Accountability produces results, says NCQA report
Accountability produces results, says NCQA report
Plans reporting HEDIS have high satisfaction
Health plan accountability received a boost from the most recent analysis of performance indicators, with plans that publicly reported their figures fairing better than those that collected HEDIS data but declined to report the results.
The third annual State of Managed Care report, released by the National Committee for Quality Assurance (NCQA) in Washington, DC, also showed a link between higher HEDIS scores and high patient satisfaction. Plans in the top quartile of HEDIS effectiveness of care indicators had consistently higher ratings of satisfaction with care, service, access, plan, and provider.
"This is tremendously important," says NCQA spokesman Barry Scholl. "What it means is that employers, who are vitally interested in high satisfaction rates, now have a really clear reason to choose plans that are delivering high clinical quality. The data can’t be disputed. Across every single measure of care, the plans that perform best on HEDIS also have the highest satisfaction scores."
In fact, amid the success of HEDIS, two state-based organizations are working toward quality measurement at the medical group and even individual physician level. (See related article, p. 117.)
This year’s Quality Compass database includes information from 247 managed care organizations on 410 health plan products covering about 70 million Americans. Another 112 managed care organizations provided data for national averages and benchmarks.
Measurement produces quality improvement
Perhaps the most important conclusion that outcomes experts draw from the NCQA data is a link between measurement and quality improvement.
Those plans that have publicly reported HEDIS for three years showed the greatest improvement. For example, diabetic eye exams rose from 45% in 1996 to 49% in 1998, while beta-blocker use after heart attacks rose from 70.5% to 85%. In 1998, first-year reporters had a rate for diabetic eye exams of 38% and beta-blocker use of 72.8%. (See chart, above.)
The Value of Publicly Reported Data | ||
The latest quality of care data released by the National Committee on Quality Assurance in Washington, DC, showed a significant advantage for health plans that consistently report data for public review. Here are some of the results: | ||
Measure |
3-Year Public Reporters |
First-Year Reporters |
Adolescent Immunization Status | 67.9% |
42.9% |
Advising Smokers to Quit | 66.1% |
59.9% |
Antidepressant Medication Management | 55.0% |
52.1% |
Beta-Blocker Treatment | 85.0% |
72.8% |
Breast Cancer Screening | 76.1% |
68.9% |
Cervical Cancer Screening | 75.4% |
64.7% |
Chicken Pox Vaccination | 52.6% |
49.8% |
Childhood Immunization Status | 72.8% |
58.0% |
Cholesterol Screening | 63.6% |
55.3% |
Eye Exams for Diabetics | 49.4% |
38.0% |
Mental Health Follow-up | 76.1% |
63.3% |
Prenatal Care in the First Trimester | 87.7% |
78.6% |
Performance measurement leads to a commitment to quality improvement, says James Marks, MD, MPH, director of the National Center for Chronic Disease Prevention and Health Promo-tion at the Centers for Disease Control and Prevention in Atlanta.
"Those that reported for several years show, on average, steady improvement," says Marks. "That means that a commitment that’s characterized by persistent management attention can make a difference, can lead to improved quality. For those that are new to the process, we can hope that they’ll show the same improvement over time."
Quality of care indicators also may encourage plans and medical groups to work together on common improvement goals, says Marks. For example, health plans may provide resources for patient education and self-management that can ultimately improve outcomes.
"Patient education on self-management can substantially improve how well people take care of their condition," says Marks.
Other findings from the NCQA State of Managed Care report include:
• The greatest gains occurred with relatively new measures. For example, the average reported rate for beta-blocker use after heart attack rose from 62.5% in 1996 to 79.9% in 1998. The average rate for chicken pox vaccine rose from 40% in 1996 to 51.9% in 1998.
• On a scale of 1 to 10, 71.7% of managed care plan members gave their physician or other provider a rating of 8 or higher. In the highest performing plans — those in the 90th percentile — 77.9% of members gave those high ratings.
• Health plan performance varied widely among regions of the country and within regions. New England health plans outscored other regions in nine out of 12 measures, while the South Central region recorded the lowest averages.
• More than 85% of the data in Quality Compass was audited by independent auditors in accordance with NCQA standards.
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