The performance of health plans participating in Medicare lagged behind for a second consecutive year. Medicare managed care plans improved in only 7 of 21 measures of care. However, in 2006, 44 new Medicare managed care plans reported on quality for the first time, bringing the total to 211 publicly reporting plans this year. These results highlight the need for policymakers and plan leaders to refocus their quality improvement efforts by expanding the number and type of plans that are required to report on quality and to comparing that performance to the care delivered by the traditional Medicare fee-for-service program, for which no systematic quality reporting currently exists.
“For the 80 million Americans in accountable plans this is great news. These improvements mean better health and longer lives,” said NCQA President Margaret E. O’Kane. “But we all need to be concerned about the 100 million Americans who are in the dark about their health plan’s quality. The stakes are just too high.”
Tremendous strides in cardiac care
The combined efforts of health plans, physicians, advocates and patients have resulted in an historic improvement in care for patients after a heart attack. In 1996, only 62 percent of such patients received a beta-blocker drug, which reduces the possibility of a second, often fatal heart attack. In 2006, that figure reached 97.7 percent and plan performance was extremely consistent. There is little room left for improvement on this measure of care. To assure these advances in quality continue, NCQA has replaced this measure with a new, more challenging measure that asks whether patients are still on beta-blockers six months after their heart attack. In 2006, that figure was 72.5 percent.
Among the other improvements cited in the report:
* Immunization rates among children and adolescents continued a nine-year upward trend. Almost 80 percent of children in commercial health plans received all recommended immunizations and 73.4 percent of children in Medicaid plans were fully immunized.
* The percentage of Americans who received recommended screening for colon cancer rose from 52.3 percent to 54.5 percent, resulting in 182,000 more Americans receiving this important, often life-saving, screening.
Costly, dangerous gaps in care persist
Despite reported advances in quality, the U.S. health care system still has a great deal of room to improve. If the entire health care system were to perform as well as the top 10 percent of accountable plans, NCQA estimates that between 35,000 and 75,000 deaths could be avoided each year. Such improvement in health care quality would also improve productivity. NCQA estimates that 45 million sick days would be eliminated and $7.4 billion in lost productivity would be recouped if the entire health system were to perform at the level of the highest-quality plans.
Such improvements are not out of reach. Since 2000, improvement in just four areas of care – beta-blocker treatment for heart attack patients, cholesterol management, controlling high blood pressure and improving blood sugar control among diabetics – has saved the lives of almost 125,000 Americans.
"Health care represents the central fiscal challenge facing the nation," said Peter R. Orszag, Director of the U.S. Congressional Budget Office, "yet we do too little to measure what we receive in return for the money we're spending. Recognizing -- and rewarding -- high-value health care is essential to improving our fiscal outlook and the efficiency of the health care sector."
PPO plans come forward to report performance
Due to the efforts of health plan leaders, employers, federal and state government the number of preferred provider organizations (PPOs) reporting on care quality has risen substantially. In 2005, NCQA called on PPOs to voluntarily report HEDIS data and 80 plans did so. This year, 141 PPOs (83 commercial and 58 Medicare) – covering more than 21 million Americans – reported audited HEDIS results [see attached list]. The expanded reporting allows NCQA to report the results of 22 measures of clinical quality and 8 measures of consumer experience. A comparison of select rates shows comparable performance between PPOs and managed care plans.
”We invest too much in health care to be left guessing about quality,” said Laurel Pickering, executive director of the New York Business Group on Health. “The rise in the number of PPOs reporting on quality is a boon to employers and consumers alike. It lets us determine what we’re buying, not just what we’re paying.”
PPOs cover more than 6 in 10 privately insured Americans. Despite the gains in quality reporting, more than 100 million insured Americans remain in health plans that do not report quality performance data. In July, NCQA published new standards that require PPOs to report on the quality of care and will take those scores into account in determining an accreditation decision. Health plans accredited by NCQA undergo regular review of their quality improvement initiatives, utilization management, patient protection and access to care. Accredited plans consistently perform at a higher rate than unaccredited plans. In 2006, for example, accredited plans provided needed prenatal care to 92.2 percent of the women they serve compared with only 83.5 of the women in unaccredited plans.
