: 721
4. Connecticut: 725
5. New Jersey: 731
1. West Virginia: 1,229
2. Mississippi: 1,205
3. Kentucky: 1,140
4. Alabama: 1,134
5. Tennessee: 1,121
Overall Affordability Is Worst in the Northeast
1. Utah
2. Virginia
3. Colorado
4. Mississippi
5. Georgia
1. New York
2. Vermont
3. West Virginia
4. South Dakota
5. Massachusetts
States with Costliest Health Insurance Are Twice as Expensive as the 5 Cheapest States
1. Virginia: $5,172
2. Minnesota: $5,220
3. Maryland: $5,256
4. Kentucky: $5,316
5. Idaho: $5,424
1. New York: $18,396
2. West Virginia: $11,472
3. Alaska: $10,584
4. Wyoming: $10,500
5. Vermont: $10,236
Access to Care Varies Widely Across Regions
1. Iowa
2. Rhode Island
3. West Virginia
4. Ohio
5. Massachusetts
1. Nevada
2. Texas
3. New Mexico
4. Alaska
5. Arizona
Northeastern States Have the Lowest Uninsured Rates; Southern States Have the Highest
1. Massachusetts: 2.5%
2. Vermont: 3.6%
3. Hawaii: 3.9%
4. Rhode Island: 4.4%
5. Minnesota: 4.5%
1. Texas: 18.0%
2. Oklahoma: 13.8%
3. Georgia: 12.6%
4. Wyoming: 12.1%
5 Florida: 12.1%
Northeast States Have Double the Primary Care Providers of Western States
1. Rhode Island: 258.5
2. Massachusetts: 233.4
3. New York: 226.1
4. Connecticut: 210.3
5. Pennsylvania: 203.5
1. Idaho: 97.9
2. Utah: 98.8
3. Nevada: 104.9
4. Montana: 108.5
5. Texas: 111.8
Expert Insights
Geographic variation in health care costs, access and outcomes is well documented. Some differences are due to local-level conditions and social determinants of health or non-medical factors that affect health, like advantage, isolation and opportunity. The drivers of variation are not predetermined and can be influenced through policy and practice.
MoneyGeek consulted health industry experts to understand some of the potential choices states can make — or are making — to affect their local health care systems for better and worse.
- States vary widely on quality, cost and access measures. To what do you attribute geographic variation in health outcomes and access?
- What could or should states with worse health outcomes and access do to improve health care for their residents?
- Are there principles or best practices for optimizing health spending to optimize outcomes (at the state level or otherwise)?
- Is there anything else you’d like to add about the general phenomenon of geographic variation in health care outcomes, access and cost?
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Full Data Set
The data points presented are defined as follows:
Rank: Based on the “Final Score” ranging from 1-100
Final Score: Cumulative total of Outcome, Cost and Access scores
- Outcome Factor Rank: Based on cumulative scores across the following factors:
- Infant mortality rate: The number of infant deaths per 1,000 live births
- Preventable death rate: Deaths that can be avoided through effective preventative health care and interventions per 100,000 residents
- Diabetes mortality rate: Deaths attributed to diabetes per 100,000 residents
- Obesity: Percentage of population considered obese
- Smoking rate: Percentage of adults who reported smoking
- Life expectancy: The average number of years a person can expect to live
- Suicide rates: Suicide deaths among persons age 12 and over per 100,000 residents
- New HIV cases per 100,000 residents over the age of 13
- Opioid-related hospital stay rate: Inpatient hospital stays involving opioid-related diagnoses per 100,000 residents
- Cost Factor Rank: Based on cumulative scores across the following factors:
- Health care spending as a percentage of state GDP: Government spending on health care and social assistance out of total state GDP
- State government spending on health care and social assistance per resident
- Average annual private health insurance premium costs
- Access Factor Rank: Based on cumulative score across the following factors:
- Number of hospital beds per 1,000 residents
- Number of primary care providers per 100,000 residents
- Primary care provider shortage areas (HPSAs) by state: Designations that identify areas of the U.S. experiencing health care professional shortages
- Percentage of population with access to any insurance versus just health insurance
- Ease of access to care at the doctor’s office or clinic using Medicare
- Ease of access to care at a specialist using Medicare
State | Rank | Final
Score | Outcome Factor Rank
(1st = Best) | Cost Factor Rank
(1st = Lowest) | Access Factor Rank
(1st = Best) |
---|---|---|---|---|---|
Hawaii | 1 | 73.0 | 1 | 18 | 30 |
Rhode Island | 2 | 68.0 | 10 | 40 | 2 |
Iowa | 3 | 67.7 | 15 | 13 | 1 |
Massachusetts | 4 | 67.4 | 3 | 46 | 5 |
Minnesota | 5 | 67.0 | 11 | 35 | 6 |
New Hampshire | 6 | 66.9 | 9 | 30 | 11 |
Colorado | 7 | 66.8 | 8 | 3 | 33 |
Vermont | 8 | 66.6 | 2 | 49 | 13 |
Connecticut | 9 | 64.5 | 6 | 44 | 16 |
New Jersey | 10 | 63.6 | 5 | 41 | 31 |
California | 11 | 63.5 | 4 | 22 | 43 |
Washington | 12 | 62.7 | 12 | 11 | 41 |
Virginia | 13 | 62.5 | 22 | 2 | 26 |
Utah | 14 | 61.5 | 14 | 1 | 39 |
Wisconsin | 15 | 61.3 | 16 | 37 | 10 |
Illinois | 16 | 60.9 | 18 | 25 | 21 |
Nebraska | 17 | 60.4 | 17 | 34 | 18 |
North Dakota | 18 | 60.4 | 19 | 33 | 12 |
Oregon | 19 | 59.9 | 13 | 27 | 34 |
Maryland | 20 | 57.8 | 23 | 15 | 35 |
Delaware | 21 | 57.6 | 21 | 29 | 29 |
Idaho | 22 | 57.4 | 20 | 9 | 42 |
Pennsylvania | 23 | 57.3 | 25 | 43 | 8 |
Michigan | 24 | 57.3 | 35 | 19 | 9 |
Kansas | 25 | 57.0 | 32 | 23 | 15 |
New York | 26 | 55.9 | 7 | 50 | 17 |
Maine | 27 | 55.4 | 26 | 42 | 24 |
Wyoming | 28 | 53.5 | 30 | 12 | 44 |
Montana | 29 | 53.3 | 24 | 39 | 37 |
Florida | 30 | 52.6 | 29 | 28 | 40 |
Ohio | 31 | 52.4 | 42 | 31 | 4 |
South Carolina | 32 | 52.4 | 40 | 6 | 32 |
Indiana | 33 | 51.8 | 41 | 24 | 19 |
Missouri | 34 | 51.0 | 37 | 36 | 27 |
Nevada | 35 | 50.5 | 28 | 8 | 50 |
North Carolina | 36 | 50.2 | 38 | 20 | 36 |
Georgia | 37 | 50.1 | 36 | 5 | 45 |
South Dakota | 38 | 50.1 | 34 | 47 | 23 |
Texas | 39 | 49.9 | 31 | 7 | 49 |
Arizona | 40 | 49.9 | 27 | 32 | 46 |
Alabama | 41 | 48.0 | 45 | 10 | 22 |
Kentucky | 42 | 47.4 | 47 | 21 | 7 |
Arkansas | 43 | 46.6 | 46 | 16 | 20 |
Tennessee | 44 | 45.6 | 43 | 38 | 25 |
New Mexico | 45 | 45.2 | 39 | 17 | 48 |
Oklahoma | 46 | 44.6 | 44 | 14 | 38 |
Louisiana | 47 | 44.4 | 48 | 26 | 14 |
Alaska | 48 | 44.2 | 33 | 45 | 47 |
Mississippi | 49 | 42.1 | 49 | 4 | 28 |
West Virginia | 50 | 35.4 | 50 | 48 | 3 |
Methodology
To explore and rank health care quality by state, MoneyGeek analyzed three core categories — health outcomes, cost and access to care — using health care data from the Kaiser Family Foundation, the Centers for Disease Control and HealthData.gov. We assigned weights to each factor within these core categories to measure health care quality.
MoneyGeek used the following metrics in our analysis:
- Preventable death rate: Full weight
- Infant mortality rate: Full weight
- Life expectancy: Half weight
- Diabetes mortalities per 100,000 people: Half weight
- Obesity as a percentage of the population: Half weight
- Hospital inpatient stays involving opioid-related diagnoses per 100,00 people: Quarter weight
- Smoking rate among adults: Quarter weight
- Suicide deaths among persons ages 12 and older per 100,000 people: Quarter weight
- New HIV cases among persons ages 13 and older per 100,000 people: Quarter weight
- Annual health insurance costs: Full weight
- Health care spending as a percentage of state GDP: Half weight
- Health care spending as a share of GDP per resident: Half weight
- Percentage of population with health insurance: Full weight
- Number of hospital beds per 100,000 people: Half weight
- Adults who had a doctor's office or clinic visit in the last 12 months and needed care, tests, or treatment who sometimes or never found it easy to get the care, tests, or treatment, Medicare fee-for-service: Quarter weight
- Adults who needed to see a specialist in the last six or 12 months who sometimes or never found it easy to see a specialist, Medicare fee-for-service: Quarter weight
- Primary care health professional shortage areas: % of need met to remove shortage designation: Quarter weight
- Number of primary care providers per 100,000 population: Quarter weight
About Deb Gordon
![Deb Gordon headshot](https://res.cloudinary.com/moneygeek/image/upload/c_scale,q_auto:eco,f_auto,fl_lossy,w_160/v1594738343/inofhsivkhr8hk4nhf2c.jpg)
Deb Gordon, the co-founder and CEO of Umbra Health Advocacy, has held executive roles in health insurance and health care technology services. She authored a book titled “The Health Care Consumer’s Manifesto,” based on her research as a senior fellow at Harvard Kennedy School’s Mossavar-Rahmani Center for Business and Government. Her works have been published on JAMA Network Open, Harvard Business Review blog, USA Today and RealClear Politics, among others.
Gordon is an Aspen Institute Health Innovators Fellow and an Eisenhower Fellow. She was a 2011 Boston Business Journal 40 Under 40 honoree and a volunteer at MIT’s Delta V start-up accelerator, the Fierce Healthcare Innovation Awards. She earned her bioethics degree from Brown University and her MBA with distinction from Harvard Business School.
sources
- Dartmouth Atlas Project. "The Dartmouth Atlas of Health Care." Accessed June 29, 2022.
- JAMA Network Open. "Quantification of Neighborhood-Level Social Determinants of Health in the Continental United States." Accessed June 29, 2022.