NCQA report highlights performance comparisons

Physicians can judge health plan effectiveness

How is the health network you participate in performing in terms of treating selected illnesses, satisfying its members, and providing access to care? If you participate in physician networks for one of the 329 health plans participating in the National Committee for Quality Assurance (NCQA) Quality Compass project, you can now access this information.

NCQA in October released its Quality Compass report, a database of comparative information about the performance of 329 HMOs across the country. Although NCQA does not grade or rank the health plans in the study, physicians and consumers can compare health plan performance on selected measures that are important to your patient population — such as mammography screenings or childhood immunization rates — and look for regional trends. For example, NCQA found significant regional variations in childhood immunization rates and use of beta blockers to treat heart attack patients.

"In some plans, fewer than 30% of such patients receive beta blockers, while in others more than 90% do. The patients lost in the gap between what is achievable and what we actually achieve are at greatly increased risk for another heart attack and even death," says NCQA President Margaret E. O’Kane.

Data collection is hard work

Physicians should be concerned with Quality Compass for two reasons. In some cases, patients may associate the quality of care in your practice with the health plan you participate in. National media such as US News & World Report typically issue comparative rankings on selective performance measures between health plans. Secondly, the day of published performance measures by physician groups is coming.

Two major employer coalitions — the Buyers Action Health Care Group in Minneapolis and San Francisco’s Pacific Business Group on Health — publish patient satisfaction and clinical data by medical group on the Internet and through published materials available to members during open enrollment season, when they are required to select their health coverage and identify a primary care physician.

One health plan leader interviewed by Physician’s Managed Care Report echoed the need for good outcomes data, but lamented the hard work that goes into data collection. Hugh Straley, MD, associate medical director for Seattle-based Group Health Cooperative of Puget Sound, says their physicians are struggling to deal with strained resources and increasing patient loads. "Until we can help them deal with these kinds of conditions, this [outcomes reporting] is extra work," he says.

However, Group Health has used the Quality Compass data as part of its overall outcomes reporting system designed to help the health plan provide care for specific populations, Straley adds.

[Editor’s note: For more information on the Quality Compass report and a related NCQA document, the first annual State of Managed Care Quality report, see NCQA’s Web site at http://www.ncqa.org, which lists a summary of the findings and a list of the 329 participating health plans. Or contact NCQA at (800) 839-6487. The Quality Compass report is available on CD-ROM for $2500.]