Minnesota ranks second among health care systems in all 50 states and the District of Columbia according to a new analysis. WalletHub’s analysts compared the states across three key dimensions: 1) Cost, 2) Access and 3) Outcomes. The ranking reinforces Minnesota’s longstanding reputation for quality health care and an accessible, affordable system.

Among the strengths cited in the report, Minnesota ranks third of highest physician Medicare-acceptance rates. According to the CDC, 94.1 percent of physicians accept new Medicare patients, higher than the national average of 83.7 percent. Other states above the national average include Nebraska, New Hampshire, North Dakota, Pennsylvania, South Dakota and Wyoming.

Minnesota also ranks fifth in the highest percent of insured adults aged 18-64. Minnesota has historically seen high rates of insurance coverage varying between 91 and 94 percent. This is largely due to significant employer participation and a population with higher income and education levels. In 2015, Minnesota reached 96 percent coverage, the highest rate ever recorded.

Heart disease is relatively uncommon in Minnesota compared to other states; it ranks second for lowest heart disease rate in the nation. But that does not mean it’s rare: more than 18 percent of all deaths in Minnesota are due to heart disease, making it the second leading cause of death in the state behind cancer. Heart disease is also an economic burden on the state. Minnesotans incurred almost $2 billion in charges for inpatient hospitalizations due to heart disease in 2013.

Looking ahead, Minnesota’s heart disease future is less optimistic. The state’s childhood obesity rate is 26 percent and has skyrocketed in recent decades. While Minnesota’s childhood obesity rate is relatively low compared to other sates, it’s near the top in a race to the bottom. The country’s childhood obesity rate is high and getting higher, Minnesota is jut among the least bad.

Finally, Minnesota ranks third in lowest percent of adults with no dental visits in past years. Although Minnesota’s biggest health insurance program for the poor covers dental care, the reimbursement rates to dentists in the program is so low that many dental offices aren’t accepting new patients covered by Medical Assistance or drop out of the program altogether. The problem is especially problematic in Greater Minnesota where the number of dentists has shrunk so far that most rural counties are designated as dental workforce shortage areas. This makes it even harder to find a dentist who will accept Medical Assistance, forcing some patients to travel hours to get dental care, if they can get an appointment at all.

Minnesota’s health care continues to rank high when compared to other states but there is still work to be done and improvements to be made. If the state wants to continue to be a leader in health care, Minnesota cannot rest on the fact that it outpaces other states when there are growing issues to address at home.