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Health plans that publicly reported their performance data to the National Committee on Quality Assurance (NCQA) markedly improved their clinical performance in the past two years.
National averages improved in all key areas of care and service, according to the report.
"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," says NCQA president Margaret O’Kane.
The information in the fifth edition of NCQA’s State of Managed Care Quality report is based on data collected for Quality Compass, NCQA’s database of managed care information and for NCQA’s accreditation program.
The report is based on HEDIS data reported to NCQA by 372 health plans. Of those plans, 273 allowed their data to be reported publicly.
According to the study’s results, health plans demonstrated increased success in preventive and disease management services. For instance, the reported rate of patients who received a cholesterol screening after a cardiovascular event was 74%, an increase from 60% just a year earlier.
The rate of diabetics screened for low-density lipoprotein cholesterol increased from 69% in 1999 to 77% in 2000. Those monitored for kidney disease rose from 36% to 41% over the same period.
Rates for controlling high blood pressure increased from 29% in 1999 to 52% in 2000. Average rates for cholesterol control went from 45% to 53%.
The report also pinpointed areas of weakness, such as chlamydia screening and mental health care, where performance is below acceptable levels.
Only about 25% of women who should have been screened for chlamydia received the screenings. Less than half of patients received recommended follow-up visits within seven days of being discharged from an inpatient mental health facility.
The 2001 report marks the fifth year that the NCQA has issued an assessment of the industry’s performance and its impact on American overall health. This year’s version expands on previous versions and includes a cost-benefit analysis of results, measure-by-measure results and analysis, and a discussion of the importance of provider groups in improving quality, including profiles of quality improvement initiatives.
The report contains a new section this year designed to quantify the effect of quality improvement. The NCQA is developing an economic model to allow employers to calculate the financial benefits of selecting high quality vs. low quality health care.
For instance, the report points out that indirect costs related to lost productivity, sick days, and related wages totaled $3.8 billion for asthma in 1998. In 1990, major depression cost $23 billion in lost workdays.
The report includes an analysis of a hypothetical manufacturer with 20,000 employees which showed that choosing an NCQA-accredited plan vs. an unaccredited plan would help save more than 1,500 sick days and more than $800,000 in indirect costs per year among the employer’s diabetes population alone.
Some other findings:
Members participating in health plans are more satisfied than in past years in areas such as customer service and claims processing. Results for the Overall Rating of Health Plan section rose nearly three percentage points to 59.3% in 2000.
Plans that give HEDIS data to NCQA but do not allow them to be shared with the public typically received lower scores than those who allowed the data to be made public.
The gap between the top and bottom performers is shrinking. Plans that have performed poorly in the past have registered impressive gains. For instance, for plans performing in the 10th percentile, the average rate of cholesterol screenings increased from 53% in 1999 to 63% in 2000.
The State of Managed Care Report: 2001 is available at NCQA’s Web site, www.ncqa.org.