NCQA: Quality measures up for third year in a row

Improvements seen in more than 12 key measures

For the third year in a row, health care quality in the United States improved substantially, despite broad public concerns over cost, the uninsured, patient safety, and other systemwide ills, according to a new report from the Washington, DC-based National Committee for Quality Assurance (NCQA).

The group’s "State of Health Care Quality" report documented significant improvements in clinical performance on more than a dozen key measures among selected health plans serving the Medicare, Medicaid, and commercially insured populations.

The report also found that, despite these improvements, more than 6,000 deaths and 22 million sick days could be avoided annually if the "best practice" care found at the nation’s top organizations were adopted universally, says Margaret E. O’Kane, NCQA president.

She says the encouraging results in the report reflect the health care available to 71 million Americans enrolled in various health care organizations that measure and report on their performance. Information about the performance of the rest of the U.S. health care system is either non-existent or unavailable.

"This year, 13 health plans delivered beta-blockers to 100% of patients who had a heart attack. That’s the payoff for measuring quality," O’Kane says. "But we have work to do. A large part of the health care system still doesn’t measure anything."

Among the positive findings in this year’s report were substantial gains on a range of clinical measures reported by commercial health plans. For example, between 2000 and 2001, the percent of patients who had their high blood pressure under control rose from 51.5% to 55.4%. In 1999, this rate was 39%.

Fifty million Americans have high blood pressure, which, left uncontrolled, can cause stroke, coronary heart disease, kidney failure, and blindness. Cholesterol control rates have registered similar increases.

Among commercial managed care organizations, 59.3% of heart attack patients had their cholesterol under control in 2001, nearly a six-percentage-point increase from the previous year, and up 14 percentage points from 1999 levels. High cholesterol can cause coronary artery disease, a condition afflicting 15 million Americans.

Medicaid, Medicare strong performers

NCQA’s report includes performance results from Medicaid and Medicare organizations for 2000. When viewed against results from the same year for the commercial sector, the data reveal that on the whole, the care received in the three sectors is comparable, a finding of special note considering the demographic and access issues faced by the public programs.

For example, in 2000, 89.4% of heart attack patients in commercial organizations received beta-blockers, vs. 89.3% in Medicare plans and 82.9% in the Medicaid program. Beta-blockers are extremely effective in reducing the chances of a second heart attack and increase long-term survival rates by as much as 40%.

Notably, Medicaid and Medicare organizations actually outperformed commercial plans in several measures. In terms of chlamydia screening for women ages 16 to 20, 23.6% of women enrolled in commercial organizations were screened, vs. 37.4% in Medicaid. And Medicare plans outscored the commercial sector on every single measure of diabetes care when comparing rates for 2000.

As has been the case in the commercial sector, there was a considerable difference in performance between Medicare organizations accredited by NCQA and those that were not.

In one key example, 57.8% of heart attack patients enrolled in accredited Medicare organizations in 2000 had properly controlled cholesterol levels, as opposed to 44.1% in nonaccredited plans.

That difference should hold a lesson for quality and peer review professionals, says John Rother, director of legislation and public policy for the American Association of Retired Persons in Washington, DC.

"The gaps between accredited and nonaccredited plans are compelling. They suggest that Medi-care beneficiaries would benefit tremendously from a plan that is accredited and accountable," he says.

"In light of these results, all Medicare managed care should commit to meeting the NCQA accreditation standards, for the sake of their patients and their public standing."

Measurement promotes quality

Also for the first time, the report examines the impact of physician-level quality measurement and reporting. Since 1997, NCQA and the American Diabetes Association have cosponsored the Diabetes Physician Recognition Program (DPRP), which recognizes physicians who deliver superior diabetes care.

To participate in the DPRP, individual physicians or medical groups voluntarily submit data related to the treatment of their patients with diabetes. If their performance meets or surpasses national benchmarks, they earn recognition and receive referrals from the two sponsoring organizations. The cumulative performance of participating physicians demonstrates in no uncertain terms that measurement at the provider level is an effective means of promoting quality.

Performance scores among DPRP-recognized physicians far exceed national averages on every single measure of diabetes care, making patients of these providers far less likely to suffer adverse health conditions (such as blindness or diabetes-related nephropathy) as a result of their disease. For example, 98% of patients with diabetes who saw a recognized provider received at least one hemoglobin A1c (blood sugar) test, as opposed to 81.4% of patients enrolled in commercial organizations.

The rate of patients with poorly controlled blood sugar levels was 9% among recognized physicians, as compared to the commercial rate of 36.9%. (For this measure, a lower rate indicates better performance.)

The NCQA also announced that draft standards for its Human Research Protection Accreditation Program (HRPAP) soon would be released for public comment. The standards address areas identified by the Institute of Medicine’s (IOM) Committee on Assessing the System for Protecting Human Research Participants.

Jessica Briefer French, NCQA assistant vice president for human research protection says accreditation can help investigators, sponsors, and research organizations demonstrate their commitment to protecting the rights and well-being of research participants.

Since last year, NCQA has accredited the human research protection programs of Veterans Affairs Medical Centers through its Veterans Affairs Human Research Protection Accreditation Program (VAHRPAP).

In the 2001 report, "Preserving Public Trust: Accreditation and Human Research Participant Protection Programs," the IOM cited NCQA’s VAHRPAP standards as being "the strongest basis for use in the accreditation of research institutions." As such, the VAHRPAP standards were used as the foundation for the new program. The IOM’s latest report highlighted accreditation’s "considerable potential to systematize and accelerate quality improvement [QI] processes," and specifically noted NCQA as having "identified numerous areas in which it will review program QI activities."

In addition to addressing QI, the draft standards incorporate other key areas identified in Responsi-ble Research as meriting increased attention. These include comprehensive reviews of research protocols, participant-investigator interactions, risk-appropriate safety monitoring, conflict of interest management, and ongoing informed consent. The draft HRPAP standards will be posted on NCQA’s web site Dec. 2, and NCQA will accept comments through mid-January.

[For more information, contact:

  • National Committee for Quality Assurance, 2000 L St. N.W., Suite 500, Washington, DC 20036. Telephone: (202) 955-3500.]