MCO service quality varies, reports NCQA

HMOs are inconsistent at best when it comes to quality, according to a survey conducted this fall by the National Committee for Quality Assurance (NCQA) in Washington, DC. "The range of health plan performance across the country, and even within regions, is striking," says Margaret O’Kane, NCQA president. Rates of breast cancer screening ranged from 30% in one system to 90% in another; children’s immunizations ranged from 81% in one area to 58.5% in another. Health plans in New England tended to do best; those in the south central states did poorest.

For its survey, NCQA used its Health Plan Employer Data and Information Set (HEDIS) 3.0 standards to assess 300 managed care plans nationwide. The committee’s full report contains data on more than 50 measures. Three of those are presented here because they coincide with standards used in the Health Care Financing Administration’s Medicare managed care quality report.

Beta-blocker treatment after heart attack.

It’s been shown that use of beta-blockers following a heart attack can reduce mortality by 10%. If industrywide performance were brought up to the 90th percentile benchmark of 85%, 1,600 cardiac deaths would be avoided among 57 million HMO enrollees each year. Expenditures for cardiac care would be reduced by tens of millions each year. The key to improving use rates is physician education.

Breast cancer screening.

Screening women between the ages of 52 and 69 can reduce mortality by as much as 23%. Early detection and treatment could save $4 billion annually. If industrywide performance were brought up to the 90th percentile benchmark of 80%, an additional 1,200 cases could be detected and 1,800 life-years saved.

Eye exams for diabetics.

Diabetics with advanced disease require yearly examinations, and those with mild disease can be screened every two years. If retinal changes are detected early and treated with laser technology, blindness can be reduced by 56%. If industrywide performance were brought up to the 90th percentile benchmark of 57%, 2,500 cases of blindness could be prevented.

The NCQA reported four key findings from its survey:

1. Wide variations. Managed care organizations vary greatly both within and across regions in terms of preventive care, treatment of the acutely and chronically ill, and member satisfaction.

2. Health consequences. If all plans were brought up to the level of the best, the health of consumers would improve significantly.

3. Satisfaction. Managed care enrollees are generally satisfied with care they receive, but have complaints about the plan’s administration.

4. Comparison to fee for service. On HEDIS measures, the performance of managed care plans is as good or better than that of fee-for-service arrangements.