What is the state of managed care quality?
What is the state of managed care quality?
The National Committee for Quality Assurance (NCQA) recently issued its first annual report, The State of Managed Care Quality, which summarizes performance, accreditation, and patient satisfaction information from over 300 managed care plans. Based in Washington, DC, NCQA accredits over half the nation's health plans.
The report outlines four key findings:
1. HMOs and other managed care organizations vary greatly both within regions and across regions in terms of preventive care, treatment of acutely ill and chronically ill patients, and member satisfaction. Plans in the New England region scored highest in six out of nine measures; plans in the South Central region scored lowest in seven out of nine measures.
2. If all plans achieved the best plans' level of performance, there would be significant consequences for the health of Americans. For example, if all plans screened breast cancer at the benchmark level, 1,200 more cases would be detected annually.
3. Managed care members are generally satisfied with the care they receive through their health plans but have complaints about the system's service.
4. On the measures evaluated for the report, managed care plans' performance is as good or better than that of fee-for-service providers.
The report focuses on eight Health Plan Employer Data and Information Set (HEDIS 3.0) clinical measures, including:
· advising smokers to quit;
· beta blocker treatment;
· breast cancer screening;
· cervical cancer screening;
· cesarean rates;
· childhood immunizations;
· diabetic eye exams;
· prenatal care in the first trimester.
Copies of the report are available by calling NCQA at (202) 955-3500. The report can also be viewed on NCQA's World Wide Web site: http://www.ncqa.org.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.