Health plans report quality improvements

The National Committee for Quality Assurance (NCQA) reports that its fifth annual State of Managed Care Quality shows significant gains in all key areas of care and service from health plans for the second year in a row.

The report is based on an analysis of health plan performance data reported to NCQA for use in Quality Compass 2001, NCQA’s database of managed care quality information. The 372 health plan products submitting data to the 2001 edition of Quality Compass cover more than 63 million people, says NCQA President Margaret E. O’Kane.

"For two years in a row, we’ve seen that participating health plans are getting better; the rest of health care is still a real question mark," she says. "Further improvement is going to depend on collaboration and measurement at all levels of the health care system."

Continued success in care and service

For the second year in a row, reporting plans registered across-the-board gains in all key areas of care and service. In particular, health plans are demonstrating increased success in delivering services aimed at controlling or preventing disease. Among reporting plans, the average rate of patients receiving a cholesterol screening after a cardiovascular event such as a heart attack rose from 69% in 1999 to 74% in 2000.

O’Kane says that is an important improvement because adequate cholesterol screenings, as part of a complete cholesterol reduction program, can help reduce morbidity and mortality from a heart attack or stroke by as much as 40%.

In addition, the rate at which diabetic members of reporting plans received an annual retinal exam increased from 45% to 48%. Retinal exams can lead to better management of the disease, thus preventing such complications as blindness and amputations, notes Gregg Meyer, MD, MSc, director of the Center for Quality Improvement and Patient Safety at the Agency for Healthcare Research and Quality.

"Improvements in health care are often measured a percentage point at a time as best practices are adopted," Meyer says. "But this year, we’re seeing something different: more rapid gains in plan performance, which have been prompted by NCQA’s efforts."

High vs. low quality health care

To help quantify the economic impact of these quality improvements, Meyer says the NCQA soon will release an economic model that will allow employers to calculate the financial benefits of selecting high quality versus low quality health care. Based on the improvement in seven key Health Plan Employer Data and Information Set (HEDIS) measures over the past several years, U.S. employers will enjoy an annual productivity dividend of 8 million sick days avoided and $1.4 billion in improved productivity and avoided sick wages saved this year.

The degree of variation among plans continues to close, as plans that have performed poorly in the past again have registered impressive gains. For plans performing in the 10th percentile, the average rate of cholesterol screenings jumped 10 percentage points, from 53% in 1999 to 63% in 2000, while 90th percentile averages increased from 83% to 85%. The 10th percentile average for childhood varicella (chicken pox) immunizations showed a similar increase, from 50% to 58%, helping to spur an increase in the overall average, which rose from 64% in 1999 to 71% in 2000.

Among the health plans reporting impressive results and strong improvement in their HEDIS measures this year were Anthem Blue Cross/Blue Shield plans. Sam Nussbaum, MD, executive vice president and chief medical officer of Anthem Blue Cross/Blue Shield, says the HEDIS results are a good indicator of how hard a plan is working to improve quality.

"When you watch a health plan’s HEDIS results increase from year to year, that plan has done a good job of developing a collaborative relationship with its physicians and members," Nussbaum says. "Health plans that work with their physicians, hospitals, and members can raise the bar dramatically on quality."

Gains in new areas are key

O’Kane says another key finding is that plans recorded their highest performance gains in newer measures, such as cholesterol control rates and controlling high blood pressure, evidence that plans that engage in measurement and reporting are devoting greater attention and resources to important areas of care.

Rates for cholesterol control rose from 45% in 1999 to 53% in 2000, and average rates for controlling high blood pressure jumped 13 percentage points in 2000, from 39% to 52%. Health plans made similar progress in diabetes care. For instance, the average rate of diabetics screened for LDL (low-density lipoprotein) cholesterol increased from 69% in 1999 to 77% in 2000.

An interesting finding in the face of the ongoing debate on a Patients’ Bill of Rights is that average rates for key indicators of member satisfaction also are rising. The percentage of members who rated their health plan 8, 9, or 10 out of 10 increased from 57% in 1999 to 59% in 2000. Members demonstrated a similar increase in satisfaction with customer service, as 67% said they did not encounter problems in obtaining plan information, getting help, or completing paperwork (up from 65% in 1999).